The First Mediterranean Seminar on Science Writing, Editing & Publishing (SWEP 2016) was held in Sarajevo, Bosnia & Herzegovina from 2nd to 3rd December 2016. It was organized by Academy of Medical Sciences of Bosnia and Herzegovina, running concurrent sessions as part of its Annual Meeting titled “ “Days of AMNuBiH - Theory and Practice in Science Communication and Scientometrics”. Hotel Bosnia in the city centre was the chosen venue. On the first day, nineteen presentations on various issues of science writing and publication ethics were delivered by speakers from Croatia, Serbia, Macedonia, Albania, Bosnia & Herzegovina and the UK (Asim Kurjak, Milivoj Boranić, Doncho Donev, Osman Sinanović, Miro Jakovljević, Enver Zerem, Dejan Milošević, Silva Dobrić, Srećko Gajović, Izet Mašić, Armen Yuri Gasparyan, Šekib Sokolović, Nermin Salkić, Selma Uzunović, Admir Kurtčehajić, Edin Begić and Floreta Kurti). Each presentation had a take-home message for novice and seasoned authors, encountering numerous problems in non-Anglophone research environment. Lecturers, who were internationally recognized editors of regional journals, generously shared their experience of adhering to the best ethical guidance. Elegant presentations by Srećko Gajović (Editor-in-Chief of the Croatian Medical Journal) and Armen Yuri Gasparyan (past Chief Editor of the European Science Editing) showcased their accomplishments that strengthened ties between authors from all over the world. Gasparyan reflected on educational resources of editorial associations, such as the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE), and called not just to declare the adherence to, but also to enforce their ethical guidance in daily practice. Editors of Medical Archives, Croatian Medica Journal, Vojnosanitetski Pregled, Psychiatria Danubina, Acta Informatica Medica, Materia Socio-Medica, The Donald School Journal of Ultrasound in Obstretics and Gynecology, Acta Medica Saliniana and Medicinski Glasnik presented their editorial strategies aimed at attracting best authors and resolving problems with authorship, conflicts of interest, and plagiarism. Topical education on science writing and editing was considered as an inseparable part of continuing professional development in biomedicine. Armen Yuri Gasparyan (UK) was offered an opportunity to interact with more than 70 participants, attending the SWEP 2016 on the second day. The lecturer talked about author contributions, disclosures of conflicts of interests, plagiarism of ideas and words, research performance and impact indicators, and targeting ethical journals. Topics were presented in a way to help non-Anglophone authors, reviewers and editors avoid common ethical problems. Dr Gasparyan stressed the importance of regularly arranging such meetings across Balkan and Mediterranean countries to eradicate plagiarism and other forms research misconduct. The organizers of the SWEP 2016 awarded selected keynote speakers with certificates of lifetime achievement in journal editing, and decided to run the Seminar annually with support of Balkan and Mediterranean editors and publishers. The SWEP 2016 marked a turning point in the process of regional developments since all attending editors opted for nurturing enthusiasm of the organizers and launching the Mediterranean Association of Science Editors and Publishers (MASEP). The Seminar was a great success with its impressive scientific and social activities. It attracted more than 100 students, researchers, editors, and publishers from Bosnia & Herzegovina and neighbouring countries. Proceedings, in the form of short reports, were published in Acta Informatica Medica and archived in PubMed Central. New friendships were forged between regional experts in editing and young specialists during those unforgettable two days of intensive discussions and informal interactions (a-y).

Aim To investigate prevalence, antimicrobial susceptibility, molecular characteristics, and genetic relationship of AmpC- and/or extended spectrum beta lactamase (ESBL)- producing Proteus spp. clinical isolates in Zenica-Doboj Canton, Bosnia and Herzegovina. Methods Antibiotic susceptibility was determined by disc diffusion and broth microdilution methods according to CLSI guidelines. Double-disk synergy test was performed in order to screen for ESBLs, and combined disk test with phenylboronic acid to detect AmpC β -lactamases. PCR was used to detect blaESBL/blacarb genes. Genetic relatedness of the strains was determined by pulsed-fieldgel-electrophoresis (PFGE). Results Eleven ESBL-producing isolates were included in the study (six inpatients and five outpatients). Susceptibility rate to amoxicillin-clavulanic acid, imipenem and meropenem was 100%. Resistance rate to cefuroxime was 100%, gentamicine 90.9%, piperacillin/tazobactam 81.8%, cefotaxim, ceftriaxone and ceftazidime 72.7%, cefoxitine and ciprofloxacine 63.6% and to cefepime 45.5%. In five (out of 11) isolates multi-drug resistance (MDR) to cephalosporins, cefamicines, amynocligosides and fluoroquinolones was detected. Besides TEM-1 which was detected in all isolates, CTX-M+OXA-1 β-lactamases were detected in seven (out of 11; 63.6%) isolates (five blaCTX-M-1 and two blaCTX-M-15 genes), and CMY-2 β-lactamase in two isolates. PFGE showed no genetic relatedness. Conclusion Because of high prevalence of MDR strains in epidemiologically unrelated patients with AmpC- and/or ESBL producing Proteus spp. infection, further surveillance is needed. Molecular characterization and strain typing, or at least phenotypic test for AmpC/ESBL production is important for appropriate therapy and the detection of sources and modes of spread, which is the main step in order to design targeted infection control strategies.

Forty-four mecA-positive and eight mecA-negative Staphylococcus aureus isolates confirmed by PCR were further tested by disc-diffusion (DD) oxacillin and cefoxitin, oxacillin Epsilon (E)-test, and oxacillin and cefoxitin minimal inhibitory concentration (MIC) Strip methicillin-resistant phenotype in S. aureus (MRSA) tests. Among 44 mecA-positive S. aureus isolates, two (4·5%) were detected as MRSA by DD-oxacillin, 17 (38·6%) by DD-cefoxitin test, and seven (15·9%) by the E-test. In the cefoxitin MIC Strip MRSA test, 19 (43·2%) isolates were resistant. In the oxacillin MIC Strip MRSA test, 18 (40·9%) isolates were resistant and 26 (59·1%) were sensitive, i.e. oxacillin-sensitive MRSA (OS-MRSA) (MIC range 0·25-≤0·25 mg/l). Fifteen out of 26 OS-MRSA (57·7%) belonged to spa-CC 355/595, 78% of which belonged to the largest PFGE clone. Some discrepancies between the phenotypic methods for MRSA identification obtained in this study were caused by large proportion of OS-MRSA. Misidentification of OS-MRSA as MSSA might result in an appearance of highly resistant MRSA in patients treated with beta-lactam antibiotics.

AIM To investigate the characteristics of meticillin-resistant S. aureus (MRSA), extended-spectrum (ESBL), and plasmid-mediated AmpC beta-lactamase producing Gram-negative bacteria causing skin and soft tissue infections (SSTIs) in hospital and outpatient settings of Zenica-Doboj Canton, Bosnia and Herzegovina. METHODS Antibiotic susceptibility was determined by disc-diffusion and broth microdillution methods according to CLSI guidelines. MecA gene was detected by PCR, and genetic characterization of MRSA was performed using spa-typing and the algorithm based upon repeat patterns (BURP). Double-disk-synergy test was used to screen for ESBLs. PCR was used to detect blaESBL alleles. Genetic relatedness of the strains was tested by PFGE. RESULTS Seventeen in-patients with MRSA, 13 with ESBL-producing Gram-negative bacteria and three patients co-infected with both, were detected. Five MRSA and 16 ESBL-producing Gram-negative bacteria were found in outpatient samples. Klebsiella spp. was isolated in 11 in- and seven outpatients. MLST CC152 was the most prevalent MRSA. Seven (38.9%) Klebsiella spp. yielded amplicons with primers specific for SHV, TEM-1 and CTX-M group 1 β-lactamases. Eight K. pneumonia (44.4%) and 16 (64%) MRSA (including the in- and outpatient) strains were clonally related. CONCLUSION The presence of MRSA and ESBL-producing organisms causing SSTIs in the community poses a substantial concern, due to the high morbidity and mortality associated with possible consequent hospital infections.

Carbapenems are potent β-lactam antibiotics used to treat serious infections in hospital settings. In comparison to penicillins, cephalosporins or β-lactam/β-lactamase inhibitor they have broad antimicrobial spectrum that includes Gram-positive (e.g. imipenem, doripenem) and Gram-negative bacteria (e.g. meropenem, ertapenem). Imipenem and meropenem have better activity against P. aeruginosa while imipenem and doripenem have better activity than meropenem against Acinetobacter baumannii. Doripenem has the lowest MIC against P. aeruginosa and A. baumannii in comparison to imipenem and meropenem, and it is least susceptible to hydrolysis by carbapenemases. To act on PBPs, carbapenems have to enter the wall of Gram-negative bacteria through outer membrane proteins (porins). Binding to different PBPs they inhibit the synthesis of cell wall finally leading to the death of bacterium [1]. Carbapenem resistance in Gram-negative bacteria can be the consequence of the production of a β-lactamase, expression of efflux pumps, porin loss and alterations in PBPs. Since β-lactams, including carbapenem-like compounds, are natural products of several environmental bacteria and fungi, it is supposed that other bacteria started to produce their intrinsic β-lactamase to give them selective advantage for survival. Thus, several genes encoding different carbapenemases can be found in environmental bacteria like Bacillus anthracis, Serratia fonticola, Pseudomonas cepacia or Acinetobacter spp. as part of their chromosome [1, 2]. Further step in this evolution of resistance was the escape of carbapenemase encoding genes to mobile genetic elements (plasmids, transposons) providing possibility of successful horizontal spread of resistance genes even between different genera [3]. Since this discovery, carbapenemases became global problem. According to the Ambler classification (based on structural similarities) they belong to the class A, B and D [1]. Class A carbapenemases contain serine at their active site and are capable of hydrolyzing all β-lactams, including aztreonam. In this group of carbapenemases, Sme (Sme-1 to Sme-3), IMI (IMI-1-3), NmcA and SFC-1 enzymes are mostly chromosomally encoded, while KPC (KPC- 2 to KPC-13) and GES (GES 1-GES-20) are plasmid encoded. Dominant carbapenemase from this group is KPC, identified in 1996 in North Caroline, USA, now causing many regional outbreaks, with endemicity in northeastern part of the USA, Israel, China, Porto Rico, Colombia, Israel, Greece, and becoming more and more prevalent throughout the Europe [4]. Beside K. pneumoniae, represented by a predominant clone (ST258), it has been found in other Enterobacteriaceae, as well as in P. aeruginosa and A. baumannii–calcoaceticus complex. It is sometimes difficult to be recognized since MICs to carbapenems are in many cases lower than the breakpoints [2, 5]. Class B carbapenemases are also known as metallo-β-lactamase (MBL) since they contain metal ion(s) in their active site. Beside those chromosomally located in environmental bacteria (Bacillus cereus-BCI, BCII, Aeromonas spp-CphA, S. maltophilia-L1), acquired MBL encoding genes are often located in gene cassettes within integron, being part of a plasmid or chromosome. Firstly described acquired MBLs were in Japan in 1991, so called IMP-enzymes (there are now more than 30 derivatives) and are still dominant MBLs in Asian continent causing mainly sporadic outbreaks [6]. VIM-enzymes (there are now more than 30 derivatives) were firstly described in P. aeruginosa but later arisen to Enterobacteriaceae as well, and fastly spread over whole Europe, causing outbreaks in many Mediterranean countries (like Greece, Italy, Turkey). VIM metallo-β-lactamase are now the most prevalent carbapenemase spreading globally, and although largely connected to P. aeruginosa, now reported more often from Enterobacteriacea from Mediterranean countries, particulary Greece and Turkey, with the description of many panresistant strains [6, 7]. Another worrisome metallo-enzyme, arose from India in 2008, namely New-Delhi MBL (NDM-1 ; until now more than ten variants are described), and spread fastly over Indian subcontinet in next few years. NDM-enzymes are mostly associated with nonclonally related isolates of K. pneumoniae and E. coli, but also described in P. aeruginosa and A. baumannii [8]. Beside proven facts that those enzymes exist in isolates spreading in environment, and are carried in general population by enteric flora, the magnitude of the problem potentiates the huge population reservoir from Indian subcontinet and Middle Asia that moves across the world spreading further the resistance genes [9, 10, 11]. Another new source of those enzymes could be the Balkan region [12, 13]. Oxacillinases from molecular class D demonstrating carbapenemase activity are often found in Acinetobacter spp. They are divided into the most globally spread OXA-23 group, found also in environmental isolate of Acinetobacter spp. suggesting the possible natural and not nosocomial source of these genes, OXA-24 group, not so widespread as OXA-23, mostly described in Europe and USA, and OXA-58 group, described in several outbreaks all over the world [14]. The problem became more global with the discovery of OXA-48 in Enterobacteriaceae, particulary in K. pneumoniae and to lesser extent in E. coli, spreading all around the world but specifically in countries close to the Mediterranean Sea [14-16]. Carbapenemase producing Gram-negative bacteria can cause a wide spectrum of infections including bacteraemia, nosocomial pneumonia, wound infections, endocarditis, urinary tract infections. Those infections are often associated with treatment failures, long hospital stay and high mortality rates ; for example attributable mortality for carbapenem resistant P. aeruginosa infections ranged between 51.2 and 95% [17, 18].

ABSTRACT Objectives Klebsiella spp. is a common cause of urinary tract infections (UTIs) and it is important nosocomial pathogen. There is currently little information about a prevalence of AmpC beta-lactamases in these strains. The aim of the study was to investigate a prevalence of plasmid –mediated AmpC (pAmpC) beta-lactamases in Klebsiella spp. causing UTIs in Bosnia and Herzegovina (B&H), during December 2009-May 2010. Methods Minimum inihibitory concentrations (MICs) of various antibiotics were determined by broth microdilution method according to CLSI guidelines. Double-disk synergy test and combined disk test with phenylboronic acid were used to detect ESBLs and pAmpC beta-lactamases respectively. BlaESBL, and blaAmpC genes were detected by PCR. Genetic relatedness of the strains was tested by pulsed-field gel electrophoresis (PFGE). Results ESBL. were found in 28 Klebsiella spp (22 K. pneumoniae and six K. oxytoca). Genes encoding pAmpC beta-lactamases were detected in two (7.1%) isolates, one from K. oxytoca and one from K. pneumoniae. Sequence analysis revealed blaDHA-1genes in both isolates. One isolate was obtained from Pediatric (2 years old patients) and one from Orthopedic and Traumatology Department (68 years old patient). ESBL-encoding genes were found in both isolates positive for pampC (SHV-5, and TEM-1/CTX-M-15/SHV-1, respectively). The isolate from Pediatric Department showed resistance to aminoglycosides, and third generation cephalosporins, intermediate susceptibility to cefepime, but was susceptible to fluoroquinolone and, carbapenems, while the other isolate showed high level resistance to all antibiotics (multidrug resistance), except of carbapenems. PFGE showed no genetic relatedness between the isolates. Conclusion The prevalence of pAmpC-type mediated resistance in most countries is unknown. The presence of multiple beta-lactamases was reported previously. The clonal relatedness among isolates suggests vertical spread of blaDHA-1 in Klebsiella spp. It is very important to characterize pAmpC positive isolaters of Klebsiella spp in order to prevent the spread of these multidru-resistant isolates in hospital environment. This is the first report of Klebsiella spp. isolate producing DHA-1 beta-lactamases in Bosnia and Hercegovina.

AIM To investigate the iMLSB prevalence in 142 methicillin-sensitive (MSSA) and 48 methicillin-resistant (MRSA) in-patient (65), outpatient (75), and healthy carrier (150) Staphylococcus aureus isolates in Zenica-Doboj Canton, Bosnia and Herzegovina. METHODS Disk diffusion testing by placing clindamycin (CLI) and erythromycin (ERY) disks 15 mm apart (edge to edge) on a Mueller-Hinton agar, as per CLSI guideline was performed. Two distinct induction phenotypes labelled as D and D+, and three noninduction phenotypes designated as Neg, R (constitutive, cMLSB), and S (susceptible). Methicillin-resistance was confirmed by the presence of mecA gene by PCR. The genetic characterization was performed using spa-typing and the algorithm based upon repeat patterns (BURP). RESULTS iMLSB was detected in six (2.1%) isolates, of which five (3.5%) (two outpatients and three carriers) were MSSA, and one (2.1%) (outpatient) MRSA. One of them, D+ phenotype (iMLSB) was obtained from a carrier (MSSA). None of the inpatients had iMLSB. HD phenotype was not detected. One (MRSA) isolate has shown negative phenotype. Two strains with iMLSB originated from skin and soft tissue (MRSA) and eye infection (MSSA) belonged to the same MLST CC8, with different spa-types (t451 and t008, respectively). R phenotype (cMLSB) was detected in two (inpatient) isolates (0.7%). CONCLUSION D test identified 2% of wrongly reported isolates as clindamycin sensitive. Despite low prevalence of S. aureus with iMLSB , it is a significant finding that they were mostly MSSA, and all were isolated from outpatients or carriers. D-test becomes an imperative part of routine antimicrobial susceptibility test for all S. aureus isolates.

Acinetobacter spp. is an important opportunistic bacterial pathogen responsible for serious infections in the hospital environment. Objectives were to determine the antibiotic susceptibility and to characterize carbapenem-resistance mechanisms of 24 (19 in- and five outpatient) Acinetobacter spp. isolates collected during Decembar 2009 to May 2010 in Bosnia and Herzegovina were investigated. Susceptibility testing was performed by disc-diffusion (DD) and broth microdilution method. The modified Hodge and combined disc test with EDTA with phenylboronic acid were used to screen for carbapenemase production. Production of ESBLs was determined by double-disc synergy test. Ten (52.6%) of the in-and three (60.0%) of outpatient isolates were produced ESBL, MBL or oxacillinases. More than 50% of the isolates showed multidrug-resistance. Resistance rates to gentamicin and ciprofloxacin of the in-and outpatients were 80.0% and 60.0%, and 75.0% and 25.0%, respectively. MICs of carbapenems for resistant isolates ranged from 32->256 g/mL. Six (out of 10) of the in- and one (out of 3) outpatient imipenem-resistant strains were possessed blaOXA-51, as well as blaVIM. Three (out of 10) of the in- and one outpatient isolates possessing blaOXA-51 and blaVIM additionally produced other beta-lactamases (TEM, CTX-M, AmpC, OXA-1).None of the in- and outpatient isolates were positive for other carbapenemases, especially acquired oxacillinases (blaOXA-23, blaOXA-24, blaOXA-58, blaOXA-143) A predominance of blaOXA-51 was noticed with high prevalence of imipenem resistance. Presence of blaOXA-51 and blaVIM presents an emerging threat in imipenem-resistant Acinetobacter spp. from Bosnia and Herzegovina.

Objectives To investigate molecular epidemiology of extended-spectrum (ESBL) and plasmid-mediated AmpC β-lactamase and carbapenemase producing Gram-negative bacteria the cause of urinary tract infections (UTI) in in- and outpatients in Bosnia and Herzegovina (BH 57.1%) E. coli in-patient isolates were positive for the blaCTX-M-15 and one for blaCTX-M-3. AmpC β-lactamases were detected by phenotypic test in 20 (45.5%) in- and 21 (51.2%) outpatients. One in-patient strain was positive for blaCMY and two for blaDHA, whereas four outpatient strains were positive for blaCMY and one for blaFOX. Conclusion: The CTX-M-15 was most prevalent β -lactamase in the in- and outpatients. This is the firtst report of blaCTX-M-28, blaCTX-M-3, blaCMY, blaDHA, and blaFOX from B&H. Due to high resistance rates observed for gentamicin and ciprofloxacin, carbapenems remain the antibiotics of choice for the treatment of UTIs caused by β-lactamase-producing Enterobacteriaceae in this region.

AIM To determine the prevalence and etiological agents of significant bakteriuria in children younger than six, as well as the incidence of anatomical abnormalities of the urinary system in children with established significant bakteriuria. METHODS Data were collected from hospital records of children treated at the Department for Preschool and School Health Care, the Primary Health Care Center Zenica and from discharge letters for children hospitalized at the Department of Pediatrics, Cantonal Hospital Zenica, Bosnia and Herzegovina in the period 2007-2009. RESULTS A total of 5379 children were included in the study. Significant bacteriuria was present in 352 (6.5%) children, among those 114 (32.4%) were boys and 238(67.6%) girls. Recidivism of significant bakteriuria was found in 92 children (26.1%), and abnormal ultrasound findings in 58 (16.4%) children. The most common isolated pathogens were E. coli, in 170 (48.3%), K. pneumoniae, in 61 (17.3%), P. mirabilis in 53 (15%), and P. vulgaris, in 12 (34.1%) cases. CONCLUSION As UTIs in children are often symptomless and unrecognizable, and an untreated UTI can lead to subsequent impairment of renal function, it is very important to detect bakteriuria in children.

During the 2002-2006 periods two bilateral government scientific projects between R Slovenia and R/F Bosna and Herzegovina related to Campylobacter epidemiology and antimicrobial resistance took place, resulting in significant results. In this review key findings relating to Campylobacter epidemiology in Zenica-Doboj Canton, Bosnia and Herzegovina, were presented.

Aim To investigate the microbiological quality of meat, meat products and ready-to-eat food in Zenica-Doboj Canton in order to point out the importance of food monitoring and to provide safe food for consumers. Methods Using the protocols of bacteriological food analysis the Laboratory for Sanitary and Clinical Microbiology, Cantonal Public Health Institute Zenica, retrospectively analyzed the results of bacteriological testing of all samples of meat, meat products and ready-to-eat food samples submitted in the period 2008 2010. The legal regulations of BiH were applied. Results Out of the total number of 2,534 meat and meat products samples, 66 (2.6%) were relatively satisfactory, 11 (0.4%) did not satisfy. Out of 4,448 ready-to-eat food samples, 133 (3.0%) did not satisfy the requirements of the regulations. The most common cause of contamination of ready–to–eat food samples was total bacterial count> 20 000 in 39 (29.3%) samples; thermotolerant E. coli was found in 18 (13.5%) samples. The most common reason for improper quality of meat and meat products was the presence of thermotolerant E. coli, in 20 (26%), Proteus spp. in eight (10.4%) and Salmonella in two (2.6%) samples. Conclusion The most common cause of food borne diseases is a consequence of mistakes or ignorance in the process of food handling in the manufactures and sales facilities. Supervision and monitoring of food quality is a powerful way to detect new diseases, to determine the specific source, thus contributing to the education of food handlers in order to prevent contamination.