Amir Ibrahimagić - Academia.edu (original) (raw)

Papers by Amir Ibrahimagić

Research paper thumbnail of Detection and epidemiological characteristics of Trichinella spp. and Macracanthorhynchus hirudinaceus isolated from wild boars, domestic pigs and badgers in Zenica-Doboj Canton, Bosnia and Herzegovina

Research paper thumbnail of Arrival of carbapenem-hydrolyzing-oxacillinases in Acinetobacter baumannii in Bosnia and Herzegovina

Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases, Mar 22, 2017

Multidrug-resistant Acinetobacter baumannii (MDR-AB) is an important threat for critically ill pa... more Multidrug-resistant Acinetobacter baumannii (MDR-AB) is an important threat for critically ill patients. It can infect the respiratory tract, blood, soft tissues, urinary tract and central nervous system. Recently, carbapenem-resistance was observed in A. baumannii clinical isolates from Bosnia and Herzegovina. This prompted us to analyze these isolates with regards to genotypic diversity, antibiotic susceptibility and occurrence of acquired carbapenem resistance genes. Twelve carbapenem-resistant isolates were collected at a University hospital during two different periods of 2011 and 2015-2016: four isolates in 2011 and eight isolates 2015-2016 and compared to determine the dynamic changes in carbapenemase resistance mechanisms and population structure. All twelve isolates were positive for intrinsic blaOXA-51-like, nine for blaOXA-40-like and one for the blaOXA-23-like gene. ISAba1 was found upstream of blaOXA-51 in all and upstream of blaOXA-23-like gene in one isolate. Sequencing of the selected PCR products revealed the presence of OXA-72 βlactamase (strain 1) and OXA-23 β-lactamase (strain 41). WGS of the selected isolate (AB 5) revealed the presence of blaOXA-72, chromosomal genes blaOXA-69 and blaADC. Moreover, the aac (3)-1a and aadA1 genes encoding aminoglycoside resistance, and sul1encoding sulphonamide resistance were identified. PFGE and rep-PCR revealed two clones containing highly similar isolates positive for OXA-40-like; one from 2011 and the other from 2015-2016. Implementation of hospital hygiene measures, screening of the patients on admission for carriage of MDR-AB, and the early and accurate detection, with restriction of antibiotic use should be recommended to control the spread of these important hospital pathogenes. To our knowledge, this is the first report of A. baumannii isolates producing carbapenem-hydrolyzing oxacillinases (CHDL) from Bosnia and Herzegovina.

Research paper thumbnail of Prevalence of co-existence genes and clonal spread of ESBL-producing isolates causing hospital and community-acquired infections in Zenica-Doboj Canton, Bosnia and Herzegovina

Journal of Health Sciences, 2017

Introduction: Co-existence type of ESBL-producing isolates are serious problem in the public heal... more Introduction: Co-existence type of ESBL-producing isolates are serious problem in the public health world. Methods Antibiotic susceptibility was determined by disc diffusion and broth microdilution according to CLSI guidelines. Double-disk synergy test was performed in order to screen for ESBLs/pAmpC beta-lactamases. PCR was used to detect blaESBL/blaampC/blacarb genes. Genetic relatedness of the strains was determined by pulsed-field-gel-electrophoresis (PFGE). Results In this study 88 of the inpatient isolates (n=126; 10.0%) and 62 of the outpatient (n=184; 6.4%) Beta-lactamase-producing isolates were taken for the study. They included 50.0/29.0% K. pneumoniae, 12.5/30.6% E. coli, 11.4/4.8% A. baumannii, 8.0/14.5% K. oxytoca, 8.0/4.8% E. cloacae, 5.7/8.1% Proteus spp., and less than 3.5% of other isolates. Co-existence of more than two type of beta-lactamases was detected in 77.3% of inpatient and 45.2% of outpatient isolates. Among inpatient isolates, Klebsiella spp. and E. coli ...

Research paper thumbnail of Molecular characteristics and antibiotic resistance of Acinetobacter baumanniibeta-lactamase-producing isolates, a predominance of intrinsic blaOXA-51, and detection of TEM and CTX-M genes

TURKISH JOURNAL OF MEDICAL SCIENCES, 2017

The aim of this study was to determine the molecular characteristics and antibiotic resistance of... more The aim of this study was to determine the molecular characteristics and antibiotic resistance of 13 (10 inpatient and three outpatient) Acinetobacter baumannii beta-lactamase-producing isolates collected in Bosnia and Herzegovina between December 2009 and May 2010. Materials and methods: Susceptibility testing was performed by disk diffusion and broth microdilution methods. The modified Hodge and combined disk test with EDTA/phenylboronic acid was used to screen for carbapenemase production. Production of extended spectrum beta-lactamases (ESBLs) was determined by double-disk synergy test. PCR was used to detect blaESBL/blacarb genes. Results: Ten (22.2%) inpatient and three (13.6%) outpatient isolates produced beta-lactamases, ESBLs, or oxacillinases. More than 50% of the isolates showed multidrug resistance. Resistance rates to gentamicin and ciprofloxacin of the inpatients and outpatients were 80.0%, 60.0%, 75.0%, and 25.0%, respectively. MICs of carbapenems for resistant isolates ranged from 32 to >256 µg/mL. All imipenemresistant Acinetobacter baumannii strains contained bla OXA-51. Three of the 10 inpatient isolates and one outpatient isolate containing bla OXA-51 additionally produced other beta-lactamases (TEM/CTX-M/OXA-1). None of the inpatient or outpatient isolates were positive for other carbapenemases, especially acquired oxacillinases (bla OXA-23 /bla OXA-24 /bla OXA-58 /bla OXA-143). Conclusion: Production of bla OXA-51 presents an emerging threat in imipenem-resistant Acinetobacter spp. from Bosnia and Herzegovina.

Research paper thumbnail of Prevalence and antimicrobial resistance of beta-lactamase-producing Gram-negative isolates from outpatient clinical and environmental samples in the Zenica-Doboj Canton, Bosnia and Herzegovina

Journal of Health Sciences, 2016

Introduction: Infections due to extended-spectrum beta-lactamase (ESBL)-producing isolates in pat... more Introduction: Infections due to extended-spectrum beta-lactamase (ESBL)-producing isolates in patients are hard to treat and cause high morbidity and mortality. ESBL-producing bacteria have been increasingly detected in environmental samples in different countries since 2002, and have gained considerable attention worldwide.Methods: Antibiotic susceptibility of all isolates was determined using the disk diffusion method. The production of ESBLs was determined by the double-disk synergy test.Results: Among the outpatient clinical samples, out of 2857 Gram-negative bacteria, 184 (6.5%) ESBL-producing bacteria were isolated. In this group, 143 (77.7%) were from urine samples, 26 (14.1%) from surgical wounds, 6 (3.3%) from umbilical swabs, and 9 (4.9%) from other patients sites (upper respiratory tract, cannula, eyes, genital swabs). Escherichia coli was isolated in 62 (33.7%), and Klebsiella spp. in 50 (27.8%) cases. Among the environmental samples, out of 381 Gram-negative bacteria, 5...

Research paper thumbnail of Molecular characterisation of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in inpatients and outpatients in Bosnia and Herzegovina

Wiener Medizinische Wochenschrift, 2012

Molecular characterisation of methicillin-susceptible and methicillin-resistant Staphylococcus au... more Molecular characterisation of methicillin-susceptible and methicillin-resistant Staphylococcus aureus 13 1 3 Molekulare Charakterisierung Methacillinsensibler und Methacillin-resistenter Isolate von Staphylococcus aureus bei stationären und ambulant behandelten Patienten in Bosnien und Herzegovina Zusammenfassung Das Ziel der vorliegenden Arbeit war es, den genetischen Hintergrund von Methacillinsensiblen (MSSA) und Methacillin-resistenten Staphylococcus aureus (MRSA), die aus verschiedenen klinischen Proben bei stationär und ambulant behandelten Patienten gewonnen wurden, zu erforschen. Die Me thacillin-Resistenz wurde durch die Anwesendheit von Meca-Genen PCR-DM bestätigt. Die genetische Charakterisierung erfolgte mittels SPA Typisierung und BURP. Staphylococcus aureus wurde aus 68 und 79 Proben der stationär bzw. ambulant behandelten Patienten isoliert, 31 (46 %) bzw. 14 (18 %) davon waren MRSA. Bei 37 stationären und 65 ambulanten Patienten mit MSSA wurden 22 bzw. 38 SPA-Typen in sieben bzw. acht Haupt-SPA-Clonal Complexes (CC) klassifiziert. Haupt-MSSA SPA-CC war CC015 (MLST CC45), bei 16 % der stationären bzw. 21 % der ambulanten Patienten. Die meisten der MRSA Isolate waren SPA-CC 355/595 (MLST CC152). Bei 32 % der stationären und 43 % der ambulanten Patienten wiesen die MSSA Isolate einen MRSA-Hintergrund auf; dies weist darauf hin, dass die MRSA nicht aus den dominanten MSSA-Klonen hervorgegangen sind.

Research paper thumbnail of Prevalence, molecular characterization and antimicrobial resistance of extended-spectrum beta-lactamase-producing Gramnegative bacteria isolated from outpatient clinical and environmental samples in Zenica-Doboj Canton, Bosnia and Herzegovina

Research paper thumbnail of Molecular characteristics and antibiotic resistance of Acinetobacter spp ; predominance of blaOXA-51 and blaVIM, isolates from patients in Bosnia and Herzegovina

Acinetobacter spp. is an important opportunistic bacterial pathogen responsible for serious infec... more Acinetobacter spp. is an important opportunistic bacterial pathogen responsible for serious infections in the hospital environment. Objectives were to determine the antibiotic susceptibility and to characterize carbapenem-resistance mechanisms of 24 (19 in- and five outpatient) Acinetobacter spp. isolates collected during Decembar 2009 to May 2010 in Bosnia and Herzegovina were investigated. Susceptibility testing was performed by disc-diffusion (DD) and broth microdilution method. The modified Hodge and combined disc test with EDTA with phenylboronic acid were used to screen for carbapenemase production. Production of ESBLs was determined by double-disc synergy test. Ten (52.6%) of the in-and three (60.0%) of outpatient isolates were produced ESBL, MBL or oxacillinases. More than 50% of the isolates showed multidrug-resistance. Resistance rates to gentamicin and ciprofloxacin of the in-and outpatients were 80.0% and 60.0%, and 75.0% and 25.0%, respectively. MICs of carbapenems for ...

Research paper thumbnail of Molecular epidemiology and antimicrobial susceptibility of AmpC- and/or extended-spectrum (ESBL) ß-lactamaseproducing Proteus spp. clinical isolates in Zenica-Doboj Canton, Bosnia and Herzegovina

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2016

Aim To investigate prevalence, antimicrobial susceptibility, molecular characteristics, and genet... more Aim To investigate prevalence, antimicrobial susceptibility, molecular characteristics, and genetic relationship of AmpC- and/or extended spectrum beta lactamase (ESBL)- producing Proteus spp. clinical isolates in Zenica-Doboj Canton, Bosnia and Herzegovina. Methods Antibiotic susceptibility was determined by disc diffusion and broth microdilution methods according to CLSI guidelines. Double-disk synergy test was performed in order to screen for ESBLs, and combined disk test with phenylboronic acid to detect AmpC β -lactamases. PCR was used to detect blaESBL/blacarb genes. Genetic relatedness of the strains was determined by pulsed-fieldgel-electrophoresis (PFGE). Results Eleven ESBL-producing isolates were included in the study (six inpatients and five outpatients). Susceptibility rate to amoxicillin-clavulanic acid, imipenem and meropenem was 100%. Resistance rate to cefuroxime was 100%, gentamicine 90.9%, piperacillin/tazobactam 81.8%, cefotaxim, ceftriaxone and ceftazidime 72.7%...

Research paper thumbnail of Detection and characterization of DHA-1 beta-lactamase in Klebsiella spp. causing urinary tract infections in Bosnia and Herzegovina

Objectives Klebsiella spp. is a common cause of urinary tract infections (UTIs) and it is importa... more Objectives Klebsiella spp. is a common cause of urinary tract infections (UTIs) and it is important nosocomial pathogen. There is currently little information about a prevalence of AmpC beta-lactamases in these strains. The aim of the study was to investigate a prevalence of plasmid –mediated AmpC (pAmpC) beta-lactamases in Klebsiella spp. causing UTIs in Bosnia and Herzegovina (B&H), during December 2009-May 2010. Methods Minimum inihibitory concentrations (MICs) of various antibiotics were determined by broth microdilution method according to CLSI guidelines. Double-disk synergy test and combined disk test with phenylboronic acid were used to detect ESBLs and pAmpC beta-lactamases respectively. BlaESBL, and blaAmpC genes were detected by PCR. Genetic relatedness of the strains was tested by pulsed-field gel electrophoresis (PFGE). Results ESBL. were found in 28 Klebsiella spp (22 K. pneumoniae and six K. oxytoca). Genes encoding pAmpC beta-lactamases were detected in two (7.1%) is...

Research paper thumbnail of Inducible clindamycin resistance in methicillin-susceptible and methicillin-resistant Staphylococcus aureus of inpatient, outpatient and healthy carriers in Bosnia and Herzegovina

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2013

AIM To investigate the iMLSB prevalence in 142 methicillin-sensitive (MSSA) and 48 methicillin-re... more AIM To investigate the iMLSB prevalence in 142 methicillin-sensitive (MSSA) and 48 methicillin-resistant (MRSA) in-patient (65), outpatient (75), and healthy carrier (150) Staphylococcus aureus isolates in Zenica-Doboj Canton, Bosnia and Herzegovina. METHODS Disk diffusion testing by placing clindamycin (CLI) and erythromycin (ERY) disks 15 mm apart (edge to edge) on a Mueller-Hinton agar, as per CLSI guideline was performed. Two distinct induction phenotypes labelled as D and D+, and three noninduction phenotypes designated as Neg, R (constitutive, cMLSB), and S (susceptible). Methicillin-resistance was confirmed by the presence of mecA gene by PCR. The genetic characterization was performed using spa-typing and the algorithm based upon repeat patterns (BURP). RESULTS iMLSB was detected in six (2.1%) isolates, of which five (3.5%) (two outpatients and three carriers) were MSSA, and one (2.1%) (outpatient) MRSA. One of them, D+ phenotype (iMLSB) was obtained from a carrier (MSSA). N...

Research paper thumbnail of AUTHOR'S CORRECTION: Molecular epidemiology and antimicrobial susceptibility of AmpC- and/or extended-spectrum (ESBL) ß-lactamaseproducing Proteus spp. clinical isolates in Zenica-Doboj Canton, Bosnia and Herzegovina

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2017

Volume 13, no. 2, p. 103-112, 2016. Page 103: The byline should appear as shown above.

Research paper thumbnail of High prevalence of blaCTX-M-15 ; first report of blaCTX-M-28, blaCTX-M-3 blaCMY, blaDHA and blaFOX producing Enterobacteriaceae causing urinary tract infections in Bosnia and Herzegovina in hospital and community settings

Objectives To investigate molecular epidemiology of extended-spectrum (ESBL) and plasmid-mediated... more Objectives To investigate molecular epidemiology of extended-spectrum (ESBL) and plasmid-mediated AmpC β-lactamase and carbapenemase producing Gram-negative bacteria the cause of urinary tract infections (UTI) in in- and outpatients in Bosnia and Herzegovina (BH 57.1%) E. coli in-patient isolates were positive for the blaCTX-M-15 and one for blaCTX-M-3. AmpC β-lactamases were detected by phenotypic test in 20 (45.5%) in- and 21 (51.2%) outpatients. One in-patient strain was positive for blaCMY and two for blaDHA, whereas four outpatient strains were positive for blaCMY and one for blaFOX. Conclusion: The CTX-M-15 was most prevalent β -lactamase in the in- and outpatients. This is the firtst report of blaCTX-M-28, blaCTX-M-3, blaCMY, blaDHA, and blaFOX from B&H. Due to high resistance rates observed for gentamicin and ciprofloxacin, carbapenems remain the antibiotics of choice for the treatment of UTIs caused by β-lactamase-producing Enterobacteriaceae in this region.

Research paper thumbnail of Antibiotic resistance in Enterobacter cloacae strains with derepressed/partly derepressed/inducible AmpC and extendedspectrum beta-lactamases in Zenica-Doboj Canton, Bosnia and Herzegovina

Aim To investigate the prevalence of derepressed/partly derepressed/inducible and ESBL/AmpC-produ... more Aim To investigate the prevalence of derepressed/partly derepressed/inducible and ESBL/AmpC-producing Enterobacter cloacae isolates and treatment options for infections associated with those isolates. Methods Antibiotic susceptibility was determined by disc diffusion and broth microdilution according to CLSI guidelines. Doubledisk synergy test (DDST) was performed in order to screen for ESBLs and combined disk test with phenylboronic acid to detect AmpC β -lactamases. PCR was used to detect blaESBL/blacarb genes. Genetic relatedness of the strains was determined by pulsed-fieldgel-electrophoresis (PFGE). Results Among 14 isolates with the ESBL positive E. cloaceae producing isolates, four (28.6%), nine (64.3%) and one (7.1%) isolates were derepressed/partly derepressed and inducible AmpC producers. Eleven (out of 14) isolates were resistant to cefotaxime, ceftazidime, ceftriaxone, aminoglycosides and fluoroquinolones. All isolates were susceptible to imipenem and meropenem, 79% to c...

Research paper thumbnail of Antibiotic resistance in Enterobacter cloaceae with derepressed/partly derepressed/inducible AmpC and extended-spectrum beta-lactamase in Zenica-Doboj Canton, Bosnia and Herzegovina

International Journal of Infectious Diseases

cat values, while K m values remain at the millimolar range. In vitro selection of CAZ-resistant ... more cat values, while K m values remain at the millimolar range. In vitro selection of CAZ-resistant E. coli strains yielded D240G CTX-M producers with MIC values of 32 and 64 g/ml while those with no substitution was only 8 g/ml. Conclusion: D240G mutation leads to a remarkable increase in ceftazidime resistance in CTX-M producing clones only when expressed in an OmpF deficient background, suggesting the importance of this porin in the entrance of ceftazidime. Kinetic analysis showed that G240 variants have only weak activity toward ceftazidime. The presence of this mutation may favor the selection of porin deficient variants, and primary characterization as "susceptible" may mask the possibility for in vivo selection of this variants.

Research paper thumbnail of Molecular epidemiology and antimicrobial susceptibility of AmpC- and/or extended-spectrum (ESBL) β-lactamase- producing Proteus spp. clinical isolates in Zenica-Doboj Canton, Bosnia and Herzegovina

International Journal of Infectious Diseases

Research paper thumbnail of High occurrence of multiple genes in ESBL-producing inpatient and outpatient isolates in Zenica-Doboj Canton, Bosnia and Herzegovina

International Journal of Infectious Diseases, 2016

Purpose: To investigate the prevalence and antimicrobial resistance of Gram-negative isolates pro... more Purpose: To investigate the prevalence and antimicrobial resistance of Gram-negative isolates producing more than two types of beta-lactamases, obtained from in-and outpatient infections in Zenica-Doboj Canton, Bosnia and Herzegovina. Methods & Materials: Antibiotic susceptibility was determined by disc diffusion and broth microdilution methods according to CLSI guidelines. Double-disk synergy test was performed to screen for ESBLs and pAmpC beta-lactamases. PCR was used to detect bla ESBL , bla AmpC , bla carb genes. Genetic relatedness of the strains was determined by PFGE. Results: Among 88 inpatient (n=126; 10.0%) and 62 outpatient (n=184; 6.4%) beta-lactamase producing isolates, 50.0/29.0% K. pneumoniae, 12.5/30.6% E. coli, 11.4/4.8% A. baumannii, 8.0/14.5% K. oxytoca, 8.0/4.8% E. cloacae, 5.7/8.1% Proteus spp., and less than 3.5% of other isolates, respectively, were found. Sixty-eight (out of 88; 77.3%) inpatient and 28 (out of 62; 45.2%) outpatient isolates possessed more than two genes. Among inpatient isolates, Klebsiella spp. and E. coli was the most prevalent strain producing more than two types of genes, in 90.0% and 70% cases, respectively. The combination of blaTEM+blaSHV+blaCTX-M+blaOXA-1 were noticed in 34 (out of 68; 50.0%) inpatient isolates; blaCTX-M+blaSHV+blaOXA-1 in seven (10.3%); blaCTX-M+blaOXA-1 in six (8.8%). In outpatient isolates combination of blaTEM+blaSHV were noticed in seven (out of 28; 25.0%) and blaTEM+blaSHV+blaCTX-M+blaOXA-1 in six (21.4%) cases. The most prevalent combination of blaTEM+blaSHV+blaCTX-M+blaOXA-1 was noticed in 28 (out of 38; 73.7%) inpatient Klebsiella pneumonia. Prevalence of antimicrobial resistance were higher to all cephalosporins, amynoclicosides and piperacillin in Klebsiella spp., and E. coli inpatient isolates producing more than two types of beta-lactamases comparing to isolates producing only one type of beta-lactamase. PFGE showed no genetic relatedness between the isolates. Conclusion: High prevalence of Gram-negative isolates producing more then two types of beta-lactamases, especially in inpatient isolates were found. Continous surveillance, and implementation of infection control and prevention measures will help in limitation of further spread of these isolates.

Research paper thumbnail of Detection and characterisation of extended-spectrum and plasmid-mediated AmpC β-lactamase produced by Escherichia coli isolates found at poultry farms in Bosnia and Herzegovina

Archives of Industrial Hygiene and Toxicology

Extended-spectrum β-lactamases (ESBLs) hydrolyse extended-spectrum cephalosporins (ESC) and aztre... more Extended-spectrum β-lactamases (ESBLs) hydrolyse extended-spectrum cephalosporins (ESC) and aztreonam. As ESBL-producing organisms have been identified in food producing animals, the aim of our study was to detect and analyse such Escherichia coli isolates from poultry. Antibiotic susceptibility of the isolates was determined with disk-diffusion and broth microdilution methods. ESBLs were detected with the double-disk synergy and inhibitor-based test with clavulanic acid. The transferability of cefotaxime resistance was determined with conjugation experiments, and genes encoding ESBLs, plasmid-mediated AmpC β-lactamases, and quinolone resistance determinants identified by polymerase chain reaction. The study included 108 faecal samples (cloacal swabs) from 25 different poultry farms in the Zenica-Doboj Canton, Bosnia and Herzegovina. Of these, 75 (69.4 %) were positive for E. coli, of which 27 were resistant to cefotaxime, amoxicillin, cefazoline, and cefriaxone, and susceptible to ...

Research paper thumbnail of Human Brucellosis as an Epidemic Zoonosis in Zenica-Doboj Canton (Bosnia and Herzegovina) During 2008-2018

The Open Infectious Diseases Journal

Background: Brucellosis is associated with people living in close proximity to their animals, whe... more Background: Brucellosis is associated with people living in close proximity to their animals, where conditions for disease onset and spread exist. An epidemic of brucellosis in Bosnia and Herzegovina (B&H) has persisted since 2004. Zenica-Doboj Canton is one of the most affected areas. Objective: To investigate the epidemiological characteristics of human brucellosis from the year 2008 to2018. Methods: Data collected from paper-based patients/cases reported to the Epidemiology Department were analyzed. Results: After 2008, the annual number of patients diagnosed with brucellosis was decreasing, except in 2017 and 2018 with 20 and 35 cases, respectively. Within the 2008-2018 period, a total of 263 human brucellosis cases were recorded, decreasing from 102 (incidence of 44.7/100,000) cases in 2008 to three cases in 2012, but increased to 35 cases in 2018. Males were predominant, with a total of 205 (77.9%) cases. The mean age of the affected patients was 39.2 years; but the most affec...

Research paper thumbnail of Methicillin-resistant S. aureus (MRSA), extended-spectrum (ESBL)- and plasmid-mediated AmpC ß-lactamase -producing Gram-negative bacteria associated with skin and soft tissue infections in hospital and community settings

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2015

Aim To investigate the characteristics of meticillin-resistant S. aureus (MRSA), extended-spectru... more Aim To investigate the characteristics of meticillin-resistant S. aureus (MRSA), extended-spectrum (ESBL), and plasmid-mediated AmpC beta-lactamase producing Gram-negative bacteria causing skin and soft tissue infections (SSTIs) in hospital and outpatient settings of Zenica-Doboj Canton, Bosnia and Herzegovina. Methods Antibiotic susceptibility was determined by disc-diffusion and broth microdillution methods according to CLSI guidelines. MecA gene was detected by PCR, and genetic characterization of MRSA was performed using spa-typing and the algorithm based upon repeat patterns (BURP). Double-disk-synergy test was used to screen for ESBLs. PCR was used to detect blaESBL alleles. Genetic relatedness of the strains was tested by PFGE. Results Seventeen in-patients with MRSA, 13 with ESBL-producing Gram-negative bacteria and three patients co-infected with both, were detected. Five MRSA and 16 ESBL-producing Gram-negative bacteria were found in outpatient samples. Klebsiella spp. was...

Research paper thumbnail of Detection and epidemiological characteristics of Trichinella spp. and Macracanthorhynchus hirudinaceus isolated from wild boars, domestic pigs and badgers in Zenica-Doboj Canton, Bosnia and Herzegovina

Research paper thumbnail of Arrival of carbapenem-hydrolyzing-oxacillinases in Acinetobacter baumannii in Bosnia and Herzegovina

Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases, Mar 22, 2017

Multidrug-resistant Acinetobacter baumannii (MDR-AB) is an important threat for critically ill pa... more Multidrug-resistant Acinetobacter baumannii (MDR-AB) is an important threat for critically ill patients. It can infect the respiratory tract, blood, soft tissues, urinary tract and central nervous system. Recently, carbapenem-resistance was observed in A. baumannii clinical isolates from Bosnia and Herzegovina. This prompted us to analyze these isolates with regards to genotypic diversity, antibiotic susceptibility and occurrence of acquired carbapenem resistance genes. Twelve carbapenem-resistant isolates were collected at a University hospital during two different periods of 2011 and 2015-2016: four isolates in 2011 and eight isolates 2015-2016 and compared to determine the dynamic changes in carbapenemase resistance mechanisms and population structure. All twelve isolates were positive for intrinsic blaOXA-51-like, nine for blaOXA-40-like and one for the blaOXA-23-like gene. ISAba1 was found upstream of blaOXA-51 in all and upstream of blaOXA-23-like gene in one isolate. Sequencing of the selected PCR products revealed the presence of OXA-72 βlactamase (strain 1) and OXA-23 β-lactamase (strain 41). WGS of the selected isolate (AB 5) revealed the presence of blaOXA-72, chromosomal genes blaOXA-69 and blaADC. Moreover, the aac (3)-1a and aadA1 genes encoding aminoglycoside resistance, and sul1encoding sulphonamide resistance were identified. PFGE and rep-PCR revealed two clones containing highly similar isolates positive for OXA-40-like; one from 2011 and the other from 2015-2016. Implementation of hospital hygiene measures, screening of the patients on admission for carriage of MDR-AB, and the early and accurate detection, with restriction of antibiotic use should be recommended to control the spread of these important hospital pathogenes. To our knowledge, this is the first report of A. baumannii isolates producing carbapenem-hydrolyzing oxacillinases (CHDL) from Bosnia and Herzegovina.

Research paper thumbnail of Prevalence of co-existence genes and clonal spread of ESBL-producing isolates causing hospital and community-acquired infections in Zenica-Doboj Canton, Bosnia and Herzegovina

Journal of Health Sciences, 2017

Introduction: Co-existence type of ESBL-producing isolates are serious problem in the public heal... more Introduction: Co-existence type of ESBL-producing isolates are serious problem in the public health world. Methods Antibiotic susceptibility was determined by disc diffusion and broth microdilution according to CLSI guidelines. Double-disk synergy test was performed in order to screen for ESBLs/pAmpC beta-lactamases. PCR was used to detect blaESBL/blaampC/blacarb genes. Genetic relatedness of the strains was determined by pulsed-field-gel-electrophoresis (PFGE). Results In this study 88 of the inpatient isolates (n=126; 10.0%) and 62 of the outpatient (n=184; 6.4%) Beta-lactamase-producing isolates were taken for the study. They included 50.0/29.0% K. pneumoniae, 12.5/30.6% E. coli, 11.4/4.8% A. baumannii, 8.0/14.5% K. oxytoca, 8.0/4.8% E. cloacae, 5.7/8.1% Proteus spp., and less than 3.5% of other isolates. Co-existence of more than two type of beta-lactamases was detected in 77.3% of inpatient and 45.2% of outpatient isolates. Among inpatient isolates, Klebsiella spp. and E. coli ...

Research paper thumbnail of Molecular characteristics and antibiotic resistance of Acinetobacter baumanniibeta-lactamase-producing isolates, a predominance of intrinsic blaOXA-51, and detection of TEM and CTX-M genes

TURKISH JOURNAL OF MEDICAL SCIENCES, 2017

The aim of this study was to determine the molecular characteristics and antibiotic resistance of... more The aim of this study was to determine the molecular characteristics and antibiotic resistance of 13 (10 inpatient and three outpatient) Acinetobacter baumannii beta-lactamase-producing isolates collected in Bosnia and Herzegovina between December 2009 and May 2010. Materials and methods: Susceptibility testing was performed by disk diffusion and broth microdilution methods. The modified Hodge and combined disk test with EDTA/phenylboronic acid was used to screen for carbapenemase production. Production of extended spectrum beta-lactamases (ESBLs) was determined by double-disk synergy test. PCR was used to detect blaESBL/blacarb genes. Results: Ten (22.2%) inpatient and three (13.6%) outpatient isolates produced beta-lactamases, ESBLs, or oxacillinases. More than 50% of the isolates showed multidrug resistance. Resistance rates to gentamicin and ciprofloxacin of the inpatients and outpatients were 80.0%, 60.0%, 75.0%, and 25.0%, respectively. MICs of carbapenems for resistant isolates ranged from 32 to >256 µg/mL. All imipenemresistant Acinetobacter baumannii strains contained bla OXA-51. Three of the 10 inpatient isolates and one outpatient isolate containing bla OXA-51 additionally produced other beta-lactamases (TEM/CTX-M/OXA-1). None of the inpatient or outpatient isolates were positive for other carbapenemases, especially acquired oxacillinases (bla OXA-23 /bla OXA-24 /bla OXA-58 /bla OXA-143). Conclusion: Production of bla OXA-51 presents an emerging threat in imipenem-resistant Acinetobacter spp. from Bosnia and Herzegovina.

Research paper thumbnail of Prevalence and antimicrobial resistance of beta-lactamase-producing Gram-negative isolates from outpatient clinical and environmental samples in the Zenica-Doboj Canton, Bosnia and Herzegovina

Journal of Health Sciences, 2016

Introduction: Infections due to extended-spectrum beta-lactamase (ESBL)-producing isolates in pat... more Introduction: Infections due to extended-spectrum beta-lactamase (ESBL)-producing isolates in patients are hard to treat and cause high morbidity and mortality. ESBL-producing bacteria have been increasingly detected in environmental samples in different countries since 2002, and have gained considerable attention worldwide.Methods: Antibiotic susceptibility of all isolates was determined using the disk diffusion method. The production of ESBLs was determined by the double-disk synergy test.Results: Among the outpatient clinical samples, out of 2857 Gram-negative bacteria, 184 (6.5%) ESBL-producing bacteria were isolated. In this group, 143 (77.7%) were from urine samples, 26 (14.1%) from surgical wounds, 6 (3.3%) from umbilical swabs, and 9 (4.9%) from other patients sites (upper respiratory tract, cannula, eyes, genital swabs). Escherichia coli was isolated in 62 (33.7%), and Klebsiella spp. in 50 (27.8%) cases. Among the environmental samples, out of 381 Gram-negative bacteria, 5...

Research paper thumbnail of Molecular characterisation of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in inpatients and outpatients in Bosnia and Herzegovina

Wiener Medizinische Wochenschrift, 2012

Molecular characterisation of methicillin-susceptible and methicillin-resistant Staphylococcus au... more Molecular characterisation of methicillin-susceptible and methicillin-resistant Staphylococcus aureus 13 1 3 Molekulare Charakterisierung Methacillinsensibler und Methacillin-resistenter Isolate von Staphylococcus aureus bei stationären und ambulant behandelten Patienten in Bosnien und Herzegovina Zusammenfassung Das Ziel der vorliegenden Arbeit war es, den genetischen Hintergrund von Methacillinsensiblen (MSSA) und Methacillin-resistenten Staphylococcus aureus (MRSA), die aus verschiedenen klinischen Proben bei stationär und ambulant behandelten Patienten gewonnen wurden, zu erforschen. Die Me thacillin-Resistenz wurde durch die Anwesendheit von Meca-Genen PCR-DM bestätigt. Die genetische Charakterisierung erfolgte mittels SPA Typisierung und BURP. Staphylococcus aureus wurde aus 68 und 79 Proben der stationär bzw. ambulant behandelten Patienten isoliert, 31 (46 %) bzw. 14 (18 %) davon waren MRSA. Bei 37 stationären und 65 ambulanten Patienten mit MSSA wurden 22 bzw. 38 SPA-Typen in sieben bzw. acht Haupt-SPA-Clonal Complexes (CC) klassifiziert. Haupt-MSSA SPA-CC war CC015 (MLST CC45), bei 16 % der stationären bzw. 21 % der ambulanten Patienten. Die meisten der MRSA Isolate waren SPA-CC 355/595 (MLST CC152). Bei 32 % der stationären und 43 % der ambulanten Patienten wiesen die MSSA Isolate einen MRSA-Hintergrund auf; dies weist darauf hin, dass die MRSA nicht aus den dominanten MSSA-Klonen hervorgegangen sind.

Research paper thumbnail of Prevalence, molecular characterization and antimicrobial resistance of extended-spectrum beta-lactamase-producing Gramnegative bacteria isolated from outpatient clinical and environmental samples in Zenica-Doboj Canton, Bosnia and Herzegovina

Research paper thumbnail of Molecular characteristics and antibiotic resistance of Acinetobacter spp ; predominance of blaOXA-51 and blaVIM, isolates from patients in Bosnia and Herzegovina

Acinetobacter spp. is an important opportunistic bacterial pathogen responsible for serious infec... more Acinetobacter spp. is an important opportunistic bacterial pathogen responsible for serious infections in the hospital environment. Objectives were to determine the antibiotic susceptibility and to characterize carbapenem-resistance mechanisms of 24 (19 in- and five outpatient) Acinetobacter spp. isolates collected during Decembar 2009 to May 2010 in Bosnia and Herzegovina were investigated. Susceptibility testing was performed by disc-diffusion (DD) and broth microdilution method. The modified Hodge and combined disc test with EDTA with phenylboronic acid were used to screen for carbapenemase production. Production of ESBLs was determined by double-disc synergy test. Ten (52.6%) of the in-and three (60.0%) of outpatient isolates were produced ESBL, MBL or oxacillinases. More than 50% of the isolates showed multidrug-resistance. Resistance rates to gentamicin and ciprofloxacin of the in-and outpatients were 80.0% and 60.0%, and 75.0% and 25.0%, respectively. MICs of carbapenems for ...

Research paper thumbnail of Molecular epidemiology and antimicrobial susceptibility of AmpC- and/or extended-spectrum (ESBL) ß-lactamaseproducing Proteus spp. clinical isolates in Zenica-Doboj Canton, Bosnia and Herzegovina

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2016

Aim To investigate prevalence, antimicrobial susceptibility, molecular characteristics, and genet... more Aim To investigate prevalence, antimicrobial susceptibility, molecular characteristics, and genetic relationship of AmpC- and/or extended spectrum beta lactamase (ESBL)- producing Proteus spp. clinical isolates in Zenica-Doboj Canton, Bosnia and Herzegovina. Methods Antibiotic susceptibility was determined by disc diffusion and broth microdilution methods according to CLSI guidelines. Double-disk synergy test was performed in order to screen for ESBLs, and combined disk test with phenylboronic acid to detect AmpC β -lactamases. PCR was used to detect blaESBL/blacarb genes. Genetic relatedness of the strains was determined by pulsed-fieldgel-electrophoresis (PFGE). Results Eleven ESBL-producing isolates were included in the study (six inpatients and five outpatients). Susceptibility rate to amoxicillin-clavulanic acid, imipenem and meropenem was 100%. Resistance rate to cefuroxime was 100%, gentamicine 90.9%, piperacillin/tazobactam 81.8%, cefotaxim, ceftriaxone and ceftazidime 72.7%...

Research paper thumbnail of Detection and characterization of DHA-1 beta-lactamase in Klebsiella spp. causing urinary tract infections in Bosnia and Herzegovina

Objectives Klebsiella spp. is a common cause of urinary tract infections (UTIs) and it is importa... more Objectives Klebsiella spp. is a common cause of urinary tract infections (UTIs) and it is important nosocomial pathogen. There is currently little information about a prevalence of AmpC beta-lactamases in these strains. The aim of the study was to investigate a prevalence of plasmid –mediated AmpC (pAmpC) beta-lactamases in Klebsiella spp. causing UTIs in Bosnia and Herzegovina (B&H), during December 2009-May 2010. Methods Minimum inihibitory concentrations (MICs) of various antibiotics were determined by broth microdilution method according to CLSI guidelines. Double-disk synergy test and combined disk test with phenylboronic acid were used to detect ESBLs and pAmpC beta-lactamases respectively. BlaESBL, and blaAmpC genes were detected by PCR. Genetic relatedness of the strains was tested by pulsed-field gel electrophoresis (PFGE). Results ESBL. were found in 28 Klebsiella spp (22 K. pneumoniae and six K. oxytoca). Genes encoding pAmpC beta-lactamases were detected in two (7.1%) is...

Research paper thumbnail of Inducible clindamycin resistance in methicillin-susceptible and methicillin-resistant Staphylococcus aureus of inpatient, outpatient and healthy carriers in Bosnia and Herzegovina

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2013

AIM To investigate the iMLSB prevalence in 142 methicillin-sensitive (MSSA) and 48 methicillin-re... more AIM To investigate the iMLSB prevalence in 142 methicillin-sensitive (MSSA) and 48 methicillin-resistant (MRSA) in-patient (65), outpatient (75), and healthy carrier (150) Staphylococcus aureus isolates in Zenica-Doboj Canton, Bosnia and Herzegovina. METHODS Disk diffusion testing by placing clindamycin (CLI) and erythromycin (ERY) disks 15 mm apart (edge to edge) on a Mueller-Hinton agar, as per CLSI guideline was performed. Two distinct induction phenotypes labelled as D and D+, and three noninduction phenotypes designated as Neg, R (constitutive, cMLSB), and S (susceptible). Methicillin-resistance was confirmed by the presence of mecA gene by PCR. The genetic characterization was performed using spa-typing and the algorithm based upon repeat patterns (BURP). RESULTS iMLSB was detected in six (2.1%) isolates, of which five (3.5%) (two outpatients and three carriers) were MSSA, and one (2.1%) (outpatient) MRSA. One of them, D+ phenotype (iMLSB) was obtained from a carrier (MSSA). N...

Research paper thumbnail of AUTHOR'S CORRECTION: Molecular epidemiology and antimicrobial susceptibility of AmpC- and/or extended-spectrum (ESBL) ß-lactamaseproducing Proteus spp. clinical isolates in Zenica-Doboj Canton, Bosnia and Herzegovina

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2017

Volume 13, no. 2, p. 103-112, 2016. Page 103: The byline should appear as shown above.

Research paper thumbnail of High prevalence of blaCTX-M-15 ; first report of blaCTX-M-28, blaCTX-M-3 blaCMY, blaDHA and blaFOX producing Enterobacteriaceae causing urinary tract infections in Bosnia and Herzegovina in hospital and community settings

Objectives To investigate molecular epidemiology of extended-spectrum (ESBL) and plasmid-mediated... more Objectives To investigate molecular epidemiology of extended-spectrum (ESBL) and plasmid-mediated AmpC β-lactamase and carbapenemase producing Gram-negative bacteria the cause of urinary tract infections (UTI) in in- and outpatients in Bosnia and Herzegovina (BH 57.1%) E. coli in-patient isolates were positive for the blaCTX-M-15 and one for blaCTX-M-3. AmpC β-lactamases were detected by phenotypic test in 20 (45.5%) in- and 21 (51.2%) outpatients. One in-patient strain was positive for blaCMY and two for blaDHA, whereas four outpatient strains were positive for blaCMY and one for blaFOX. Conclusion: The CTX-M-15 was most prevalent β -lactamase in the in- and outpatients. This is the firtst report of blaCTX-M-28, blaCTX-M-3, blaCMY, blaDHA, and blaFOX from B&H. Due to high resistance rates observed for gentamicin and ciprofloxacin, carbapenems remain the antibiotics of choice for the treatment of UTIs caused by β-lactamase-producing Enterobacteriaceae in this region.

Research paper thumbnail of Antibiotic resistance in Enterobacter cloacae strains with derepressed/partly derepressed/inducible AmpC and extendedspectrum beta-lactamases in Zenica-Doboj Canton, Bosnia and Herzegovina

Aim To investigate the prevalence of derepressed/partly derepressed/inducible and ESBL/AmpC-produ... more Aim To investigate the prevalence of derepressed/partly derepressed/inducible and ESBL/AmpC-producing Enterobacter cloacae isolates and treatment options for infections associated with those isolates. Methods Antibiotic susceptibility was determined by disc diffusion and broth microdilution according to CLSI guidelines. Doubledisk synergy test (DDST) was performed in order to screen for ESBLs and combined disk test with phenylboronic acid to detect AmpC β -lactamases. PCR was used to detect blaESBL/blacarb genes. Genetic relatedness of the strains was determined by pulsed-fieldgel-electrophoresis (PFGE). Results Among 14 isolates with the ESBL positive E. cloaceae producing isolates, four (28.6%), nine (64.3%) and one (7.1%) isolates were derepressed/partly derepressed and inducible AmpC producers. Eleven (out of 14) isolates were resistant to cefotaxime, ceftazidime, ceftriaxone, aminoglycosides and fluoroquinolones. All isolates were susceptible to imipenem and meropenem, 79% to c...

Research paper thumbnail of Antibiotic resistance in Enterobacter cloaceae with derepressed/partly derepressed/inducible AmpC and extended-spectrum beta-lactamase in Zenica-Doboj Canton, Bosnia and Herzegovina

International Journal of Infectious Diseases

cat values, while K m values remain at the millimolar range. In vitro selection of CAZ-resistant ... more cat values, while K m values remain at the millimolar range. In vitro selection of CAZ-resistant E. coli strains yielded D240G CTX-M producers with MIC values of 32 and 64 g/ml while those with no substitution was only 8 g/ml. Conclusion: D240G mutation leads to a remarkable increase in ceftazidime resistance in CTX-M producing clones only when expressed in an OmpF deficient background, suggesting the importance of this porin in the entrance of ceftazidime. Kinetic analysis showed that G240 variants have only weak activity toward ceftazidime. The presence of this mutation may favor the selection of porin deficient variants, and primary characterization as "susceptible" may mask the possibility for in vivo selection of this variants.

Research paper thumbnail of Molecular epidemiology and antimicrobial susceptibility of AmpC- and/or extended-spectrum (ESBL) β-lactamase- producing Proteus spp. clinical isolates in Zenica-Doboj Canton, Bosnia and Herzegovina

International Journal of Infectious Diseases

Research paper thumbnail of High occurrence of multiple genes in ESBL-producing inpatient and outpatient isolates in Zenica-Doboj Canton, Bosnia and Herzegovina

International Journal of Infectious Diseases, 2016

Purpose: To investigate the prevalence and antimicrobial resistance of Gram-negative isolates pro... more Purpose: To investigate the prevalence and antimicrobial resistance of Gram-negative isolates producing more than two types of beta-lactamases, obtained from in-and outpatient infections in Zenica-Doboj Canton, Bosnia and Herzegovina. Methods & Materials: Antibiotic susceptibility was determined by disc diffusion and broth microdilution methods according to CLSI guidelines. Double-disk synergy test was performed to screen for ESBLs and pAmpC beta-lactamases. PCR was used to detect bla ESBL , bla AmpC , bla carb genes. Genetic relatedness of the strains was determined by PFGE. Results: Among 88 inpatient (n=126; 10.0%) and 62 outpatient (n=184; 6.4%) beta-lactamase producing isolates, 50.0/29.0% K. pneumoniae, 12.5/30.6% E. coli, 11.4/4.8% A. baumannii, 8.0/14.5% K. oxytoca, 8.0/4.8% E. cloacae, 5.7/8.1% Proteus spp., and less than 3.5% of other isolates, respectively, were found. Sixty-eight (out of 88; 77.3%) inpatient and 28 (out of 62; 45.2%) outpatient isolates possessed more than two genes. Among inpatient isolates, Klebsiella spp. and E. coli was the most prevalent strain producing more than two types of genes, in 90.0% and 70% cases, respectively. The combination of blaTEM+blaSHV+blaCTX-M+blaOXA-1 were noticed in 34 (out of 68; 50.0%) inpatient isolates; blaCTX-M+blaSHV+blaOXA-1 in seven (10.3%); blaCTX-M+blaOXA-1 in six (8.8%). In outpatient isolates combination of blaTEM+blaSHV were noticed in seven (out of 28; 25.0%) and blaTEM+blaSHV+blaCTX-M+blaOXA-1 in six (21.4%) cases. The most prevalent combination of blaTEM+blaSHV+blaCTX-M+blaOXA-1 was noticed in 28 (out of 38; 73.7%) inpatient Klebsiella pneumonia. Prevalence of antimicrobial resistance were higher to all cephalosporins, amynoclicosides and piperacillin in Klebsiella spp., and E. coli inpatient isolates producing more than two types of beta-lactamases comparing to isolates producing only one type of beta-lactamase. PFGE showed no genetic relatedness between the isolates. Conclusion: High prevalence of Gram-negative isolates producing more then two types of beta-lactamases, especially in inpatient isolates were found. Continous surveillance, and implementation of infection control and prevention measures will help in limitation of further spread of these isolates.

Research paper thumbnail of Detection and characterisation of extended-spectrum and plasmid-mediated AmpC β-lactamase produced by Escherichia coli isolates found at poultry farms in Bosnia and Herzegovina

Archives of Industrial Hygiene and Toxicology

Extended-spectrum β-lactamases (ESBLs) hydrolyse extended-spectrum cephalosporins (ESC) and aztre... more Extended-spectrum β-lactamases (ESBLs) hydrolyse extended-spectrum cephalosporins (ESC) and aztreonam. As ESBL-producing organisms have been identified in food producing animals, the aim of our study was to detect and analyse such Escherichia coli isolates from poultry. Antibiotic susceptibility of the isolates was determined with disk-diffusion and broth microdilution methods. ESBLs were detected with the double-disk synergy and inhibitor-based test with clavulanic acid. The transferability of cefotaxime resistance was determined with conjugation experiments, and genes encoding ESBLs, plasmid-mediated AmpC β-lactamases, and quinolone resistance determinants identified by polymerase chain reaction. The study included 108 faecal samples (cloacal swabs) from 25 different poultry farms in the Zenica-Doboj Canton, Bosnia and Herzegovina. Of these, 75 (69.4 %) were positive for E. coli, of which 27 were resistant to cefotaxime, amoxicillin, cefazoline, and cefriaxone, and susceptible to ...

Research paper thumbnail of Human Brucellosis as an Epidemic Zoonosis in Zenica-Doboj Canton (Bosnia and Herzegovina) During 2008-2018

The Open Infectious Diseases Journal

Background: Brucellosis is associated with people living in close proximity to their animals, whe... more Background: Brucellosis is associated with people living in close proximity to their animals, where conditions for disease onset and spread exist. An epidemic of brucellosis in Bosnia and Herzegovina (B&H) has persisted since 2004. Zenica-Doboj Canton is one of the most affected areas. Objective: To investigate the epidemiological characteristics of human brucellosis from the year 2008 to2018. Methods: Data collected from paper-based patients/cases reported to the Epidemiology Department were analyzed. Results: After 2008, the annual number of patients diagnosed with brucellosis was decreasing, except in 2017 and 2018 with 20 and 35 cases, respectively. Within the 2008-2018 period, a total of 263 human brucellosis cases were recorded, decreasing from 102 (incidence of 44.7/100,000) cases in 2008 to three cases in 2012, but increased to 35 cases in 2018. Males were predominant, with a total of 205 (77.9%) cases. The mean age of the affected patients was 39.2 years; but the most affec...

Research paper thumbnail of Methicillin-resistant S. aureus (MRSA), extended-spectrum (ESBL)- and plasmid-mediated AmpC ß-lactamase -producing Gram-negative bacteria associated with skin and soft tissue infections in hospital and community settings

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2015

Aim To investigate the characteristics of meticillin-resistant S. aureus (MRSA), extended-spectru... more Aim To investigate the characteristics of meticillin-resistant S. aureus (MRSA), extended-spectrum (ESBL), and plasmid-mediated AmpC beta-lactamase producing Gram-negative bacteria causing skin and soft tissue infections (SSTIs) in hospital and outpatient settings of Zenica-Doboj Canton, Bosnia and Herzegovina. Methods Antibiotic susceptibility was determined by disc-diffusion and broth microdillution methods according to CLSI guidelines. MecA gene was detected by PCR, and genetic characterization of MRSA was performed using spa-typing and the algorithm based upon repeat patterns (BURP). Double-disk-synergy test was used to screen for ESBLs. PCR was used to detect blaESBL alleles. Genetic relatedness of the strains was tested by PFGE. Results Seventeen in-patients with MRSA, 13 with ESBL-producing Gram-negative bacteria and three patients co-infected with both, were detected. Five MRSA and 16 ESBL-producing Gram-negative bacteria were found in outpatient samples. Klebsiella spp. was...