AimAcute respiratory infections caused by viral pathogens are the most common reason for hospitalization of children. Annually, 150 million infants worldwide are diagnosed with bronchiolitis, and 2-3% of them are hospitalized. This study aimed to compare bronchiolitis severity before and after the COVID-19 pandemic. MethodsThis retrospective study was conducted at the Department of Pulmonology, Paediatric Clinic, Clinical Centre University of Tuzla, covering the period from November 1st, 2018, to April th 30, 2019 (pre-COVID period) and November 1st, 2023, to April 30th, 2024 (post-COVID period). A total 129 children under the age of 2 years were involved. Results No significant differences in the age, body mass, comorbidities, duration of hospitalization, use of oxygen therapy, and mechanical ventilation was found. There was a significant reduction in antibiotic in the post-COVID group (p=0.0173), and a significant increase in the use of aminophylline and inhalation therapy drugs in the post-COVID group. There was a significantly higher number of isolated respiratory syncytial virus (RSV) cases in the post-COVID group, 32 (42.7%). prevalence of fully vaccinated children was significantly higher in the pre-COVID period compared to the post-COVID period,  34 (74.4%?) and  29 (45.3%), respectively. Conclusion This study reveals a significant increase in the severity of bronchiolitis and an increase in RSV cases after the COVID-19 pandemic. Keywords: anti-bacterial agents,coinfection, oxygen inhalation therapy,respiratory syncytial virus infections, vaccination.

Pseudomonas aeruginosa is an opportunistic pathogen that frequently causes infections in immunocompromised patients and is involved in outbreaks of hospital-acquired infections with a high mortality rate. Aminoglycosides are a large category of antibiotics that bind specifically to 16S rRNA in 30S ribosomal subunits and disturb protein translation. This antibiotic class plays a significant bactericidal role against a wide range of Gram-negative bacteria such as P. aeruginosa. Among different aminoglycoside resistance mechanisms, inactivation of drugs by plasmid-encoded aminoglycoside-modifying enzymes (AMEs) is a common determinant of aminoglycoside resistance in  P. aeruginosa. These plasmids are spread worldwide, and they are transferred to a wide range of different species. This study aims to detect resistance mechanisms and  identify the most prevalent aminoglycoside resistance genes in P. aeruginosa clinical isolates, collected from the University Clinical Centre Tuzla. This study included a total of 230 clinical P. aeruginosa isolates. Antimicrobial susceptibility tests were performed using the disk diffusion method and the Vitek2 system. Isolates displaying increased MIC values for aminoglycoside antibiotics were included in the multiplex PCR reaction, for the detection of aminoglycoside-modifying enzyme genes. The most prevalent genotype among isolates was aac (6')-I. All aac (6')-I genotyped isolates also displayed a high rate of resistance to other classes of antibiotics, and they were characterized as multidrug-resistant (MDR) or extensively drug-resistant (XDR). Results indicate that the aminoglycoside-resistance genes are highly prevalent and could easily spread among P. aeruginosa strains.

Background: Community-acquired bacterial meningitis (CABM) remains a life-threatening infection with high morbidity and mortality, despite advances in antibiotic therapy and vaccination. Understanding local epidemiology is crucial for improving outcomes. Objective: To evaluate clinical and epidemiological characteristics and outcome of patients with bacterial meningitis in all age groups. Methods: This retrospective study analyzed 78 cases of CABM treated at the University Clinical Center Tuzla from 2014 to 2024. Patients were divided by age and outcome. Clinical features, laboratory results, microbiological findings, and prognostic factors were examined. Results: Adults comprised 59% of cases, and children 41%, with a median age of 29 years. The most common symptoms were fever (91%), positive meningeal signs (76.9%), vomiting (69.2%), and headache (66.7%). Streptococcus pneumoniae (24.4%) and Neisseria meningitidis (14.1%) were the leading pathogens. Mortality was 14.1%, significantly higher in adults (19.6%) than in children (6.3%). Poor outcomes were associated with older age, coma, ICU admission, and complications such as cerebral abscess or shock. Laboratory indicators of worse prognosis included thrombocytopenia, elevated urea and creatinine, hypokalemia, and low CSF cell count. Conclusion: CABM remains a serious clinical problem in Tuzla Canton. Early recognition, appropriate empiric antibiotic treatment, ICU management, and preventive measures such as vaccination are essential for improving survival, particularly in high-risk populations.

We report on an ongoing measles outbreak in the Federation of Bosnia and Herzegovina with 141 cases notified between week 52 2023 and week 6 2024. Among those with known vaccination status, 97% were unvaccinated and the most affected group is children under the age of 5 years (n = 87) who were not vaccinated during the pandemic years. Sixty-eight cases were hospitalised, the most common complications were measles-related pneumonia and diarrhoea. The sequenced measles viruses from four cases belonged to genotype D8.

Aim To evaluate Helicobacter pylori (H. pylori) resistance to clarithromycin and quinolones in patients with dyspepsia in Tuzla Canton, Bosnia and Herzegovina, a region with no data on clarithromycin or quinolones resistance. Methods A prospective cross-sectional study was conducted at the Department of Gastroenterology and Hepatology at University Clinical Centre Tuzla between January 2021 and June 2022. The study included 99 patients who underwent esophagogastroduodenoscopy (EGDS) due to dyspepsia. In all patients biopsies were taken for rapid urease test (RUT) and histology findings, concomitantly with blood samples for IgG serology. All RUT positive patient samples were tested for clarithromycin and quinolones susceptibility with GenoType HelicoDr, a PCR method which detects point mutations in 23S rRNA and mutations in the gyrA gene. Results Out of 99 dyspeptic patients, 67 (67.7%) were serologically positive to H. pylori, 46 (46.4.%) were RUT positive, and 19 (19.2 %) had a positive histology finding. Antibiotic (AB) resistance was tested in the total of 46/99 (46.4%) patients. Resistance to clarithromycin was detected in 28.26% (13/46), quinolones resistance in 36.96% (17/46) , and resistance to both AB was detected in 8.69% (4/46) tested biopsies. Conclusions Due to high clarithromycin and quinolones resistance rates, we recommend the use of bismuth quadruple or non-bismuth concomitant quadruple therapy for H. pylori eradication in Tuzla Canton, Bosnia and Herzegovina.

Aim To evaluate clinical and epidemiological characteristics and outcome of patients with COVID-19, and impact of vaccine against COVID-19 on them. Methods This retrospective study included 225 patients treated from COVID-19 in the period from 1 to 30 September 2021 at the Clinic for Infectious Diseases, University Clinical Centre Tuzla (UCC Tuzla). For the diagnosis confirmation of Covid-19, RTPCR was used. Patients were divided in two groups: fully vaccinated with two doses of vaccine, and non-vaccinated or partially vaccinated. Results Of 225 patients, 120 (53.3%) were females, and 105 (46.7%) males. Mean age was 65.6 years. There were 26 (11.6%) fully vaccinated patients. Most common symptoms in unvaccinated patients were fatigue (70.9%), cough (70.4%) and fever (69.8%), and in vaccinated fever (76.9%), fatigue (69.2%) and cough (46.2%). Cough was more common in unvaccinated patients (p=0.013). Fatal outcome happened in 84 (37.3%) patients. Transfer to the Intensive Care Unit (ICU) and older age had a higher risk of death (p<0.001). Older age patients were more likely to have comorbidities like atrial fibrillation (p=0.017), hypertension (p<001) and diabetes mellitus (p=0.002). Atrial fibrillation (p<0.001), hypertension (p<0.001), diabetes mellitus (p=0.009) and history of stroke (p=0.026), were related to fatal outcome in unvaccinated patients, also did a shorter duration of illness prior to hospitalization (p<0.001) and shorter length of hospitalization (p=0.002). Conclusion Older patients with comorbidities, as well as those who were not vaccinated against COVID-19, were at higher risk for severe form of the disease and poor outcome.

Aims: The aims of this study was to investigate the susceptibility of extended-spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae clinical isolates to antibiotics and essential oils - Origanum compactum, Origanum majorana and Thymus serpyllum. Study Design: Study included 30 isolates of Klebsiella pneumoniae obtained from clinical material provided from the University Clinical Center Tuzla. Place and Duration of Study: Department of Biology, Faculty of Science, University of Tuzla, BiH, between September 2019 to September 2020. Methodology: Antibiotic susceptibility testing was performed by the Kirby-Bauer disk diffusion method. The following commercially available antibiotic discs were used: amoxicillin (30µg), cefalexin (30 µg), gentamicin (10 µg), amikacin (30 µg), imipenem (10 µg), piperacillin (75µg), ampicilin (10 µg), meropenem (10 µg), ciprofloksacin (10 µg), ceftazidim (30 µg), cefotaksim (30 µg), ceftriaxone (30 µg), cefepime (30 µg) and aztreonam (30 µg). The antibacterial effect of the essential oils was tested for ESBL K. pneumoniae isolates using the diffusion method according to Clinical laboratory standards institute (CLSI) guidelines. Results: O. compactum and O. majorana essential oils showed the same antimicrobial activity with 80.0% effect on ESBL K. pneumoniae isolates, Thymus serpyllum EO showed antimicrobial activity of 60.0%. The lowest MIC value had the O. compactum essential oil (MIC 6 mg/ml-10.5 mg/ml), followed by the T. serpyllum (MIC 17.2 mg/ml-43 mg/ml), while the O. majorana essential oil showed MIC values in range from 11 mg/ml to 39 mg/ml. Conclusion: The results of the study showed the exceptional sensitivity of ESBL K. pneumoniae clinical isolates to the essential oils from Origanum and Thymus genera, which highly suggests their potential application in the struggle against these pathogens in the future.