title: High prevalence of CTX-M-15 and first report of CTX-M-3, CTX-M-22, CTX-M-28 and plasmid-mediated AmpC beta-lactamase producing Enterobacteriaceae causing urinary tract infections in Bosnia and Herzegovina in hospital and community settings.
abstract: OBJECTIVE
  To investigate molecular epidemiology of extended-spectrum β-lactamase/ESBL and plasmid-mediated AmpC β-lactamase/pAmpC producing Gram-negative bacteria causing urinary tract infections (UTIs) in Zenica-Doboj Canton, Bosnia and Herzegovina, in the period Decembar 2009-May 2010.
  
  
  METHODS
  Antibiotic susceptibility was determined by disc diffusion and broth microdilution according to CLSI guidelines. Double-disk synergy test was performed in order to screen for ESBLs/pAmpC beta-lactamases. PCR was used to detect bla(ESBL)/bla(ampC)/bla(carb) genes. Genetic relatedness of the strains was determined by pulsed-field-gel-electrophoresis (PFGE).
  
  
  RESULTS
  Among 85 patients with UTIs caused by ESBL producing isolates, 44 (51.8%) were from in-patients and 41 (48.2%) from outpatients. Klebsiella spp. was the most frequently isolated from in-patients, in 28 (63.6%) cases. Among outpatients, Klebsiella spp./Escherichia coli were the most frequently isolated, in 19 (46.3%)/16 (39.0%) cases. Twenty-one (75.0%) from hospital and nine (47.4%) from outpatient Klebsiella spp. isolates were positive for blaTEM, whereas 27 (96.4%) from in-patients and 6 (31.6%) from outpatient were bla(CTX-M) positive (18 hospital and five outpatient isolates were encoding bla(CTX-M-15)). One Klebsiella oxytoca and one Enterobacter cloacae inpatient isolates were positive for blaCTX-M-28. One Klebsiella pneumoniae outpatient isolate were positive for bla(CTX-M-22) and one E. coli for bla(CTX-M-3). One hospital Proteus mirabilis strain was positive for bla(CMY-2) and two Klebsiella spp. strains for blaDHA-1, whereas two E. coli, one K. oxytoca and one Proteus vulgaris outpatient strains were positive for bla(CMY-2).
  
  
  CONCLUSIONS
  Identification of bla(CTX-M-3), bla(CTX-M-22) and bla(CTX-M-28) among Enterobacteriaceae is uncommon. In this study we report the emergency of CMY-2 and DHA-1 plasmid-mediated beta-lactamases.
authors: Department for Laboratory Diagnostics, Cantonal Public Health Institute Zenica, fra Ivana Jukića 2, 72 000 Zenica, Bosnia and Herzegovina. Electronic address: ibrahimagic.amir@gmail.com.
authors: Amir
authors: A
authors: Ibrahimagić
authors: School of Medicine, University of Zagreb, Šalata 3, 10 000 Zagreb, Croatia; Clinical Department of Clinical and Molecular Microbiology, University Hospital Center Zagreb, Kišpatičeva 12, 10 000 Zagreb, Croatia. Electronic address: branka.bedenic@zg.htnet.hr.
authors: Branka
authors: B
authors: Bedenić
authors: Microbiology Department, Biotechnical faculty, University of Ljubljana, Večna pot 111, 1000 Ljubljana, Slovenia. Electronic address: farah_kamb@hotmail.com.
authors: Farah
authors: F
authors: Kamberović
authors: Department for Laboratory Diagnostics, Cantonal Public Health Institute Zenica, fra Ivana Jukića 2, 72 000 Zenica, Bosnia and Herzegovina; Faculty for Health Care, University "VITEZ" Travnik, Školska 23, 72 270 Travnik, Bosnia and Herzegovina. Electronic address: selma_kamb@yahoo.com.
authors: Selma
authors: S
authors: Uzunović
mesh_terms: D000553:Ambulatory Care; D001426:Bacterial Proteins / Q000235:genetics; D017522:Bosnia and Herzegovina / Q000453:epidemiology; D016971:Citrobacter freundii / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D052978:Disk Diffusion Antimicrobial Tests; D016521:Electrophoresis, Gel, Pulsed-Field; D016972:Enterobacter cloacae / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004926:Escherichia coli / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D029968:Escherichia coli Proteins / Q000235:genetics; D006760:Hospitalization; D006801:Humans; D007223:Infant; D041121:Klebsiella oxytoca / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D007711:Klebsiella pneumoniae / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D008875:Middle Aged; D017720:Molecular Epidemiology; D058889:Molecular Typing; D010957:Plasmids / Q000235:genetics; D015995:Prevalence; D011513:Proteus mirabilis / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000235:genetics / Q000382:microbiology*; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D001426:Bacterial Proteins; D029968:Escherichia coli Proteins; C103022:beta-lactamase CMY-2; C473109:beta-lactamase CTX-M-15; C417271:beta-lactamase CTX-M-3; C048795:AmpC beta-lactamases; C544678:CTX-M-28 beta-lactamase, Klebsiella pneumoniae; D001618:beta-Lactamases; C542394:beta-lactamase CTX-M-22, E coli; C000601045:beta-lactamase DHA-1, Klebsiella pneumoniae
keywords: Antibiotic resistance; ESBL; bla(CMY-2); bla(DHA-1)