OBJECTIVE This study is to define the statistical significance for detection of ESBL producers by the double disk synergy test and molecular test (Check-MDR CT102), microdilution test (VITEK 2 with AES) and double disk synergy test (DDST), as well as the microdilution test and molecular test. MATERIALS AND METHODS Phenotypic testing of 55 isolates Enterobacteriaceae (Escherichia coli (14/55), Klebsiella pneumoniae (34/55), Klebsiella oxytoca (3/55) and Proteus mirabilis (4/55) was performed by VITEK 2 Compact/AES. When this test showed positive results for the ESBL phenotype, then DDST with amoxicillin/clavulanate, ceftazidime, cefpodoxime, aztreonam, ceftriaxone and cefoxitin disks was performed along with Check-MDR CT102 which identified CTX-M, TEM and SHV β-lactamases. RESULTS Applying the McNemar test, we determined that there was a statistically significant difference in the results of detection of ESBLs bacteria using DDST compared to molecular methods (95% CI=41.92 to 54.55; p<0.0001), as well as a DDST and VITEK 2/AES (95% CI=40.13 to 52.73; p<0.0001). We did not find any statistically significant difference in the results of detection of ESBL producers using molecular techniques and VITEK 2/AES (CI=-4,43 to 5,36; p=1). Also we did not find any statistical.. difference between the resistance to cefpodoxime and ceftriaxone (50/50) compared to the results of molecular tests. CONCLUSION In routine daily testing, good detection of ESBLs bacteria, especially CTX-M can be obtained with phenotypic methods with VITEK 2/AES and by DDST with cefpodoxime, and ceftriaksone disks.

OBJECTIVE Serratia marcescens is a well-established as a nosocomial pathogen, resulting in considerable morbidity and mortality in immunocompromised patients. The aim of this study was to investigate an outbreak of Serratia marcescens at the Orthopaedic Clinic of the Clinical Center University of Sarajevo. METHODS A total of 96 strains from 79 patients were isolated. The isolates were identified by conventional methods. Susceptibility testing was performed by the discdiffusion method following CLSI guidelines. Results were confirmed by VITEC-2 Compact. RESULTS From January to December 2010, 96 strains from 79 patients were isolated at the Orthopaedic Clinic of the Clinical Center, University of Sarajevo.The strains were isolated from wound swabs, blood cultures and cerebrospinal fluid. The strains were identifed using current phenotypic methods as Serratia marcescens with identical biochemical characteristics and antibiotic susceptibility patterns. All strains were susceptible to imipenem, meropenem, amikacin, ciprofloxacin, levofloxacin and piperacillin/tazobactam. The infection control team was alerted and after investigation they discovered the same phenotype of Serratia marcescens in the anaesthetic vials used in procedures. This outbreak was extremely difficult to terminate, even with cohorting of patients, sterilisation of equipment, reinforcement of handwashing and deep-cleaning of facilities. The implementation of new control measures terminated the outbreak in February 2011. CONCLUSION Continuous monitoring of nosocomial infections is indispensable. Phenotypic characterization of the isolates is useful for studying the relationship of microbial pathogens. The relationship of one clinical isolate to another during an outbreak is important in motivating the search for a common source or mode of transmission.

The aim of this study was to investigate changes in serum nitric oxide (NO) concentration in inflammatory bowel diseases (IBD) patients and its use as potential biomarker in differential diagnosis of ulcerative colitis (UC) and Crohn's disease (CD) and in disease activity assessment. In 60 patients of both genders - 30 with ulcerative colitis and 30 with Crohn's disease - and 30 controls serum nitric oxide concentration was determined by measuring nitrite concentration, a stable metabolic product of NO with oxygen. Conversion of nitrates (NO3-) to nitrites (NO2-) was done with elementary zinc. The nitrite concentration was determined by classic colorimetrical Griess reaction. Median serum NO concentration was statistically different (p=0,0005) between UC patients (15.25 µmol/L; 13.47 - 19.88 µmol/L), CD patients (14.54 µmol/L; 13.03 -16.32 µmol/L) and healthy controls (13.29 µmol/L; 12.40 - 13.92 µmol/L). When active UC and CD patients were compared with inactive UC and CD patients respectively a significant difference in serum NO level was found (p=0.0005). With a cut-off level of 17.39 µmol/L NO had a sensitivity of 100% and a specificity of 100% in discriminating between active and inactive UC patients. With cut-off value of 14.01 µmol/L serum NO level had a sensitivity of 88% and a specificity of 69% in distinguishing between patients with active CD and inactive CD. Serum NO concentration is a minimally invasive and rapid tool for discriminating between active and inactive IBD patients and could be used as useful biomarker in monitoring of disease activity in IBD patients.

Candidiasis is defined as an infection or disease caused by a fungus of the genus Candida. Rate of disseminated candidiasis increases with the growth of the number of immunocompromised patients. In the the last few decades the incidence of disseminated candidiasis is in growth as well as the mortality rate. The aim of this survey is to show the importance of serological tests implementation in disseminated candidiasis diagnose. This is a prospective study involving 60 patients with malign diseases with and without clinical signs of disseminated candidiasis and 30 healthy people who represent the control group. Apart from hemoculture, detection of circulating mannan antigen and adequate antibodies of Candida species applying comercial ELISA test was determined in each patient. This survey deals with relevant factors causing disseminated candidiasis. This survey showed that the group of patients with clinical signs of disseminated candidiasis had more patients with positive hemoculture to Candida species, then the group of patients without clinical signs of disseminated candidiasis. The number of patients being examined and positive to antigens and antibodies was higher (p < 0.01) in the group of patients with clinical signs of disseminated candidiasis (7/30; 23.3%), then in the group of patients without clinical signs of disseminated candidiasis (0/30; 0%): Average value of titra antigen was statistically higher (p < 0.001) in patients with Candida spp. positive hemocultures rather then in patients with Candida spp. negative hemocultures. In the group of patients with clinical signs of disseminated candidiasis 6/30 (20%) of patients had Candida spp.positive hemocultures while in the group of patients without clinical signs of disseminated candidiasis 1/30 (3.3%) of patients had Candida spp. positive hemocultures, which was considerably higher (p < 0.05). Correlation of results of hemoculture and mannan antigens and antibodies in patients with disseminated candidiasis were statistically significant, while correlation of results of hemoculture and antibodies was insignificant. Because of low sensitivity of hemoculture and time needed for isolation of Candida spp., introducing serological tests in regular procedures would speed disseminated candidiasis diagnose.

AIM To analyze the frequency and antimicrobial resistance of Acinetobacter baumannii isolated from blood cultures. METHODS Blood cultures of all consecutive patients hospitalized in different departments of the University Clinical Centre of Sarajevo from January 2003 to December 2010 were processed by "BACTEC 9120" system. The isolates were identified by conventional methods. Susceptibility testing was performed by disc-diffusion method following guidelines from the Clinical Laboratory Standards Institute (CLSI). RESULTS A total of 93,215 blood cultures were examined, 6,338 (6.8%) were positive. Acinetobacter baumannii was isolated in 283 (4.5%) cases. Overall yearly resistance rates to antibiotics had an increasing trend during the eight year period: amicacin from 45.3% to 71.4%; gentamycin from 70.6% to 83.2%; ciprofloxacin from 60.6% to 85.8%; carbapenems (imipenem and meropenem) from 0% to 52.8%. Carbapenem-resistant Acinetobacter baumannii (CRAB) emerged in 2009 and was rapidly disseminated in intensive care units. Resistance to tobramycin and colistin was not detected. CONCLUSION High resistance rates and an increase of Acinetobacter baumannii to all antimicrobials, especially to carbapenems, were noted. The dissemination of carbapenem-resistant isolate may indicate the appearance of untreatable infection by this organism. It points out the rationality in prescribing antimicrobial drugs.

AIM To determine the occurrence of colonization and subsequent infection with multidrug-resistant organisms (MDROs) among patients in the neonatal intensive care unit and to assess the yield of surveillance cultures. METHODS Cultures of nose, throat and stool were obtained from 196 neonates admitted to the Neonatal Intensive Care Unit (NICU) at the Clinical Center of the University of Sarajevo in the six-month period upon admission and once a week if the length of stay was more than seven days. At the same time clinical relevant samples (blood, urine, CSF, wounds swabs, tracheal aspirates) were examined for presence of MDROs. Identification and antibiotic sensitivity pattern of organisms were determined according to the CLSI. RESULTS A total of 126 (64.3%) patients were identified as colonized and 50 (25.5%) as infected with MDROs. 44.4% (56) of patients were colonized on admission. Fecal carriage was most common with extended-spectrum beta lactamase (ESBL)-producing Klebsiella pneumonia, and nose/throat with Acinetobacter baumannii. The patients become colonized more often during the first week of hospitalization (31.7%; p less .001). The infection is more observed in patients who had previously been colonized than those who had not (78% vs. 22%; p less 0.05). The most common infection was the blood infection (bacteremia). The median length of stay in neonates with an infection was 3.5 weeks and without infection 1 week (p less than 0.001). CONCLUSION An infection was more frequently observed in patients who had been previously colonized than those who had not. Microbial surveillance is necessary to detect colonized neonates when multidrug-resistant organisms become epidemic.

Introduction: Chickenpox is very contagious childhood disease, which occurs due to varicella-zoster virus (VZV) primary infection. Disease in healthy children resolves usually without complications, but risk of complication is much higher in adults and immunocompromised hosts. The goal of this study was to determine different clinical and epidemiological characteristics, laboratory features, clinical course, and outcome of chickenpox in children and adults. Material and methods: The descriptive study was conducted at the Department of Infectious Diseases, Clinical Center in Sarajevo, Bosnia-Herzegovina. The study included 120 patients chosen randomly. We compared their clinical and epidemiological characteristics, laboratory investigations, complications and the outcome of the disease. Results: Age of patients was in range from one to 48 years. Male patients prevailed in both groups (65% in adults, 52% in children). Hospitalization rate was 10.7/100,000 inhabitants. Positive contact with chickenpox was confirmed in 80% adults and 82% children. Dominating symptoms were fever, rash and muscle aches. Levels of C-reactive protein, erythrocyte sedimentation rates (ESR) and fibrinogen levels were elevated in both groups, while thrombocytopenia was presented in 33% of adults and 3% of children. Adults had complications in 83.3% and their hospitalization rate was longer compared to children (11.5 days vs. 9.5 days, p<0.001). Conclusions: Chickenpox is a potentially severe illness in adult patients. Introduction of active immunization in BosniaHerzegovina should be considered to prevent severe forms of chickenpox. J Microbiol Infect Dis 2012; 2(2): 64-67

Hantavirus infections are reported from many countries in Europe and with highly variable annual case numbers. In 2010, more than 2,000 human cases were reported in Germany, and numbers above the baseline have also been registered in other European countries. Depending on the virus type human infections are characterised by mild to severe forms of haemorrhagic fever with renal syndrome. The member laboratories of the European Network for diagnostics of Imported Viral Diseases present here an overview of the progression of human cases in the period from 2005 to 2010. Further we provide an update on the available diagnostic methods and endemic regions in their countries, with an emphasis on occurring virus types and reservoirs.

From December 2010 until the end of July 2011, 5,261 mumps cases were recorded in the Federation of Bosnia and Herzegovina, Bosnia and Herzegovina, leading to an incidence of 225.8 per 100,000. Fifteen to 19 year-olds (43%) were most affected and 62% of cases were male. Mumps-specific IgM antibodies were found in about 70% of sera investigated, complications were reported in 41% of 81 hospitalised patients. The outbreak affected mainly those unvaccinated or unaware of their vaccination status and is probably due to vaccination failures during the war and postwar period (1992–1998).

Listeria monocytogenes is often present in meat and meat products that are sold in the area of northeast Bosnia and Herzegovina. The major objective of this study was to examine the virulence of L. monocytogenes strains isolated from these types of food in that geographic area. Polymerase chain reaction was used to detect eight genes responsible for virulence of this pathogen, namely, prfA, inlA, inlB, hly, plcA, plcB, actA, and mpl. All examined isolates were confirmed to possess the eight virulence genes. Ten different pulsed-field gel electrophoresis (PFGE) macrorestriction profiles were recognized among 19 L. monocytogenes strains after restriction with two different endonucleases (ApaI and AscI). The pathogenicity of three different PFGE types of L. monocytogenes was confirmed through in vivo tests, which were performed on female white mice (Pasteur strain), and it ranged from 3.55 × 10(8) LD50 to 1.58 × 10(10) LD50. All of the three different PFGE types of L. monocytogenes were regarded as moderately virulent in relation to the reference strain L. monocytogenes Scott A. This result might be one of the reasons for the absence of reported listeriosis in northeast Bosnia and Herzegovina, despite the high degree of food contamination with this pathogen.

SUMMARY A rubella outbreak involving 1900 cases was recorded in the Federation of Bosnia and Herzegovina between mid-December 2009 and the end of May 2010. Sera from 389 suspected rubella cases were examined for the presence of rubella-specific IgM and IgG antibodies. A total of 32 throat swabs from suspected rubella cases were tested by RT–PCR and were used to attempt virus isolation. Most patients (945/1900, 49·73%) had never received rubella vaccination or had an unknown vaccination status (563/1900, 29·63%). About 45% (178/389) of suspected rubella patients were IgM positive. From 13 of the throat swabs a virus isolate and E1 gene sequences attributed to genotype 2B were obtained. The rubella outbreak was due to failure to vaccinate during the war period (1992–1995) and emphasizes the need for additional vaccination opportunities.