Methicillin-resistant S. aureus (MRSA), extended-spectrum (ESBL)- and plasmid-mediated AmpC ß-lactamase -producing Gram-negative bacteria associated with skin and soft tissue infections in hospital and community settings.
OBJECTIVE
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.


CONCLUSIONS
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.
Department of Laboratory Diagnostics, Cantonal Public Health Institute of Zenica-Doboj Canton; Bosnia and Herzegovina.
Selma
S
Uzunović
School of Medicine, University of Zagreb, Department of Molecular Microbiology, Clinical Hospital Center Zagreb; Croatia.
Branka
B
Bedenić
Department of Molecular Microbiology, Clinical Hospital Center Zagreb; Croatia.
Ana
A
Budimir
Department of Laboratory Diagnostics, Cantonal Public Health Institute of Zenica-Doboj Canton; Bosnia and Herzegovina.
Amir
A
Ibrahimagić
Microbiology Department, Biotechnical Faculty, University of Ljubljana, Slovenia.
Farah
F
Kamberović
Department of Surgery, Clinical Hospital Center Zagreb, Croatia.
Zlatko
Z
Fiolić
Department of Medical Microbiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Mastricht, The Netherlands.
Michelle I A
MI
Rijnders
Department of Medical Microbiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Mastricht, The Netherlands.
Ellen E
EE
Stobberingh
D000328:Adult; D000667:Ampicillin; D017522:Bosnia and Herzegovina; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007297:Inpatients; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D012871:Skin Diseases / Q000382:microbiology*; D018461:Soft Tissue Infections / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000382:microbiology
D000667:Ampicillin
CTX-M beta-lactamase; MLST CC152; antibiotic resistance; surgical wound infections