M. Cizman - Academia.edu (original) (raw)

Papers by M. Cizman

Archives of disease in childhood, Jan 28, 2015

To assess the availability and source of guidelines for common infections in European paediatric ... more To assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their content and characteristics. Participating hospitals completed an online questionnaire on the availability and characteristics of antibiotic prescribing guidelines and on empirical antibiotic treatment including duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children. 84 hospitals from 19 European countries participated in the survey of which 74 confirmed the existence of guidelines. Complete guidelines (existing guidelines for all requested infection syndromes) were reported by 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for urinary tract infection (UTI) (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin were the antibiotics most commonly recom...

The Pediatric infectious disease journal, 1989

This retrospective study (1979 to 1986) investigated the possible etiologic relationship between ... more This retrospective study (1979 to 1986) investigated the possible etiologic relationship between vaccination and aseptic meningitis in 115 hospitalized children who became ill within 30 days of vaccination with the Leningrad 3 strain of mumps virus and the Edmonston-Zagreb strain of measles virus. The etiologic viral diagnosis was based on serologic tests and the isolation of virus from cell cultures which distinguished between attenuated and "virulent" mumps virus. The incidence of mumps vaccine-associated meningitis was 1/1000 vaccine recipients. In 92% of children the incubation period was 11 to 25 days and 28% had associated swelling of the salivary glands. Sixteen cases (13.9%) had a positive cerebrospinal fluid culture (attenuated mumps virus, 6 cases; "virulent" mumps virus, 7 cases; echoviruses, 3 cases). Clustering of cases, seasonal occurrence and age of the patients suggested causal relationship with the vaccination in the majority of children. In 4 pa...

Emerging Infectious Diseases, 2006

We surveyed the populations of 19 European countries to compare the prevalence of antimicrobial d... more We surveyed the populations of 19 European countries to compare the prevalence of antimicrobial drug selfmedication in the previous 12 months and intended self-medication and storage and to identify the associated demographic characteristics. By using a multistage sampling design, 1,000-3,000 adults in each country were randomly selected. The prevalence of actual self-medication varied from 1 to 210 per 1,000 and intended self-medication from 73 to 449 per 1,000; both rates were high in eastern and southern Europe and low in northern and western Europe. The most common reasons for self-medication were throat symptoms (e.g., dry, inflamed, red, or sore throat, inflamed tonsils, tonsil pain). The main medication sources were pharmacies and medication leftover from previous prescriptions. Younger age, higher education, and presence of a chronic disease were associated with higher rates of self-medication. Attempts to reduce inappropriate self-medication should target prescribers, pharmacists, and the general public. A ntimicrobial drug resistance is a rapidly increasing global problem (1,2), and prevalence varying widely among countries (3).

Journal of Antimicrobial Chemotherapy, 2005

Compared with European countries, the use of antibiotics in Slovenia is moderate. In the period 1... more Compared with European countries, the use of antibiotics in Slovenia is moderate. In the period 1999-2002 an 18.67% decrease in outpatient antibiotic consumption was noted. The aim of the present study was to analyse this decrease and its consequences.

The Pediatric Infectious Disease Journal, 1993

The etiology of acute encephalitis was evaluated in a retrospective study of 170 children (98 boy... more The etiology of acute encephalitis was evaluated in a retrospective study of 170 children (98 boys and 72 girls) ages 1 month to 15 years, who were hospitalized during a 13-year period from 1979 to 1991. The etiology was confirmed or considered very probable in 68% of cases. The identified etiologic agents included Central European tick-borne encephalitis virus (28.8%), varicella-zoster virus (17.0%), herpes simplex (10.0%), rubella (2.9%), mumps (2.3%), measles virus, Chlamydia psittaci (1.1%) and some other agents found in individual cases. The etiology remained unknown in 54 children (31.7%). Forty-two patients had encephalitis with focal neurologic signs. The most common confirmed or presumptive infective agent in those cases was herpes simplex virus (40.4%), followed by rubella (7.1%), Central European tick-borne encephalitis virus (4.7%) and some other agents identified in individual cases. The etiology remained unknown in 15 (36%) children with focal encephalitis.

Wiener klinische Wochenschrift, 2000

BACKGROUND Little is known about the seroprevalence of ehrlichiosis in adults and much less about... more BACKGROUND Little is known about the seroprevalence of ehrlichiosis in adults and much less about the same in children. METHODS One hundred and forty-three healthy children and young adults (6-24 years of age, male to female ratio, 1:1) were assessed for the presence of antibodies to the agents of human granulocytic ehrlichiosis (HGE), human monocytic ehrlichiosis (HME), Borrelia burgdorferi sensu stricto (BB), and tick-borne encephalitis (TBE) virus in Slovenia, where tick-related infections are endemic. Antibodies to HGE and HME agents were assayed by indirect immunofluorescence, and antibodies to BB and TBE by enzyme-linked immunosorbent assay. A questionnaire about tick exposure was answered by all subjects. In the event of a positive result, a detailed interview was conducted. RESULTS Of 143 study subjects, 22 (15.4%) had detectable antibodies to HGE agent, 22 (15.4%) were positive to BB, 18 (12.6%) were positive to TBE virus (12 of these were vaccinated) and 4 (2.8%) were posi...

Wiener klinische Wochenschrift, 1999

Records of patients aged 0 to 15 years, hospitalised between 1993 and 1998 at the intensive care ... more Records of patients aged 0 to 15 years, hospitalised between 1993 and 1998 at the intensive care unit (ICU) of the Department of Infectious Diseases, Ljubljana, Slovenia, suffering from a severe attack of tick-borne encephalitis (TBE), were reviewed. Of 133 children hospitalised due to TBE virus infection during the observation period, 7 (5.2%) were treated in the ICU. All patients were male, aged 6 to 14 (mean, 11.1) years. In six cases, focal encephalitis was diagnosed, and in one case it was suspected. All patients survived. After a mean follow-up period of 7.9 (range, 1.5 to 17) months, one patient was found to have severe neurologic sequelae and two patients had moderate sequelae. In conclusion, the results of our retrospective study of severe forms of TBE in children demonstrate that this disease can run a severe course and may lead to permanent sequelae, most often in boys of school-going age who present with focal encephalitis. Therefore, immunisation of school children agai...

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 1994

Aims: To estimate the occurrence of recent, past, and "persistent" infections with Chlamydia pneu... more Aims: To estimate the occurrence of recent, past, and "persistent" infections with Chlamydia pneumoniae-as indicated by serology-in an Israeli population without clinical evidence of respiratory infection. Methods: Serum samples from 402 subjects (172 children and 230 adults), without known respiratory symptoms, were collected. Antibodies to C pneumoniae (IgG, IgA, and IgM) were evaluated using the microimmunofluorescence (MIF) assay. Antibody prevalence and indication of recent, past, and persistent infections were calculated and their distribution determined according to age, sex, and season. Results: Antibodies to C pneumoniae were detected in 53 children (31%) and 171 adults (74%). Recent infection was indicated in only one of 50 children under 5 years of age, in nine of 122 older children, and in 19 of 230 adults. IgM antibodies were detected in nine children, but only in three adults. Past infection was indicated in six of 96 young children (aged 1-10 years), in 28 of 76 teenagers, and in 128 of 230 adults. Persistent infection was indicated in three young children, in six teenagers, and in 24 adults, with a significantly higher frequency (p = 0.012) in men (18 of 117) than in women (six of 113). No seasonal differences could be detected. Conclusions: Infection with C pneumoniae was detected serologically in children and adults without clinical signs of respiratory disease. These results should serve as a basis for studies on the role of C pneumoniae infections and their sequelae in Israel and contribute to the general understanding of asymptomatic infection with C pneumoniae.

Invasive strains of Neisseria meningitidis isolated from sterile body fluids of children aged 0-1... more Invasive strains of Neisseria meningitidis isolated from sterile body fluids of children aged 0-14 years were intentionally collected in nine Slovenian laboratories, and sent to the laboratory of the National Institute of Public Health, Ljubljana for final evaluation. From 1993-1999 we collected 53 invasive strains from children presented in this study. The incidence rate of invasive diseases in children shows that there is a rapid fall from 4.74/100,000 in 1993 to 0.90/100,000 in 1999. Invasive diseases predominated in children in the age group 0-1 year (19.6 cases per 100,000 children); followed by the age groups 2-4 years, 5-9 years and 10-14 years. The results of serogrouping indicate that the largest proportion of meningococci isolated (90%) were group B, while 8% of isolates were group C and only 2% group Y. The serotype/serosubtype distribution shows that the most frequent serotype (excluding 19 non-typable NT strains) was serotype 22, which was expressed in 9 strains and the...

Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin

During 1991-1999 a significant increase of consumption of macrolides and fluoroquinolones was obs... more During 1991-1999 a significant increase of consumption of macrolides and fluoroquinolones was observed in Slovenia,and this was associated with significant increase of resistance of Streptococcus pneumoniae and Streptococcus pyogenes to macrolides and Escherichia coli to fluoroquinolones, respectively.Between 1999 and 2007 the prevalence of S. pneumoniae resistant to erythromycin increased from 3.7% to 16.8% even though the use of macrolides in the same period decreased from 3.81 to 2.43 defined daily doses (DDD) per 1,000 inhabitants and per day. The co-resistance and the spread of resistant clones were the reason for constant increase in macrolide resistance. Slovenia is one of the few European countries with decreasing prevalence of methicillin resistant Staphylococcus aureus (MRSA) in hospital care during the last years. As a result of control measures introduced in 1999,the MRSA prevalence rates decreased from 21.4% in 2000 to 8.3% in 2007.

Journal of Public Health, 2007

The incidence of H. influenzae meningitis in children under five years of age was monitored durin... more The incidence of H. influenzae meningitis in children under five years of age was monitored during the years 1983-87 by a retrospective study of records from all hospitals serving a metropolitan county in Kansas. The mean annual incidence rate for the five years studied was 26.0 per 100,000. This compares with a mean of 56.0 per 100,000 measured in the same county during 1979-82. (Am

International journal of antimicrobial agents, 2003

The frequency of resistance to antibiotics among common community-acquired pathogens, and the num... more The frequency of resistance to antibiotics among common community-acquired pathogens, and the number of drugs to which they are resistant have been increasing worldwide. The relationship between antibiotic usage and resistance is strongly supported by data from several studies. Countries with the highest per capita antibiotic consumption have the highest resistance. The emergence of penicillin-resistant Streptococcus pneumoniae is related to high consumption of antibiotics in general, as well as to increased use of aminopenicillins and/or probably to wider use of oral cephalosporins. Increased consumption of macrolides, especially the longacting ones, correlates significantly with the level of macrolide resistance of group A streptococci and S. pneumoniae while increased use of oral cephalosporins might be associated with the increase of b-lactamase-producing strains of Moraxella catarrhalis. Trimethoprim/sulphamethoxazole resistance is strongly associated with resistance to penicillin. A rise in consumption of fluoroquinolones is consonant with a higher rate of resistance to quinolones of S. pneumoniae, Escherichia coli and other Gramnegative bacteria. Paediatric bacterial isolates are more often resistant to various antimicrobial agents than isolates from adult patients; this higher resistance rate may be due to more frequent antimicrobial treatments in children, and extensive child to child transmission. Reliable data on antimicrobial consumption and resistance should form a basis for national policies devised to reduce the resistance of microorganisms to antibiotics.

Journal of …, 2011

France has lower consumption expressed in DDDs/100 bed-days than Slovenia, but if we express data... more France has lower consumption expressed in DDDs/100 bed-days than Slovenia, but if we express data in DDDs/1000 inhabitants/day the relationship is reversed. The consumption expressed in DDDs/100 bed-days is different from the data expressed in DDDs/1000 inhabitants/day ...

Central European journal of public health, 2001

Invasive strains of Neisseria meningitidis isolated from sterile body fluids of children aged 0-1... more Invasive strains of Neisseria meningitidis isolated from sterile body fluids of children aged 0-14 years were intentionally collected in nine Slovenian laboratories, and sent to the laboratory of the National Institute of Public Health, Ljubljana for final evaluation. From 1993-1999 we collected 53 invasive strains from children presented in this study. The incidence rate of invasive diseases in children shows that there is a rapid fall from 4.74/100,000 in 1993 to 0.90/100,000 in 1999. Invasive diseases predominated in children in the age group 0-1 year (19.6 cases per 100,000 children); followed by the age groups 2-4 years, 5-9 years and 10-14 years. The results of serogrouping indicate that the largest proportion of meningococci isolated (90%) were group B, while 8% of isolates were group C and only 2% group Y. The serotype/serosubtype distribution shows that the most frequent serotype (excluding 19 non-typable NT strains) was serotype 22, which was expressed in 9 strains and the...

Wiener klinische Wochenschrift, Jan 13, 2000

Little is known about the seroprevalence of ehrlichiosis in adults and much less about the same i... more Little is known about the seroprevalence of ehrlichiosis in adults and much less about the same in children. One hundred and forty-three healthy children and young adults (6-24 years of age, male to female ratio, 1:1) were assessed for the presence of antibodies to the agents of human granulocytic ehrlichiosis (HGE), human monocytic ehrlichiosis (HME), Borrelia burgdorferi sensu stricto (BB), and tick-borne encephalitis (TBE) virus in Slovenia, where tick-related infections are endemic. Antibodies to HGE and HME agents were assayed by indirect immunofluorescence, and antibodies to BB and TBE by enzyme-linked immunosorbent assay. A questionnaire about tick exposure was answered by all subjects. In the event of a positive result, a detailed interview was conducted. Of 143 study subjects, 22 (15.4%) had detectable antibodies to HGE agent, 22 (15.4%) were positive to BB, 18 (12.6%) were positive to TBE virus (12 of these were vaccinated) and 4 (2.8%) were positive to the HME agent. The ...

Expert Review of Anti-infective Therapy, 2015

Rising antibiotic resistance has become an increasing public health problem. There is a well-esta... more Rising antibiotic resistance has become an increasing public health problem. There is a well-established correlation between antibiotic consumption and antimicrobial resistance. Consequently, measures to rationalize the prescribing of antibiotics should reduce the resistant strains. Following a 24% increase in antibiotic consumption at the end of the 1990s, multiple activities were designed and introduced by the Health Insurance Institute of Slovenia (ZZZS) and other organizations in Slovenia at the end of 1999. These activities reduced the antibiotic consumption by 18.7% by 2002. These measures have continued. To study changes in antibiotic utilization from 1995 to 2012 alongside the multiple interventions and their consequences, including changes in resistance patterns. This was a retrospective observational study involving all patients dispensed at least one ZZZS prescription for an antibiotic in Slovenia. Utilization was expressed in defined daily doses per thousand inhabitants per day. Multifaceted interventions were conducted over time involving all key stakeholder groups, that is, the Ministry of Health, ZZZS, physician groups and patients. These included comprehensive communication programs as well as prescribing restrictions for a number of antibiotics and classes. From 1999 to 2012, antibiotic consumption decreased by 2-9% per year, with an overall decrease of 31%. There were also appreciable structural changes. Overall antibiotic utilization and the utilization of 7 out of 10 antibiotics significantly decreased after multiple interventions. The resistance of Streptococcus pneumoniae to penicillin decreased in line with decreased utilization. However, its resistance to macrolides increased from 5.4 to 21% despite halving of its utilization. The resistance of Escherichia coli to fluoroquinolones doubled from 10 to 21% despite utilization decreasing by a third. Expenditures on antibiotics decreased by 53%. Multiple demand-side measures introduced following increased utilization significantly decreased subsequent antibiotic utilization and associated costs. However, there was variable impact on antibiotic resistance. Additional targeted activities are planned to further reduce antibiotic prescribing and resistance.

The Pediatric Infectious Disease Journal, 1993

The etiology of acute encephalitis was evaluated in a retrospective study of 170 children (98 boy... more The etiology of acute encephalitis was evaluated in a retrospective study of 170 children (98 boys and 72 girls) ages 1 month to 15 years, who were hospitalized during a 13-year period from 1979 to 1991. The etiology was confirmed or considered very probable in 68% of cases. The identified etiologic agents included Central European tick-borne encephalitis virus (28.8%), varicella-zoster virus (17.0%), herpes simplex (10.0%), rubella (2.9%), mumps (2.3%), measles virus, Chlamydia psittaci (1.1%) and some other agents found in individual cases. The etiology remained unknown in 54 children (31.7%). Forty-two patients had encephalitis with focal neurologic signs. The most common confirmed or presumptive infective agent in those cases was herpes simplex virus (40.4%), followed by rubella (7.1%), Central European tick-borne encephalitis virus (4.7%) and some other agents identified in individual cases. The etiology remained unknown in 15 (36%) children with focal encephalitis.

The Pediatric Infectious Disease Journal, 1996

Archives of disease in childhood, Jan 28, 2015

To assess the availability and source of guidelines for common infections in European paediatric ... more To assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their content and characteristics. Participating hospitals completed an online questionnaire on the availability and characteristics of antibiotic prescribing guidelines and on empirical antibiotic treatment including duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children. 84 hospitals from 19 European countries participated in the survey of which 74 confirmed the existence of guidelines. Complete guidelines (existing guidelines for all requested infection syndromes) were reported by 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for urinary tract infection (UTI) (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin were the antibiotics most commonly recom...

The Pediatric infectious disease journal, 1989

This retrospective study (1979 to 1986) investigated the possible etiologic relationship between ... more This retrospective study (1979 to 1986) investigated the possible etiologic relationship between vaccination and aseptic meningitis in 115 hospitalized children who became ill within 30 days of vaccination with the Leningrad 3 strain of mumps virus and the Edmonston-Zagreb strain of measles virus. The etiologic viral diagnosis was based on serologic tests and the isolation of virus from cell cultures which distinguished between attenuated and "virulent" mumps virus. The incidence of mumps vaccine-associated meningitis was 1/1000 vaccine recipients. In 92% of children the incubation period was 11 to 25 days and 28% had associated swelling of the salivary glands. Sixteen cases (13.9%) had a positive cerebrospinal fluid culture (attenuated mumps virus, 6 cases; "virulent" mumps virus, 7 cases; echoviruses, 3 cases). Clustering of cases, seasonal occurrence and age of the patients suggested causal relationship with the vaccination in the majority of children. In 4 pa...

Emerging Infectious Diseases, 2006

We surveyed the populations of 19 European countries to compare the prevalence of antimicrobial d... more We surveyed the populations of 19 European countries to compare the prevalence of antimicrobial drug selfmedication in the previous 12 months and intended self-medication and storage and to identify the associated demographic characteristics. By using a multistage sampling design, 1,000-3,000 adults in each country were randomly selected. The prevalence of actual self-medication varied from 1 to 210 per 1,000 and intended self-medication from 73 to 449 per 1,000; both rates were high in eastern and southern Europe and low in northern and western Europe. The most common reasons for self-medication were throat symptoms (e.g., dry, inflamed, red, or sore throat, inflamed tonsils, tonsil pain). The main medication sources were pharmacies and medication leftover from previous prescriptions. Younger age, higher education, and presence of a chronic disease were associated with higher rates of self-medication. Attempts to reduce inappropriate self-medication should target prescribers, pharmacists, and the general public. A ntimicrobial drug resistance is a rapidly increasing global problem (1,2), and prevalence varying widely among countries (3).

Journal of Antimicrobial Chemotherapy, 2005

Compared with European countries, the use of antibiotics in Slovenia is moderate. In the period 1... more Compared with European countries, the use of antibiotics in Slovenia is moderate. In the period 1999-2002 an 18.67% decrease in outpatient antibiotic consumption was noted. The aim of the present study was to analyse this decrease and its consequences.

The Pediatric Infectious Disease Journal, 1993

The etiology of acute encephalitis was evaluated in a retrospective study of 170 children (98 boy... more The etiology of acute encephalitis was evaluated in a retrospective study of 170 children (98 boys and 72 girls) ages 1 month to 15 years, who were hospitalized during a 13-year period from 1979 to 1991. The etiology was confirmed or considered very probable in 68% of cases. The identified etiologic agents included Central European tick-borne encephalitis virus (28.8%), varicella-zoster virus (17.0%), herpes simplex (10.0%), rubella (2.9%), mumps (2.3%), measles virus, Chlamydia psittaci (1.1%) and some other agents found in individual cases. The etiology remained unknown in 54 children (31.7%). Forty-two patients had encephalitis with focal neurologic signs. The most common confirmed or presumptive infective agent in those cases was herpes simplex virus (40.4%), followed by rubella (7.1%), Central European tick-borne encephalitis virus (4.7%) and some other agents identified in individual cases. The etiology remained unknown in 15 (36%) children with focal encephalitis.

Wiener klinische Wochenschrift, 2000

BACKGROUND Little is known about the seroprevalence of ehrlichiosis in adults and much less about... more BACKGROUND Little is known about the seroprevalence of ehrlichiosis in adults and much less about the same in children. METHODS One hundred and forty-three healthy children and young adults (6-24 years of age, male to female ratio, 1:1) were assessed for the presence of antibodies to the agents of human granulocytic ehrlichiosis (HGE), human monocytic ehrlichiosis (HME), Borrelia burgdorferi sensu stricto (BB), and tick-borne encephalitis (TBE) virus in Slovenia, where tick-related infections are endemic. Antibodies to HGE and HME agents were assayed by indirect immunofluorescence, and antibodies to BB and TBE by enzyme-linked immunosorbent assay. A questionnaire about tick exposure was answered by all subjects. In the event of a positive result, a detailed interview was conducted. RESULTS Of 143 study subjects, 22 (15.4%) had detectable antibodies to HGE agent, 22 (15.4%) were positive to BB, 18 (12.6%) were positive to TBE virus (12 of these were vaccinated) and 4 (2.8%) were posi...

Wiener klinische Wochenschrift, 1999

Records of patients aged 0 to 15 years, hospitalised between 1993 and 1998 at the intensive care ... more Records of patients aged 0 to 15 years, hospitalised between 1993 and 1998 at the intensive care unit (ICU) of the Department of Infectious Diseases, Ljubljana, Slovenia, suffering from a severe attack of tick-borne encephalitis (TBE), were reviewed. Of 133 children hospitalised due to TBE virus infection during the observation period, 7 (5.2%) were treated in the ICU. All patients were male, aged 6 to 14 (mean, 11.1) years. In six cases, focal encephalitis was diagnosed, and in one case it was suspected. All patients survived. After a mean follow-up period of 7.9 (range, 1.5 to 17) months, one patient was found to have severe neurologic sequelae and two patients had moderate sequelae. In conclusion, the results of our retrospective study of severe forms of TBE in children demonstrate that this disease can run a severe course and may lead to permanent sequelae, most often in boys of school-going age who present with focal encephalitis. Therefore, immunisation of school children agai...

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 1994

Aims: To estimate the occurrence of recent, past, and "persistent" infections with Chlamydia pneu... more Aims: To estimate the occurrence of recent, past, and "persistent" infections with Chlamydia pneumoniae-as indicated by serology-in an Israeli population without clinical evidence of respiratory infection. Methods: Serum samples from 402 subjects (172 children and 230 adults), without known respiratory symptoms, were collected. Antibodies to C pneumoniae (IgG, IgA, and IgM) were evaluated using the microimmunofluorescence (MIF) assay. Antibody prevalence and indication of recent, past, and persistent infections were calculated and their distribution determined according to age, sex, and season. Results: Antibodies to C pneumoniae were detected in 53 children (31%) and 171 adults (74%). Recent infection was indicated in only one of 50 children under 5 years of age, in nine of 122 older children, and in 19 of 230 adults. IgM antibodies were detected in nine children, but only in three adults. Past infection was indicated in six of 96 young children (aged 1-10 years), in 28 of 76 teenagers, and in 128 of 230 adults. Persistent infection was indicated in three young children, in six teenagers, and in 24 adults, with a significantly higher frequency (p = 0.012) in men (18 of 117) than in women (six of 113). No seasonal differences could be detected. Conclusions: Infection with C pneumoniae was detected serologically in children and adults without clinical signs of respiratory disease. These results should serve as a basis for studies on the role of C pneumoniae infections and their sequelae in Israel and contribute to the general understanding of asymptomatic infection with C pneumoniae.

Invasive strains of Neisseria meningitidis isolated from sterile body fluids of children aged 0-1... more Invasive strains of Neisseria meningitidis isolated from sterile body fluids of children aged 0-14 years were intentionally collected in nine Slovenian laboratories, and sent to the laboratory of the National Institute of Public Health, Ljubljana for final evaluation. From 1993-1999 we collected 53 invasive strains from children presented in this study. The incidence rate of invasive diseases in children shows that there is a rapid fall from 4.74/100,000 in 1993 to 0.90/100,000 in 1999. Invasive diseases predominated in children in the age group 0-1 year (19.6 cases per 100,000 children); followed by the age groups 2-4 years, 5-9 years and 10-14 years. The results of serogrouping indicate that the largest proportion of meningococci isolated (90%) were group B, while 8% of isolates were group C and only 2% group Y. The serotype/serosubtype distribution shows that the most frequent serotype (excluding 19 non-typable NT strains) was serotype 22, which was expressed in 9 strains and the...

Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin

During 1991-1999 a significant increase of consumption of macrolides and fluoroquinolones was obs... more During 1991-1999 a significant increase of consumption of macrolides and fluoroquinolones was observed in Slovenia,and this was associated with significant increase of resistance of Streptococcus pneumoniae and Streptococcus pyogenes to macrolides and Escherichia coli to fluoroquinolones, respectively.Between 1999 and 2007 the prevalence of S. pneumoniae resistant to erythromycin increased from 3.7% to 16.8% even though the use of macrolides in the same period decreased from 3.81 to 2.43 defined daily doses (DDD) per 1,000 inhabitants and per day. The co-resistance and the spread of resistant clones were the reason for constant increase in macrolide resistance. Slovenia is one of the few European countries with decreasing prevalence of methicillin resistant Staphylococcus aureus (MRSA) in hospital care during the last years. As a result of control measures introduced in 1999,the MRSA prevalence rates decreased from 21.4% in 2000 to 8.3% in 2007.

Journal of Public Health, 2007

The incidence of H. influenzae meningitis in children under five years of age was monitored durin... more The incidence of H. influenzae meningitis in children under five years of age was monitored during the years 1983-87 by a retrospective study of records from all hospitals serving a metropolitan county in Kansas. The mean annual incidence rate for the five years studied was 26.0 per 100,000. This compares with a mean of 56.0 per 100,000 measured in the same county during 1979-82. (Am

International journal of antimicrobial agents, 2003

The frequency of resistance to antibiotics among common community-acquired pathogens, and the num... more The frequency of resistance to antibiotics among common community-acquired pathogens, and the number of drugs to which they are resistant have been increasing worldwide. The relationship between antibiotic usage and resistance is strongly supported by data from several studies. Countries with the highest per capita antibiotic consumption have the highest resistance. The emergence of penicillin-resistant Streptococcus pneumoniae is related to high consumption of antibiotics in general, as well as to increased use of aminopenicillins and/or probably to wider use of oral cephalosporins. Increased consumption of macrolides, especially the longacting ones, correlates significantly with the level of macrolide resistance of group A streptococci and S. pneumoniae while increased use of oral cephalosporins might be associated with the increase of b-lactamase-producing strains of Moraxella catarrhalis. Trimethoprim/sulphamethoxazole resistance is strongly associated with resistance to penicillin. A rise in consumption of fluoroquinolones is consonant with a higher rate of resistance to quinolones of S. pneumoniae, Escherichia coli and other Gramnegative bacteria. Paediatric bacterial isolates are more often resistant to various antimicrobial agents than isolates from adult patients; this higher resistance rate may be due to more frequent antimicrobial treatments in children, and extensive child to child transmission. Reliable data on antimicrobial consumption and resistance should form a basis for national policies devised to reduce the resistance of microorganisms to antibiotics.

Journal of …, 2011

France has lower consumption expressed in DDDs/100 bed-days than Slovenia, but if we express data... more France has lower consumption expressed in DDDs/100 bed-days than Slovenia, but if we express data in DDDs/1000 inhabitants/day the relationship is reversed. The consumption expressed in DDDs/100 bed-days is different from the data expressed in DDDs/1000 inhabitants/day ...

Central European journal of public health, 2001

Invasive strains of Neisseria meningitidis isolated from sterile body fluids of children aged 0-1... more Invasive strains of Neisseria meningitidis isolated from sterile body fluids of children aged 0-14 years were intentionally collected in nine Slovenian laboratories, and sent to the laboratory of the National Institute of Public Health, Ljubljana for final evaluation. From 1993-1999 we collected 53 invasive strains from children presented in this study. The incidence rate of invasive diseases in children shows that there is a rapid fall from 4.74/100,000 in 1993 to 0.90/100,000 in 1999. Invasive diseases predominated in children in the age group 0-1 year (19.6 cases per 100,000 children); followed by the age groups 2-4 years, 5-9 years and 10-14 years. The results of serogrouping indicate that the largest proportion of meningococci isolated (90%) were group B, while 8% of isolates were group C and only 2% group Y. The serotype/serosubtype distribution shows that the most frequent serotype (excluding 19 non-typable NT strains) was serotype 22, which was expressed in 9 strains and the...

Wiener klinische Wochenschrift, Jan 13, 2000

Little is known about the seroprevalence of ehrlichiosis in adults and much less about the same i... more Little is known about the seroprevalence of ehrlichiosis in adults and much less about the same in children. One hundred and forty-three healthy children and young adults (6-24 years of age, male to female ratio, 1:1) were assessed for the presence of antibodies to the agents of human granulocytic ehrlichiosis (HGE), human monocytic ehrlichiosis (HME), Borrelia burgdorferi sensu stricto (BB), and tick-borne encephalitis (TBE) virus in Slovenia, where tick-related infections are endemic. Antibodies to HGE and HME agents were assayed by indirect immunofluorescence, and antibodies to BB and TBE by enzyme-linked immunosorbent assay. A questionnaire about tick exposure was answered by all subjects. In the event of a positive result, a detailed interview was conducted. Of 143 study subjects, 22 (15.4%) had detectable antibodies to HGE agent, 22 (15.4%) were positive to BB, 18 (12.6%) were positive to TBE virus (12 of these were vaccinated) and 4 (2.8%) were positive to the HME agent. The ...

Expert Review of Anti-infective Therapy, 2015

Rising antibiotic resistance has become an increasing public health problem. There is a well-esta... more Rising antibiotic resistance has become an increasing public health problem. There is a well-established correlation between antibiotic consumption and antimicrobial resistance. Consequently, measures to rationalize the prescribing of antibiotics should reduce the resistant strains. Following a 24% increase in antibiotic consumption at the end of the 1990s, multiple activities were designed and introduced by the Health Insurance Institute of Slovenia (ZZZS) and other organizations in Slovenia at the end of 1999. These activities reduced the antibiotic consumption by 18.7% by 2002. These measures have continued. To study changes in antibiotic utilization from 1995 to 2012 alongside the multiple interventions and their consequences, including changes in resistance patterns. This was a retrospective observational study involving all patients dispensed at least one ZZZS prescription for an antibiotic in Slovenia. Utilization was expressed in defined daily doses per thousand inhabitants per day. Multifaceted interventions were conducted over time involving all key stakeholder groups, that is, the Ministry of Health, ZZZS, physician groups and patients. These included comprehensive communication programs as well as prescribing restrictions for a number of antibiotics and classes. From 1999 to 2012, antibiotic consumption decreased by 2-9% per year, with an overall decrease of 31%. There were also appreciable structural changes. Overall antibiotic utilization and the utilization of 7 out of 10 antibiotics significantly decreased after multiple interventions. The resistance of Streptococcus pneumoniae to penicillin decreased in line with decreased utilization. However, its resistance to macrolides increased from 5.4 to 21% despite halving of its utilization. The resistance of Escherichia coli to fluoroquinolones doubled from 10 to 21% despite utilization decreasing by a third. Expenditures on antibiotics decreased by 53%. Multiple demand-side measures introduced following increased utilization significantly decreased subsequent antibiotic utilization and associated costs. However, there was variable impact on antibiotic resistance. Additional targeted activities are planned to further reduce antibiotic prescribing and resistance.

The Pediatric Infectious Disease Journal, 1993

The etiology of acute encephalitis was evaluated in a retrospective study of 170 children (98 boy... more The etiology of acute encephalitis was evaluated in a retrospective study of 170 children (98 boys and 72 girls) ages 1 month to 15 years, who were hospitalized during a 13-year period from 1979 to 1991. The etiology was confirmed or considered very probable in 68% of cases. The identified etiologic agents included Central European tick-borne encephalitis virus (28.8%), varicella-zoster virus (17.0%), herpes simplex (10.0%), rubella (2.9%), mumps (2.3%), measles virus, Chlamydia psittaci (1.1%) and some other agents found in individual cases. The etiology remained unknown in 54 children (31.7%). Forty-two patients had encephalitis with focal neurologic signs. The most common confirmed or presumptive infective agent in those cases was herpes simplex virus (40.4%), followed by rubella (7.1%), Central European tick-borne encephalitis virus (4.7%) and some other agents identified in individual cases. The etiology remained unknown in 15 (36%) children with focal encephalitis.

The Pediatric Infectious Disease Journal, 1996