Clinical Presentations, Predictive Factors, and Outcomes of Clostridioides difficile Infection among COVID-19 Hospitalized Patients­A Single Center Experience from the COVID Hospital of the University Clinical Center of Vojvodina, Serbia

Background: This study aimed to investigate the clinical form, risk factors, and outcomes of patients with COVID-19 and Clostridioides difficile co-infections. Methods: This retrospective study (2 September 2021-1 April 2022) included all patients with Clostridioides difficile infection (CDI) and COVID-19 infection who were admitted to the Covid Hospital of the University Clinical Center of Vojvodina. Results: A total of 5124 COVID-19 patients were admitted to the Covid Hospital, and 326 of them (6.36%) developed hospital-onset CDI. Of those, 326 of the CDI patients (88.65%) were older than 65 years. The median time of CDI onset was 12.88 days. Previous hospitalizations showed 69.93% of CDI patients compared to 38.81% in the non-CDI group (p = 0.029). The concomitant antibiotics exposure was higher among the CDI group versus the non-CDI group (88.65% vs. 68.42%, p = 0.037). Albumin levels were ≤ 25 g/L among 39.57% of the CDI patients and 21.71% in the non-CDI patients (p = 0.021). The clinical manifestations of CDI ranged from mild diarrhea (26.9%) to severe diarrhea (63.49%) and a complicated form of colitis (9.81%). Regarding outcomes, 79.14% of the CDI patients recovered and 20.86% had fatal outcomes in-hospital. Although a minority of the patients were in the non-CDI group, the difference in mortality rate between the CDI and non-CDI group was not statistically significant (20.86% vs. 15.13%, p = 0.097). Conclusions: Elderly patients on concomitant antibiotic treatments with hypoalbuminemia and with previous healthcare exposures were the most affected by COVID-19 and CD co-infections.

Unexpected TBEV Seropositivity in Serbian Patients Who Recovered from Viral Meningitis and Encephalitis.

The tick-borne encephalitis virus (TBEV) causes a life-threatening disease named Tick-borne encephalitis (TBE). The clinical symptoms associated with TBE range from non-specific to severe inflammation of the central nervous system and are very similar to the clinical presentation of other viral meningitis/encephalitis. In consequence, TBE is often misclassified by clinical physicians, mainly in the non-identified high-risk areas where none or only a few TBE cases have been reported. Considering this situation, we hypothesized that among persons from northern Serbia who recovered from viral meningitis or encephalitis, there would be evidence of TBEV infection. To test this hypothesis, in this observational study, we evaluated the seroreactivity against TBEV antigens in patients from northern Serbia who were hospitalized due to viral meningitis and/or viral encephalitis of unknown etiology. Three cases of seroreactivity to TBEV antigens were discovered among convalescent patients who recovered from viral meningitis and/or encephalitis and accepted to participate in the study (n = 15). The clinical and laboratory findings of these patients overlap with that of seronegative convalescent patients. Although TBE has been a notifiable disease in Serbia since 2004, there is no active TBE surveillance program for the serologic or molecular screening of TBEV infection in humans in the country. This study highlights the necessity to increase the awareness of TBE among physicians and perform active and systematic screening of TBEV antibodies among patients with viral meningitis and/or encephalitis.

Tick-Borne Encephalitis Virus Seropositivity among Tick Infested Individuals in Serbia.

Tick-borne encephalitis (TBE), caused by the TBE virus (TBEV), is a life-threatening disease with clinical symptoms ranging from non-specific to severe inflammation of the central nervous system. Despite TBE is a notifiable disease in Serbia since 2004, there is no active TBE surveillance program for the serologic or molecular screening of TBEV infection in humans in the country. This prospective cohort study aimed to assess the TBEV exposure among tick-infested individuals in Serbia during the year 2020. A total of 113 individuals exposed to tick bites were recruited for the study and screened for anti-TBEV antibodies using a commercial indirect fluorescent antibody test (IFA) test. Blood samples from 50 healthy donors not exposed to tick bites were included as a control group. Most of the enrolled patients reported infestations with one tick, being I. ricinus the most frequent tick found in the participants. The TBEV seroprevalence was higher (13.27%, 15 total 113) in tick-infested individuals than in healthy donors (4%, 2 total 50), although the difference was not significant. Notably, male individuals exposed to tick bites showed five times higher relative risk (RR) of being TBEV-seropositive than healthy donors of the same gender (RR= 5.1, CI = 1.6-19; p = 0.007). None of the seropositive individuals developed clinical manifestations of TBE, but the first clinical-stage of Lyme borreliosis (i.e., erythema migrans) was detected in seven of them. Potential TBEV foci were identified in rural areas, mostly in proximity or within the Fruska Gora mountain. We conclude that the Serbian population is at high risk of TBEV exposure. Further epidemiological studies should focus on potential TBEV foci identified in this study. The implementation of active surveillance for TBEV might contribute to evaluating the potential negative impact of TBE in Serbia.

Epidemics of the central nervous system infections caused by West Nile virus in the territory of the South Backa District, Vojvodina, Serbia.

BACKGROUND/AIM: West Nile virus (WNV) is a neurotropic RNA virus particle which belongs to the Flaviviidae family, genus Flavivirus. It is sustained in arthropods within the transmission cycle between the mosquitoes and birds. Most commonly (80% of cases) WNV infections are asymptomatic among people. Less than 1% of patients develop neuroinvasive forms of the disease--meningitis, encephalitis, or acute flaccid paralysis. The aim of the research was to determine most common clinical and laboratory manifestations, to emphazise the presence of comorbidities and outcomes of treatment among patients with WNV infection. METHODS: This retrospective study, which was conducted in the period from January 1, 2012 to December 31, 2013, evaluated 32 patients who were diagnosed with WNV infection based on clinical findings, laboratory, and serological tests. To assess statistical significance we used χ2, and t-test. RESULTS: The study involved 22 (69%) males and 10 (31%) females aged from 31 to 65 years. On admission, there were 16 (50%) febrile individuals, 27 (84.4%) with positive meningeal signs, 17 (53.2%) with pathological neurological signs, and 10 (31.3%) with consciousness disorders. WNV infection was confirmed by the method enzyme linked immuno sorbent assay (ELISA) in all the patients, while Reverse Transcription Polymerase Chain Reaction (RT-PCR) test was positive in 3 (30%) of the tested patients. Cardiovascular comorbidities dominated in 7 (21.9%) of the cases. Full recovery was accomplished in 87.5% of the cases. CONCLUSION: The results of our study show that the absence of meningeal signs and fever on the day 7 of hospital treatment are indicators of good course and prognosis of neuroinvasive forms of WNV infection. Comorbidities do not increase the risk of disease. ELISA test is a sovereign diagnostic method. In most cases, after the administered symptomatic therapy, the complete recovery of patients was achieved.

Clinical case series of nine patients with tuberculousmeningitis in the Clinical Centre of Vojvodina, Novi Sad, AP Vojvodina, Serbia 2001-2010.

AIM: To determine immediate risk factors of developing tuberculous meningitis, to assess the practical importance of clinical signs and findings in the cerebrospinal fluid (CSF) when opting for the specific therapy, and to predict the outcome of disease in relation to the beginning of treatment. METHODS: A retrospective clinical case series of nine patients with tuberculous meningitis who were treated from April 2001 until November 2010 at the Department of Infectious Diseases in Novi Sad, Serbia was presented. Data of patients' medical records and presentation of clinical and laboratory features, neuroradiologicalfindings and outcome were used. RESULTS: The factors of immediate risk/predisposition for the development of tuberculous meningitis were found in two (22.2%) patients. The duration of symptoms prior to admission was 9 days on average (from 3 to 20 days). The most frequent symptoms on admission were headache and fever in eight (88.9%) patients, whereas two patients (22.2%) were presented with stiff neck and photophobia. Consciousness was preserved in six patients (66.7%), two patients were somnolent and one was in coma. Two(22.2%) patients had concurrent pulmonary tuberculosis. Neuroradiological signs of the disease were present in two patients. CONCLUSION: The duration of symptoms before admission, clinical examination and CSF analysis can be helpful in identifying patients who are at high risk of developing tuberculous meningitis.

Clinical features, treatments and outcomes of influenza A (H1N1) 2009 among the hospitalized patients in the clinic for infectious diseases in Novi Sad.

BACKGROUND/AIM: Most infections caused by influenza A (H1N1) 2009 virus are presented by mild respiratory symptoms. However, some patients required admission to the intensive care unit (ICU). In this article we aimed to describe the clinical and laboratory characteristics of the patients with influenza A (H1N1) 2009, antiviral therapy use, the disease outcome and risk factors associated with the severe disease. METHODS: The patients with the signs and simptoms of novel influenza A (H1N1) 2009, admitted to the Clinic for Infectious Disease in Novi Sad, were evaluated. The study included 293 patients hospitalized between October 2009 and February 2010. Basic demographic data, underlying medical conditions, clinical signs and symptoms, duration of the disease before the admission, laboratory tests, radiographic findings, treatment, and the final outcome (survived, died) were all noted. Factors associated with severe disease requiring ICU admission were determined by comparing the ICU cases with control groups of the patients admitted to the hospital but not to ICU. RESULTS: The average age of the patients was 32.72 years. A total of 114 (38.9%) of the patients had an underlying medical condition. Asthma and chronic obstructive pulmonary disease were present in 44 (15.01%) of the patients, chronic cardiovascular diseases in 28 (9.56%), diabetes mellitus in 16 (5.46%), malignity in 15 (4.44%) of the patients and 11 (3.75%) of the patients were pregnant. Fever was registered in 282 (96.24%), myalgias in 119 (40.61%), headache in 48 (16.38%), cough in 240 (81.91%), sore throat in 25 (8.53%), runny nose and sneezing in 17 (5.8%) and dyspnea in 110 (37.54%) of the patients. A total of 192 (65.53%) had radiological findings that were consistent with pneumonia. A total of 154 (56.61%) of the patients received antiviral therapy within 48 h. A total of 280 (96.24%) patients were discharged and 13 (4.44%) were transferred to ICU. Fatal outcome was noticed in 2/13 (15.3%) ICU treated patients and 11/13 (84.7%) patients survived. The median time from the onset of illness to the initiation of antiviral treatment was 7.1 days for the patients admitted to ICU and 3.2 days for non-ICU patients (p < 0.05). Low blood oxygen saturation (SaO2 < or = 92%) was more common in ICU admitted patients, 10/13 (76,92%), compared to 28/280 (10%) non-ICU admitted ones (p < 0.01). Serum C-reactive protein (CRP) levels > 200 mg/L were noticed in 9/13 (69.23%) patients admitted to ICU and 85/280 (30.35%) patients who were not (p < 0.05). CONCLUSION: Most novel influenza A (H1N1) 2009 infections presented mild respiratory disease. Prompt antiviral therapy in patients with A (H1N1) virus infection seem to be the best approach to avoid serious form of the disease. Special attention should be payed to patients having low level of peripheral oxygen saturation and raised CRP serum level.

[The costs of urinary tract infection therapy with implementation of pharmacoeconomic guidelines at the Clinic for Infectious Diseases of the Clinical Center of Vojvodina].

BACKGROUND/AIM: The Serbian health system does not have strict guidelines for the treatment of bacterial infections. The choice of treatment is empirical which is not necessarily the same compared to the treatment guidelines from countries with a developed pharmacotherapeutic practice. In this study we compared the difference between the current treatment and the treatment taking into account the latest pharmacotherapeutic and pharmacoeconomic guidelines in order to estimate clinical efficiency of antibacterial drugs that were given as a therapy of urinary tract infections and to evaluate pharmacoeconomic aspect of this therapy as well. METHODS: Our study included 100 patients that were randomly chosen and divided into 2 groups. The first group was treated in an ordinary way, while the second one was treated strictly in accordance with the guidelines (British National Formulary - BNF, and Senford Guide). In both groups of the patients we compared length of hospitalization, combination of the used antibiotics, progress as a whole in clinical picture, laboratory analyses and the price of the whole treatment. RESULTS: Analyzing these values independently and according to statistical tests we proved that there were no significant differences between two groups with regard to the progress in a clinical picture as a whole and the length of hospitalization. According to this analysis, however suggested treatment based on guidelines showed a saving of 34.48% in comparison with the usual system of therapy. CONCLUSION: Efficacy of current treatment of urinary tract infection and the treatment according to foreign guidelines is the same, but the costs of the treatment are lower if the guidelines of developed health care systems are applied.

Fever of unknown origin in elderly patients.

INTRODUCTION: Causes of fever of unknown origin are different. It is considered that it can be caused with over 200 different clinical entities. Aetiological causes differ according to different categories of age. Febricity in the elderly is at most the result of autoimmune processes, malignancies, bacterial infections and vasculitis. OBJECTIVE: The aim of this study was to determine the most common characteristics of fever, the most common laboratory, bacterial and viral tests and to analyze applied therapy in patients with unknown febrile state, and to affirm final diagnosis in elderly patients, as well as younger than 65 years old, and to define outcome of disease in both groups of patients. METHODS: Research comprised 100 patients who had been treated at the Infectious Disease Clinic of the Clinical Centre of Vojvodina in Novi Sad, during a three-year period, and in whom fever of unknown origin had been diagnosed. Patients were divided into two homogenous groups of 50 people. The first one (S) consisted of patients older than 65 years, and the second, control group (K) was constituted of patients younger than the age of 65. All of them were chosen by random sample method. RESULTS: Average results of standard laboratory parameters of infection were obtained, such as erythrocyte sedimentation rate (ESR), fibrinogen, CRP, and especially leukocyte, and those were significantly higher in the group of elderly patients. The cause had not been found in 10% of elderly patient group, and in the younger group, not even in the third of patients. Among known causative agents dominant were infections, usually of respiratory and urinary tract, in both tested groups. Even 28% of the elderly had sepsis, and 10% endocarditis. Malignant diseases were more frequent in group of the elderly patients, and immune i.e. systematic disorders were evenly noticed in both groups of patients. CONCLUSION: Despite advanced studies in medicine, and existence of modern diagnostic procedures, fever of unknown origin is still today differential diagnostic problem.

[Novelties in antimicrobial therapy].

Microorganisms are the oldest forms of life on the planet--they are around 3.5 billion years old. They are characterised by the fast changing generations and by genetic flexibility. Microorganisms which live in and on us outnumber our cells nine times. The development of new antimicrobial drugs has fallen behind in the time period between year 1968 and year 2000. During this time period not a single one antimicrobial drug was discovered. Two new antibacterial drugs and one new antimicotic drug have been approved for the use in human medicine since year 2000. This paper describes the new antimicrobial drugs approved for use in human population. It describes their characteristics as well as the risks pertaining to their use in antimicrobial therapy.

[Antibiotics in the treatment of bacterial infections of the central nervous system].

INTRODUCTION: The aim of antimicrobial treatment of infections in the central nervous system (CNS) is to eradicate the bacterial cause. The choice of antibiotics should take into account its activity, pharmacokinetic properties, results of clinical trials, side effects and total treatment cost. Despite the fact that pharmacokinetics affects the ability of antibiotics to penetrate the blood brain barrier (BBB) significantly, the most important factor is that meningeal inflammation increases the permeability barrier. The selected antibiotic should have a bactericidal action and the achieved liquor concentration should be high above the minimal bactericidal concentration (MBC). ANTIBIOTIC THERAPY: Empirical antibiotic therapy should be started immediate after taking the sample to make the etiological diagnosis, taking into account the patient ' age. previous diseases and immune status. The specific or targeted antibiotic treatment is carried out according to the microbiological sensitivity test of antimicrobial agents isolated. Whenever possible, the preference should be given to a monotherapy except when it comes to a cause requiring synergistic combination of antibiotics. The length of treatment is individually assessed and is mainly based on experience. Numerous studies have shown that it is possible to reduce inflammatory response in subarachnoid space and thus improve the outcome of meningitis by using anti-inflammatory agents, along with the antibiotics. CONCLUSION: Today the increase in resistance to antibiotics is a leading medical problem in the 21st century. The most common micro organisms isolated from CSF (liquor) in our region are: Staphylococcus spp. coagulase negative. Haemophilus infuenzae, Neisseria meningitidis, serogroup B. Staphylococcus epidermidis, and Streptococcus beta haemoliticus. The resistance to antimicrobial drugs most frequently used in the treatment of bacterial meningitis is still not alarmingly. high in our country. Since there is a real possibility of development of high resistance in our area, the main recommendation is to rationalize the use of antibiotics.

[Application of antibiotics in vulnerable groups].

INTRODUCTION: Antibiotics are substances that possess bacteriostatic or bactericidal effect. Their administration is widespread in the treatment as well as in the prevention of many infections in general population, and especially in vulnerable groups. THE ELDERLY AND ANTIBIOTICS: Respiratory and urinary infections are the most common infections in the elderly. The initial empirical antibiotic therapy of pneumonia in older patients is directed to possible causative agents. Doxicicline is most frequently applied in ambulatory patients, followed by macrolides (azithromycin), fluorochinolone and amoxicillin with clavulanic acid. In the hospitalized patients, a wide spectrum of cephalosporins with macrolides is applied, as well as beta-lactamase inhibitors combined with macrolides or fluorochinolone only. Asymptomatic bacteriuria, a very common phenomenon in the elderly, is usually not treated. The antibiotic therapy of urinary infection in the older population is applied according to the causative agent. Polymicrobial infections occur in 30% of the patients, more often in those with urinary catheter. The wide spectrum antibiotics, especially cotrimoxazole and chinolone are applied in such cases. ANTIBIOTICS AND HIV/AIDS: In the HIV infected and AIDS suffering patients, antibiotics are used as a means of prophylaxis and treatment of the opportunistic infections. They occur during the terminal stage of illness, although they might be the first manifestation of the HIV illness. The treatment of the opportunistic infections in HIV/AIDS patients assumes the primary prophylaxis, then treatment of acute manifestations and the secondary prophylaxis. The aim of the treatment in this category is to prevent several opportunistic infections with a single antibiotic--the so called multiple prophylaxis. CONCLUSION: There are no general rules defining the choice of antibiotics for vulnerable groups, hence each and every patient should be considered as a separate individual and the most efficient antibiotic or a combination of antibiotics ant their optimal dosage should be selected taking into consideration all available facts.

[The choice of antimicrobial therapy by application of pharmacoeconomic principles in view of the most frequently isolated pathogens at the Clinic for Infectious Diseases of the Clinical Center of Vojvodina].

The research on the use of pharmaco-therapeutic/pharmacoeconomic guidelines in therapy of bacterial infections was carried out in all patients hospitalized at the Clinic for Infectious Diseases of the Clinical Center of Vojvodina in a three-month period. The overall antibiotic utilization in therapy of bacterial infections was determined. The total cost of all administered antibiotics was calculated as well as the defined daily dose/100 patient-days. The structure of bacterial causes and their resistance to standard antimicrobial therapy was established for all isolated strains. The results of bacterial resistance surveillance were the basis to lay down the guidelines for initial adequate antimicrobial therapy (according to the site of infection and pathogen), in view of resistance maps for bacterial strains isolated from the tested materials. The guidelines for choosing appropriate antibiotic therapy were based on pharmaco-therapeutic/pharmacoeconomic principles, taking into account the state of bacterial resistance, drug administration schedule, and lowest therapy cost. During the implementation of guidelines for appropriate initial antimicrobial therapy, large therapy cost savings of 1.275.576.9 dinars (33.9%.) were recorded, compared to the period before the implementation of the guidelines.

[Progress in antimicrobial therapy].

INTRODUCTION: Not so long ago, back in the 1900s, infectious diseases were the leading cause of death world wide. The doubling of our life span in the 20th century was achieved, first of all, by using bioactive natural products, their secondary metabolites or their derivates. These substances have prolonged our life span, reduced the pain and suffering and, at the same time, revolutionized medical science. HISTORY OF ANTIBIOTICS: Antibiotics are among the most important classes of bioactive products and as much as 78% of antimicrobial drugs are extracted from nature. This paper follows the history of progress of antimicrobial drugs, which runs parallel to the history of a man's struggle against the diseases.The golden age of progress of antimicrobial drugs went on between the 1940s and 1970s. Thereafter, there is a gradual decrease in the number of newly discovered antimicrobial drugs. During the time period between 2003 and 2007 only four antibiotics were registered. CONCLUSION: The current situation in the field of antimicrobial therapy should send off a global alarm .for the creation of a well coordinated, sound and all-encompassing monitoring of the resistance, consumption of antimicrobials and investment in the new trials.

[Enterococcal endocarditis--a case report].

INTRODUCTION: Bacteria from genus Enterococcus may cause infections mostly in those who are immunocompromised and those who underwent endoscopic or surgical procedures. Endocarditis is caused by enterococci in 5-10% of cases. Its clinical presentation does not differ from endocarditis of other bacterial origin. Previous susceptibility testing is needed for appropriate choice of antibiotics against enterococci. The treatment recommendations for enterococcal endocarditis were given by American Heart Association recently. CASE REPORT: A case ofenterococcal endocarditis in a young female person hospitalised at Clinic for infectious diseases was reviewed. The disease was diagnosed during an extensive diagnostic procedure. Multiply repeated echocardiographic examination helped to find out bacterial vegetations on the mitral valve. Enterococcus species was isolated from several blood cultures. Despite powerful antibiotic treatment, the additional valvular replacement had to be done. DISCUSSION: A case of enerococcal endocarditis in a young female person was reviewed. The right diagnosis was based on a thorough clinical examination in cooperation with cardiologists using repeated transthoracic and transesophageal echocardiography. Echocardiography, even if it is transesophageal, has limited sensitivity and specificity, so it is sometimes necessary to be repeated for several times in diagnosing endocarditis. The source of endocarditis was not identified. The combined antimicrobial and surgical treatment led to the complete recovery of patient. CONCLUSION: Enterococcal endocarditis rarely occurrs in young females. Infective disease specialists sometimes face enterococcal endocarditis in their practice, mostly when they have to cope with fever of unknown origin. An appropriate approach to such conditions includes careful search for heart valve changes by repeated echocardiographic finding, if necessary.

[Polymicrobial infections and new antimicrobial drugs].

Man's desire to conquer diseases and to find a cure for them exists from the beginnings of humankind However the first scientific discoveries of substances with antibacterial effects originate from 1877 and they are attributed to the researches of Louis Pasteur Ever since, we have been living in so-called antimicrobial era. The battle between microorganisms, trying to survive antimicrobials, and man's wish to conquer diseases, resulted in the development of resistance to antimicrobials, but simultaneously led to the development of novel antimicrobials. Their role is primarily in therapy of complicated and polymicrobial infections caused by multiresistant strains. In spite of precisely defined legal obligations, the usage of antimicrobials in Serbia is still very problematic due to their availability in pharmacies without prescription, and lack of local strategies for antimicrobial resistance surveillance.

[Pharmacoeconomical analysis of antibiotic use at the Clinic For Infectious Diseases of the Clinical Center of Vojvodina].

The investigation was performed in three phases and included all patients hospitalized at the Clinic for Infectious Diseases of the Clinical Center of Vojvodina. The first phase comprised retrospective evaluation of the total antibiotic use in therapy of all bacterial infections during a three-month period in 2006/2007. A total cost of all spent antibiotics was calculated, and a daily dose per 100 clinical day care was defined In the second phase, the structure of bacterial causes and their resistance to standard antimicrobial therapy was established for all isolated strains at the Clinic for infectious diseases. According to the the results of bacterial resistance surveilance, guidelines for initial adequate antimicrobial therapy were made (regarding localization and type of bacteria) considering resistance maps for isolated bacterial strains. The guidelines took into consideration all essential elements: pharamcotherapeutic/pharmacoeconomic principles, bacterial resistance, patterns of antimicrobial prescriptions and lowest therapy costs. In the third phase, (three-month period in 2007/2008), the guidelines were implemented in therapy of bacterial infections. In this period, only by implementing the guidelines for initial adequate antimicrobial therapy, the therapy costs savings were 1275576.9 dinars (33.9%) at the Clinic for Infectious Diseses, compared to the period before implementation of the guidelines. Pharmacoeconomic investigations should become standard part of the health system in our country.

[Antimicrobial resistance of the bacteria isolated from blood cultures in 2007].

INTRODUCTION: Antimicrobial resistance become emerging global problem. Particularly dramatic increase in the number and type of bacteria resistant to numerous and structurally different antibiotics has taken place in the last two decades. MATERIALS AND METHODS: A total of 558 strains of different bacteria isolated from blood cultures during 2007 were tested to susceptibility to different antibiotics by disc diffusion method according to CLSI. All strains were isolated and identified in the laboratories of Microbiology Center at the Institute for Public Health in Novi Sad. A total of 7748 blood cultures were processed and microorganisms were isolated from 558 of them. Blood samples were taken from the patients hospitalized in the Institutes and Clinics of Novi Sad Clinical Center and Institute for Health Care of Children and Adolescents in Novi Sad RESULTS: The structure ofpathogens shows that the most frequent isolates are Gram-positive bacteria, above all coagulase- negative staphylococci with 285 isolates (51,1%) followed with Enterococcus spp (41 isolates - 6,8%). Percentage of resistance to Methicillin in staphylococci strains was 66,7%; all isolates was susceptible to Vancomycine. Enterococcus spp showed 13,2% resistance to Vancomycine. Among Gram-negative pathogens, we find that the most frequent is Klebsiella spp with 40 isolates (7,2%) and have high resistance to wide spectrum Cephalosporins - 82,5%. Acinetobacter spp participate with 41 isolates (7,3%) and 43,9% isolates are resistant to Imipenem Also, Pseudomonas aeruginosa (20 isolates) shows high resistance to Imipenem (40%) but lower resistance to wide spectrum Cephalosporines (27,8%). CONCLUSION: Having compared the resistance to antibiotics in 2002 and 2007 speak for the trend of growing antimicrobial resistance to the very antibiotics which are recommended as the empiric or initial therapy-wide spectrum Cephalosporins, Fluoroquinolons and Imipenem.

[Frequency of methicilin-resistant Staphylococcus aureus strains in clinical spacimens obtained from hospitalized patients in 2007].

INTRODUCTION: Staphylococcus aureus is a major cause of both hospital- and community-acquired infections worldwide. Since the introduction of methicillin into clinical use, methicillin-resistant S. aureus strains have emerged with increasing frequency throughout the world. The aim of the study was to determine frequency of resistance to methicillin and other most commonly used antibiotics of S aureus strains isolated from hospitalized patients. MATERIAL AND METHODS: During the period 1.1.-31. 12. 2007, 226 strains of S. aureus isolated from hospitalized patients were tested for their susceptibility to penicillin, methicillin, erythromycin, clindamycin, gentamycin, sulfamethoxazolle-trimethoprim, fusidic acid and vancomycin using disc diffusion technique. RESULTS: Resistance to methicillin was detected in 20 (7.5%) S. aureus strains. All of them were susceptible to vancomycin. The resistance to other antimicrobial agents varied from 5% for sulfamethoxazolle-trimethoprim to 75% to gentamycin. Among methicillin susceptible strains, high resistance (84.1%) was found to penicillin only The resistance to other antimicrobial agents was low, ranging from 0 for fusidic acid and vancomycin to 12.2% for gentamycin. CONCLUSION: Our results show low rate of methicillin-resistant S. aureus strains compared to other authors "findings, but also the presence of multidrug-resistant isolates and isolates susceptible to vancomycin only These facts suggest the need for further monitoring of susceptibility in order to take adequate measures to prevent and control spreading of resistant strains.

[The choice of antimicrobial therapy in view of the most frequently isolated pathogens at the Insitute Of Surgery in the Clinical Center of Vojvodina].

Several studies have reported high rate of antimicrobial resistance, particularly in strains isolated from hospitals. The aim of this study was to review the pathogens associated with nosocomial infections at the Clinic for abdominal surgery, Clinic for urology, Clinic for orthopedic surgery and Clinic for resuscitation and anaesthesia of the Clinical Center of Vojvodina. The analysis of the collected data gave indecisive results. The percentage of positive cultures was too low to enable making therapeutic recommendations. The first-line antibiotics, according to the international reccomendations, should be included more often in sensitivity tests of isolated bacterial strains. Isolated bacteria were most frequently tested to the second and third-line antibiotics respectively, to which the resistance rate is becoming concerningly high.

[On the development of the infectology service in Novi Sad].

INTRODUCTION: Infectious diseases are a part of the history of this region. Devastating epidemics of plague, smallpox, and cholera were frequent during the 18th and the 19th centuries. Other infectious diseases were a serious problem as well: alimentary tract infections, scarlet fever, diphtheria, whooping cough. Geographic position, climate, migrations, as well as the tradition and lack of medical staff and medications, affected the frequency and outcome of infections. THE HISTORY OF THE TREATMENT OF INFECTIOUS DISEASES: Patients with infectious diseases were first treated at home. Later, a hospital in Visarion street was opened as an isolation facility and a hospital for homeless patients. The development of science and the education of medical personnel exerted the greatest influence on the control and later treatment of infectious diseases. These measures resulted in the establishment of the first specialized medical institutions in Novi Sad during the cholera outbreak in 1884. After that, temporary pediatric units were organized for the treatment of scarlet fever, diphtheria and smallpox. A ward for infectious diseases was founded in the The Great City Hospital in the second half of the 19th century (1892). The 20th century was a period of control and eradication of infectious diseases in Vojvodina (smallpox, malaria, diphtheria, polio). MODERN INFECTIOUS DISEASES: Nowdays, major infectious deseases include respiratory, alimentary and parasitic infections. However, new diseases are being registered as well - hemorrhagic fevers, Lyme disease, HIV infection. The Infectologic Service in Novi Sad was developed from an Infectology Departement as part of the Departement of Internal Diseases in the new Provincial Hospital (1909) to the independent Departement for Infectious Diseases (1945). Today, Clinic of lnfectious Diseases is an integral part of the Clinical Center of Vojvodina. DEPARTMENT OF INFECTIOUS DISEASES: The Department of Infectious Diseases of the Faculty of Medicine in Novi Sad was founded in 1960. Undergraduate studies started in 1963/64 for students of medicine and in 1978/79 jor dentistry students. Today. the faculty of the Department takes part in undergraduate studies of medicine, dentistry, health care, as well as in graduate programs. The faculty members are also taking part in specialization programs at the Faculty of Medicine. Infectious disease physicians are involved in the activities of the Infectology Section (founded in 1979) of the Society of Physicians of Vojvodine of the Medical Society of Serbia. The first president of the Infectology Section was Dr. Vera Mudric, professor, infectologists, whereas Dr. Grozdana Canak, professor, was the vice-president from 2000-2004. The Infectology Section collaborates with various national and international societies for infectious diseases.