Introduction: Clostridium difficile (C. difficile) is currently the leading cause of healthcare-associated diarrhea, but almost nothing is known about the extent of C. difficile infection (CDI) in Bosnia and Herzegovina. Goal: We aimed to retrospectively analyze CDI in hospitalized patients at University Clinical Center (UCC) Tuzla, Bosnia and Herzegovina from January 2009 through June 2012. Methods: We analyzed all patients (except children ages 0-2), diagnosed with CDI based on anamnestic and epidemiological, clinical picture and microbiological tests (proof of toxins in the stool by enzyme-linked immunosorbent assay). Results: From a total of 989 patients tested for C. difficile toxin (60.2 per 10,000 inpatient days) 347 (35.08%) were positives. The mean incidence rate of CDI was 2.23 per 10,000 inpatient days (range 1.32-2.87). Annual rates of hospitalization were 15.68 per 10,000 admissions (range 8.99-20.35). Most patients had a previously identified risk profile of old age, comorbidity and recent use of antibiotics. 41/276 (14.86%) patients had died, and 11/41 (26.82%) were CDI-associated deaths. Complicated CDI were registered in 53/276 (19.21%) patients, and recurrent infections in 65/276 (23.55%). Conclusion: Our data suggest that CDI is largely present in our setting which represents a serious problem and points to the importance of international surveillance, detection and control of CDI.

Retrospektivno su analizirane klini~ke i epidemiolo{ke karakteristike bruceloze u 91 bolesnika koji su bili hospitalizirani u Klinici za infektivne bolesti u Tuzli od 1.1.2000. godine do 1.8.2008. godine. Definitivna dijagnoza bruceloze postavljena je na temelju pozitivnih rezultata hemokulture i/ili nekog od relevantnih serolo{kih testova (ELISA test, ROSE-BENGAL aglutinacija). Ve}ina bolesnika bila je iz 5 op}ina Tuzlanskog kantona: @ivinice, Tuzla, Lukavac, Kalesija, i Srebrenik, ukupno (81,3 %) bolesnika. Najve}i broj bolesnika (93 %) bio je iz ruralne regije. Bilo je znatno vi{e mu{karaca (82,4 %). Ve}ina bolesnika bila je u dobi od 20 – 29 godina i 50 – 59 godina po 25,3 %. Najvi{e bolesnika bilo je hospitalizirano u proljetnim mjesecima, travnju 24,1% i svibnju 23,0 %. Kontakt s inficiranim `ivotinjama registriran je kod 82,4 % bolesnika. Vode}i simptomi i znaci bolesti bili su povi{ena temperatura, bolovi u zglobovima, op}a slabost, no}no znojenje, glavobolja, hepatosplenomegalija, a najva`niji patolo{ki laboratorijski nalazi ubrzana sedimentacija eritrocita i povi{ena vrijednost C-reaktivnog proteina. Bolesnici su lije~eni kombinacijom streptomicina ili gentamicina s doksiciklinom u odraslih, ili gentamicinom i trimetoprim-sulfametoksazolom u djece, u trajanju 6 tjedana. Komplikacije su dokumentirane u 23,0 % mu{karaca i 1,1 % `ena. Orchiepididimitis je utvr|en u 6,5 %, pneumonija 4,3 %, periferni artritis 4,3%, spondilitis 3,2 %, sakroileitis 2,1 %, epiduralni absces u 2,1 % i spondilodiscitis u 1 % bolesnika. Relaps je zabilje`en u 13,1 % bolesnika. Svi bolesnici su izlije~eni. Bruceloza je rastu}i javno-zdravstveni problem u Tuzlanskom kantonu, ali i {ire u Bosni i Hercegovini.