title: Emergency (clonal spread) of methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum (ESBL)--and AmpC beta-lactamase-producing Gram-negative bacteria infections at Pediatric Department, Bosnia and Herzegovina.
abstract: OBJECTIVE
  Aim of this study was to investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum (ESBL) and plasmid-mediated AmpC beta-lactamase producing Gram-negative bacteria in children.
  
  
  METHODS
  Antibiotic susceptibility of MRSA and beta-lactamase producing Gram-negative bacteria was determined by disc diffusion and broth microdilution methods according to CLSI guidelines. Methicillin resistance was confirmed by the presence of mecA gene by PCR. The genetic characterization of S. aures was performed using spa-typing and the algorithm based upon repeat pattern (BURP). Double-disk synergy test was used to screen for ESBL production. PCR was used to detect bla ESBL alleles. Genetic relatedness of the strains was tested by pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  Among 23 MRSA, 12 (52.2 %) were obtained from newborns. MLST CC152 (spa-CC 355-595) (Balkan clone) was the most prevalent, 20 (87 %) cases. Among 24 beta-lactamase producing Gram-negative bacteria, 10 (41.7 %) were obtained from each newborns and one-year-old children; 14 (58.3 %) were from urine. Among 11 Klebsiella strains isolated from urine eight (73 %) produced CTX-M-15, and one CTX-M-3 beta-lactamase. Twenty (83 %) of CTX-M producers were coproduced by other types of beta-lactamases. Fifteen (65.2 %) MRSA isolates were clonally related. Five clones among 13 K. pneumoniae isolates were detected by PFGE suggesting clonal spread of β-lactamase producing Gram-negative bacteria.
  
  
  CONCLUSIONS
  Pediatric infections caused by clonal spread of MRSA and beta-lactamase-producing Gram-negative bacteria are of major concern. Proper infection control measures should be implemented in order to avoid the transmission and major outbreaks.
authors.affiliation: Department of Laboratory Diagnostics, Cantonal Public Health Institute of Zenica, Fra I. Jukića 2, 72000, Zenica, Bosnia and Herzegovina, selma_kamb@yahoo.com.
authors.forename: Selma
authors.initials: S
authors.lastname: Uzunović
authors.forename: Branka
authors.initials: B
authors.lastname: Bedenić
authors.forename: Ana
authors.initials: A
authors.lastname: Budimir
authors.forename: Farah
authors.initials: F
authors.lastname: Kamberović
authors.forename: Amir
authors.initials: A
authors.lastname: Ibrahimagić
authors.forename: Sabina
authors.initials: S
authors.lastname: Delić-Bikić
authors.forename: Sara
authors.initials: S
authors.lastname: Sivec
authors.forename: Tomislav
authors.initials: T
authors.lastname: Meštrović
authors.forename: Dijana
authors.initials: D
authors.lastname: Varda Brkić
authors.forename: Michelle I A
authors.initials: MI
authors.lastname: Rijnders
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Stobberingh
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics*; D017522:Bosnia and Herzegovina / Q000453:epidemiology; D060965:Clonal Evolution / Q000235:genetics; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006748:Hospital Departments; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D010372:Pediatrics; D015995:Prevalence; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D001426:Bacterial Proteins; C048795:AmpC beta-lactamases; D001618:beta-Lactamases