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.

AIM To determine the etiology of peritonitis, as well as the sensitivity of isolated bacteria to antibiotics. METHODS Study was performed at the Surgical Clinic, Department of Anesthesiology and Reanimation, Department of Microbiology, Department of Clinical Pharmacology of University Clinical Centre (UCC) Tuzla. In a prospective study, starting from 1.6.2009. to 30.6.2010., was 60 patients analyzed who underwent surgery for acute peritonitis in the Surgical Clinic, UCC Tuzla. RESULTS After microbiological processing of the content of the operative field, wound swabs and smears of drainage, we isolated Gram positive coccid bacteria: Coagulase-negative Staphylococcus in 18.36%, Staphylococcus aureus in 12.6%, while Enterococcus faecalis and Enterococcus faecum were found in 3.44% isolates. In the group of Gram-negative bacteria we isolated: Escherichia coli in 15.51%, and Pseudomonas aeruginosa and Klebsiella pneumoniae in 10.34% of the cases. The sensitivity of coagulase-negative Staphylococcus was largest to vancomycin (100%), and lowest to penicillin (10%) and Staphylococcus aureus sensitivity was largest to vancomycin and amoxicillin-clavulanate (100%) and lowest to penicillins (3.7%). Sensitivity of the facultative anaerobic Gram-negative bacilli was highest to carbapenems 95-100%, and lowest to penicillin preparations 0-56%. CONCLUSION Based on the results of microbiological findings of 83.33% patients empirical antibiotic therapy was appropriately involved, and in 16.67% was inadequate and later changed, following the results of microbiological findings. This study indicates the importance and validity of microbiological diagnostics to determine the etiology of peritonitis and appropriate selection of antibiotics to treat these infections, with the required surgical treatment.

INTRODUCTION The prevalence of human brucellosis in Bosnia and Herzegovina and the Tuzla Canton reached its peak in 2008, with a reported total of 994 cases within country, and with 104 cases within the Tuzla Canton. AIM to analyze the clinical and epidemiological features of human brucellosis in patients hospitalized at the University Clinical Center Tuzla during the period from 01/01/2000 till the 31/12/2010. METHODS We retrospectively analyzed the clinical symptoms, the laboratory and X-ray findings, the treatments, and the course and outcome of the disease. The diagnosis of brucellosis was based on anamnesis, clinical presentation, in correlation with a positive blood-culture, and/or serological tests. RESULTS The majority of patients (93.18%) were from rural regions. There were more males (79.54%) than females. Most of the patients were aged between 30 to 39 years (21% cases). Contact with infected animals was registered for 83.40% of the patients. The main symptoms and signs were fever, joint-pains, night sweating, anorexia, headaches, and hepatosplenomegaly. The important laboratory findings were increased erythrocyte sedimentation rates, increased values of C-reactive protein, and anemia. Adult patients were treated with a combination of gentamicin or streptomycin with doxycycline, and the children with a combination of gentamicin, and trimethoprim-sulfametaxasol, over at least 6 weeks. Complications were documented in 20.45% of the patients. Relapses were observed in 14.20%, and a chronic form of brucellosis in 5.11% of patients. There were no cases with lethal outcomes. CONCLUSION Brucellosis is a growing public health problem, not only within the Tuzla Canton, but throughout Bosnia and Herzegovina.

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.

In transplantation method, efforts should be made to prevent the patient immunological reaction against the transplantation antigen. In the same time, the patient general immunological reactivity must be kept. With the increasing need for transplantation the interest for new immunosuppressive drugs has become greater. The use of immunosuppressive drugs have dated since early 1950 (azatioprin and steroids). 1960 there was the appearance of the polyclonal ALG/ATG. In 1970 the true advance has been the discovery of the first selective immunosuppressive-cyclosporin (second generation). The third generation of immunosuppressive drugs with high specific place of action, has become available now (tacrolimus, thymoglobulin, zenepax, rapamune). The purpose of this paper was to show the different groups of immunosuppressive drugs, taking into account a different place of effects and different mechanisms of their immunosuppressive action. The aim of the immunosuppressive drugs combination is to achieve the optimal immunosuppression with minimal side-effects.