Introduction: Intensive care units (ICUs) are associated with a greater risk of developing nosocomial infections (NIs) than other departments. Aim: The aim of this study was to determine the rate, the site and causative organisms of NIs in the surgical ICU at University Clinical Center Tuzla. Methods: All patients admitted to the surgical ICU were followed prospectively, for the development of NIs (January-December 2010). Determination of NIs was performed using standardized the Centers for Disease Control and Prevention (CDC) criteria. Results: 94 out of 834 patients (11.27%) developed NIs. Respiratory tract infections were seen in 56 (60%), urinary tract infections in 15 (16%) and gastrointestinal tract infections in 8 (9%) patients. Other infections identified were surgical site, bloodstream and skin infections. Gram-negative organisms were reported in approximately 75% of cases (78.7% extended-spectrum beta-lactamase (ESBL)-producers). Klebsiella pneumoniae was the commonest (51.0%), followed by Proteus mirabilis (21.3%) and Pseudomonas aeruginosa (10.6%). Methicillin-resistant Staphylococcus aureus (MRSA) (16%), and Clostridium difficile (9.6%) were the commonest among gram-positive bacteria. Conclusion: Respiratory and urinary tract infections made up the great majority of NIs. ICU patients are more susceptible to NIs, emphasizing the importance of continuous surveillance and enforcement of specific infection control measures.

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.

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.

Objectives: Hospital outbreaks of multidrug-resistant Klebsiella spp., especially those in neonatal wards, are often caused by new types of strains, the so-called extended-spectrum-beta-lactamase (ESBL) producers. Methods: The aim of this study was to determine the distribution of nosocomial infections caused by Klebsiella pneumoniae ESBL strain by location and kind of infections in the University Clinical Centre Tuzla during a period of one year. A prospective study was implemented for all patients who developed hospital infections caused by Klebsiella pneumoniae ESBL strain during the period from 1st of January to 31st of December 2010 year. Determination of nosocomial infections was performed using standardized CDC criteria. Mandatory registration of hospital infections was done via a written application form which is used for surveillance. Results: Hospital infections caused by Klebsiella pneumoniae ESBL strain were reported 141 times, during the year 2010. Most common hospital infection were urinary tract infections 52 times (36,9%), followed by respiratory tract infections 43 times (30,5%), infection of the gastrointestinal system 20 times (14,2%), infections of surgical sites 12 times (8,5%), 10 times (7,1%) the bloodstream infection and other infections 4 times (2,8%). Nosocomial infection was mostly reported in the Clinic of anesthesiology and reanimation 37 times (26,2%) and Clinic for children\'s diseases 33 times (23,4%). Regarding age, 41 (29,1%) of nosocomial infections were detected in patients below the age of one year and 35 (24,8%) in patients above the age of 65 years. Conclusion: Respiratory tract infections were reported more frequently in the intensive care unit than in the wards. However, infection of the urinary tract and gastrointestinal infections were reported more frequently in the wards than in intensive care units.

INTRODUCTION Intrahospital infections in surgical wards pose a significant problem, particularly in patients with impaired natural defense potential. They significantly complicate and increase the cost of basic treatment of the patient and sometimes leave permanent damage. Active control of their appearance is of paramount importance in their prevention. GOAL By this study we try to determine the frequency of individual agents, their anatomical and gender distribution at the Clinic of Surgery, University Clinical Centre Tuzla in 2005.v. RESULTS Our study showed that gram negative bacteria were more common trigger of IHI (76.37%), and especially the urinary and respiratory tract and surgical wounds infections. We also showed that men from older age groups are more likely to have IHI. CONCLUSION Active surveillance and tracing for agents, especially in high-risk groups of patients is the best method of prevention of IHI occurrence.

Ischemic stroke (IS) is defined as rapid development (focal or global) of clinical signs of brain function disorder with symptoms lasting 24 hours or longer, or leading to death, without other clear causes except destruction of blood vessel.1 Anxiety does occur in patients with IS, but not in those with intracerebral hemorrhages.2 Astrom found symptoms of anxiety in 28% of patients in acute phase of stroke.3 The aim of this study was to analyze anxiety in patients within 48 hours (hyperacute and acute phase) and 15th day (subacute phase) after the IS in relation to gender and location of the lesion. PATIENTS AND METHODS

Introduction: Intrahospital infections (IHI) are frequent occurence in modern hospitals. These infections are recognized as a significant public-health problem in the industrial developed countries, as well as in countries in developing. Material and Methods: The main goal of this study was establish epidemiological monitoring of the occurence of IHI in the surgical intensive care unit at a University clinical center Tuzla (UCC), in order to define: type of IHI according to the anatomic localisation and causative agents of IHI. A during 2002. and 2003. there were 1751 patients treated in the surgical intensive care unit. The study examination was conducted by using the method of National Nosocomial Infections Surveillance (NNIS) from the United States of America. Results and Discussion: The results of study are confirming expectations that the intensive care units are in high risk for the occurence of IHI. We have also proved certain distribution differences of IHI related to anatomic localization. At 2002. the urinary tract infections were the most frequent (35.21%), than surgical site infections (22.54%), bloodstream infections (17.61%), respiratory tract infections (9.15%) and other infections (15.49%)(p< .01). At 2003. the urinary tract infections represented 32.35% all of IHI, surgical site infections also represented 32.35%, followed by bloodstream infections (16.18%), respiratory tract infections (7.35%) and other infections (11.76%)(p< .001). In both years of study the most frequent organisms as a causative agents of IHI were Enterobacteriaceae (Klebsiella pneumoniae- 24.5% and 16.1%; Proteus mirabilis- 7.9% and 14.2%), Pseudomonas aeruginosa (23.1% and 16.9%) and Acinetobacter species (14% and 17.3%)(p< .001). Conclusion: It is expected that the continuous surveillance of IHI will improve the quality of work at the UCC-Tuzla, which lead to the improvement of patients treatment and decrease of material costs.

Intrahospital infections (IHI) and antibiotics resistance are the problems which exist in virtually all hospitals in the world. The main aim of the present research is establishing of epidemiological surveillance over occurrence of IHI at the Clinic for Gynaecology and Obstetrics at the University Clinical Center Tuzla and thus identifies: types of bacteria which cause IHI, types of infection according to anatomical localization and research resistance organisms causing of IHI on antimicrobial drugs. A study was implemented on all patients admitted to Clinic for Gynaecology and Obstetrics during the period of one year and who subsequently developed infection. Determination of intrahospital infections was done according to criteria defined by the Centres for Disease Control and Prevention from the United States. The results of our work have shown that both urinary tract infections and surgical site infections are the most frequent. As IHI causers the most found are gram-negative organisms (73,7%), such as Escherichia coli (29,8%), right after that Klebsiella pneumoniae (24,6%), Pseudomonas aeruginosa (14%) and Proteus mirabilis (5,3%) (p<0,05). Gram-positive organisms as causers of IHI are registered in 26,3% cases. Out of that Streptococcus species are isolated in 10,5% cases, Staphylococcus aureus (8,8%) and coagulasa negative staphylococci (7%) (p>0,05). High percent resistance of bacteria was evident to beta-lactams, aminoglycosids and cephalosporin's of third generation. Gram-positive organisms were 100% sensitive to vancomycin, while gram-negative organisms manifested the high percent of sensibility to imipenem and cefepime.

The first records of organized health service in Tuzla and Tuzla area date back to the nineteenth century. Friar Ivan Kljaic, military physicians Muhidin-bey, Mehmed Said-Effendi and Ignatius Gulielmus Petelenz are honourably mentioned. Dr Mehmed Sami Serbic founded the first hospital-Hastahana in Tuzla. Respected both as a physician and a humanist, Serbic’s work leaves a remarkable trace. After the annexation of Bosnia and Herzegovina by Austria-Hungary, three female physicians: Anna Bayerova, Teodora Krajewska and Jadwiga Olszewska were engaged to work in Tuzla area. Each of them made a tremendous contribution to the development of health care, not only in Tuzla area but throughout the country. Physicians Josip Lymberski and Josef Foglar are employed by so called Miners Hospital. Due to malaria and cholera epidemics which affected the region in 1893, two epidemiologists-bacteriologists arrived in Tuzla, Rudolf Fischer and Josef Katz. The objective of this overview is to preserve the memory of physicians who contributed through their work to the development of health care and service in Tuzla area in the nineteenth century.

The aim of presented research was to determine microorganisms which cause intrahospital infections (IHI) with specific anatomical localization and to determine the antimicrobial resistance of these organisms in a group of 5106 patients hospitalized at Surgery Department of the University Clinical Center Tuzla in the period between 1 January to 31 December 2004. The research was conducted in accordance with the National Nosocomial Infections Surveillance (NNIS) methodology. The results show that in 73.82% of cases the gram-negative organisms (p < 0.001) have been isolated and identified as the IHI pathogens, while the gram-positive organisms (p < 0.05) have been isolated and identified as the IHI pathogens in remaining 26.18% of cases. Urinary tract infections, surgical site infections, respiratory tract infections and bloodstream infections have been mostly caused by gram-negative organisms, while the other infections have been more often caused by gram-positive organisms. Gram-positive organisms were found to be resistant to beta-lactam antibiotics and sensitive to the vancomycin. Gram-negative organisms have shown resistance to beta-lactams, aminoglycoside and cephalosporins of third generation. They were well sensitive to cinolones and carbapenems.

Introduction: Asthma is a chronic inflammatory airway disease, with more present allergic component who cause disease. Pacient and Metods: In this study was included 35 patients who had been bronchial asthma whom was made total IgE determined by nefelometric metod and skin test by Prick metod. Subjects which had increased values of IgE, had been tested for fecal parasites . Subjects wich was positiv for scin allergens was tested for specific IgE on Hytec 288 instrument with ELISA metod. Results: Folowing resaults was obtained: 57.14% (20) of subjects had increased values of total IgE, while 42.86% (15) had normal total IgE. All patients with increased values of total IgE were tested negative for fecal parazites. Percent conform Prick tests and specific IgE was for house dust 54.55%, ragweed 53.85%, grass pollen 45.45%, Dermato-phagoides Pteronyssinus 43.75%, Pollen trees 25.00%. Conclusion and Discussion: Allergic bronchial asthma capture big percent in patients with bronchial asthma. The most frequent allergen was house dust.

Nosocomial infections are important problem for the modern medicine. Especially sensitive category, susceptible to nosocomial infections, are the infants. The aim of the research was to establish an active monitoring over the breaking out of the nosocomial infections in the Neonatology Department of the Gynecology and Obstetrics Clinic of the University Clinical Center Tuzla (UKC) and to determine the kind of bacteria that causes the nosocomial infections as well as the type of infection according to anatomical localization. The research encompassed 8000 of newborn infants at the Neonatology Department of the UKC Tuzla in the years 2005 and 2006. The determining of the nosocomial infections was done by using the standard CDC criteria. The results show that in two researching years the leading nosocomial infections were bacteriemia, followed by other infections, respiratory tract infections and urinary tract infections. The mostly identified carrier of the nosocomial infections in 2005 were gram-positive bacteria (65,5%): coagulase-negative staphylococci was isolated in 54,6%, Staphylococcus aureus in 5,5% and Streptococcus species in 5,5% of cases (p<0,001). The isolated gram-negative bacteria, carriers of nosocomial infections in 2005 were Klebisiella pneumoniae (21,8%), Escherichia coli (5,5%), Pseudomanas aeruginosa (3,6%) and Morganella morganii (3,6%) (p<0,05). In 2006 the mostly identified and isolated carriers of nosocomial infections were gram positive bacteria (64,2%): coagulase-negative Staphylococci (43,3%), Streptococcus species (13,4%) and Staphylococcus aureus (7,5%) (p<0,001). Gram negative bacteria, carriers of nosocomial infections in 2006 were Klebsiella pneumoniae (19,4%), Escherichia coli (10,5%), Acinetobacter species (3%), Pseudomonas aeruginosa (1,5%) and Proteus mirabilis (1,5%) (p<0,05). The bacteriemia was mostly caused by coagulase-negative staphylococcus. Infections of the urinary tract were caused by gram-negative bacteria Klebsiella pneumoniae and Escherichia coli. Other infections were caused by coagulase-negative Staphylococci, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli. Infections of the respiratory tract were caused by Streptococcus species, Klebsiella pneumoniae, coagulase-negative Staphylococci, Staphylococcus aureus and Pseudomonas aeruginosa. The most frequent carriers of the nosocomial infections at the Neonatology Department of the UKC Tuzla in 2005 and 2006 was gram-positive bacteria-coagulase-negative Staphylococci.

Epidemic food poisioning caused by food contaminated by microorganisms, its toxins or chemical toxic substances, emerge in the hospitals as specific kind of intrahospital infections. An occurrence of food poisoning in hospitals is facilitated by several facts as: centralized food preparation, kinds of food, staff carriers, an unfavourable hygienic regime in the kitchens and at the places where food is shared, crossing of clean and unclean paths in a kitchen, carelessness, non-education etc. Danger that contaminated food brought to hospitals is more serious since it is about consumers with disrupted health. Main goal of work was to show conditions in the central kitchen and restaurants in University clinical center Tuzla in regard to sanitary care of the staff hands, which are in direct and indirect contact with food, cutlery and working surfaces, that are in direct contact with food.