Introduction: Acinetobacter baumannii is a frequent cause of infections in hospitals around the world, which is very difficult to control and treat. It is particularly prevalent in intensive care wards. Aim: The main objective of the research was to establish the application of epidemiological monitoring of nosocomial infections (NIs) caused by A. baumannii in order to determine: the type and distribution of NIs, and to investigate antimicrobial drug resistance of A. baumannii. Material and Methods: 855 patients treated at the Clinic of Anesthesiology and Reanimation, University Clinical Center Tuzla during 2013 were followed prospectively for the development of NIs. Infections caused by A. baumannii were characterized by the anatomical site and antibiotics resistance profile. Results: NIs were registered in 105 patients (12.3%; 855/105). The predominant cause of infection was A. baumannii with an incidence of 51.4% (54/105), followed by ESBL-producing Klebsiella pneumoniae with 15.2% (16/105) of cases, methicillin-resistant Staphylococcus aureus with 8.6% (9/105), and ESBL-producing Proteus mirabilis with 7.6% (8/105). According to the anatomical site, and type of NIs caused by A. baumannii, the most frequent were respiratory infections (74.1%; 40/54). Infections of surgical sites were registered in 11.1% (6/54) of cases, while bloodstream infections in 9.2% (5/54). A. baumannii isolates tested resistant against most antibiotics examined, but showed a high degree of susceptibility to tobramycin (87%; 47/54) and colistin (100%; 54/54). Conclusion: The increasing incidence of multi- and extensively drug-resistant Acinetobacter spp. emphasizes the importance of administration of an adequate antibiotic strategy and the implementation of strict monitoring of the measures for controlling nosocomial infections.

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: Hospital-acquired Urinary tract infections make 35% of all the hospital-acquired infections, and about 80% of them are related to the catheterization of the urinary bladder Purpose: To determine clinical characteristics and dominant etiologic factors of Urinary Tract Infections associated with urinary catheter (C-UTIs). Methods: Determined clinical characteristics of C-UTIs were prospectively analyzed on 38 hospitalized patients in the Clinic for Infectious Diseases at the University Clinical Centre Tuzla, from January 1st 2011 to December 31st 2011. The control group constituted of 200 patients with community-acquired Urinary Tract Infections (Co-UTIs) hospitalized in the same period. Results: It was registered on 22 (57.89%) of symptomatic infections, 14 (36.84%) asymptomatic bacteriuria and 2 (5.26%) other C-UTIs. Dominant etiologic factors were: E. coli, caused 14 (36.84%), Extended-Spectrum Beta-lactamase producing (ESBL) Klebsiella pneumoniae 7 (18.42%), Enterococcus faecium and Candida spp. 3 (7.89%) of C-UTIs. E. coli was significantly most common etiologic factor of C-UTIs in younger women (p=0.04). E. coli from C-UTIS showed significantly higher resistance to antimicrobial drugs. Inadequate antimicrobial therapy was significantly more common prescribed to patients from C-UTIs. Lethal outcome was significantly most common associated with certain clinical and laboratory findings. Conclusion: Initial antimicrobial therapy of those serious infections should be based on data from those research.

Conflict of interest: none declared. Goal The goal of the research is to determine the relationship between frequency and reporting of stab incidents, attitudes and knowledge about stab incidents and occupational risk for transmission of viral infection with HBV, HCV or HIV among health care professionals employed in primary health care. Material and methods Conducted is prospective, cross-section study by questionnaires in 2012. The survey included health professionals in Primary Health Care Center in Tuzla. The final sample has 131 respondents (85% women). Statistical analysis was performed using the statistical package SPSS version 20.0. Results The prevalence rate of stab incidents throughout their career in our study was 66%; while the rate of reported incidents was 4.83 ˜ 5 times lower than the actual prevalence. In 49 out of 87 cases this was a case of hollow needle prick. The most common causes of stab incidents are the time pressure, unforeseen reactions of patients and lack of concentration. Conclusion Stab incidents are often not reported in in developing countries. Training in order to raise awareness and knowledge about the problem, proper procedures, good organization of work and anti-stress program, safer disposal, conducting prophylaxis before and after exposure monitored by the relevant institutions of occupational medicine should contribute to solving this problem.

SUMMARY The 4th Congress of Infectiologists of Bosnia-Herzegovina with international participation was held in Konjic, on 30. May to 02. June 2012. In addition to the prominent infectious disease experts from almost all university centers in B&H, the teachers at medical schools in Bosnia-Herzegovina, infectious disease specialists who work in health institutions in B&H, this Congress was attended by infectious disease experts from Serbia (12 participants), Turkey (3 participants), Croatia (3 participants), Macedonia (3 participants), Germany (2 participants) and Montenegro (2 participants). Topics included: Infections of the skin, soft tissue and bones, Sepsis and endocarditis, Infectious diseases emergencies and pediatric infectology, Emerging and reemerging infectious diseases, Hospital infections, Sexualy transmitted diseases, Infectious diagnostic and therapeutic protocols. Participating invited speakers were following professors: Salih Hosoglu (Turkey), Hakan Leblebicioglu (Turkey), Resat Ozaras (Turkey), Karsten Plötz (Germany), Ilija Kuzman (Croatia), Bruno Baršić (Croatia), Goran Tešović (Croatia). In addition to experts in infectious diseases at this Congress, their works were presented by experts from other medical disciplines, but with infectious character issues (Professors: Sead Ahmetagić, Ismet Gavrankapetanović, Zora Vukobrat-Bijedić, Senija Rašić, Halima Resić, Adnan Kapidžić, Ivo Curić, Jelena Ravlija, Amela Begić, Izet Mašić, Sadeta Hamzić, and others). Some of the papers that were presented at this Congress have been published in extenso, in the Medical Archives and Materia Socio Medica. One part as abstracts (both journals are indexed in over 10 databases), and will be electronically available to the general scientific community in Bosnia-Herzegovina, Europe and worldwide. In this way, the Bosnian infectious disease experts, as a science and profession, will be worthily represented to the colleagues from other countries in the region and beyond.