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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

Klonale Ausbreitung der Infektionen durch den Methicillin resistenten Staphylococcus aureus (MRSA) und die gram-negativen Bakterien, die die Beta-Laktamasen mit erweitertem Wirkungsspektrum (ESBL) und die AmpC Beta-Laktamasen an der Pädiatrischen Abteilung, Bosnien–Herzegowina, produzieren

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Abstract

Purpose

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.

Conclusion

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.

Zusammenfassung

Ziel

Ziel dieser Studie war es, die Prävalenz der Infektionen durch Methicillin-resistenten Staphylococcus aureus (MRSA) und gram-negative Bakterien bei Kindern zu untersuchen, die Beta-Laktamasen mit erweiterten Wirkungsspektrum (ESBL) und AmpC Beta-Laktamasen produzieren.

Methoden

Empfindlichkeit der MRSA- und ESBL-Isolaten gegenüber Antibiotika wurde durch die Disk-Diffusions- und Mikrodilutionsmethode gem. den CLSI-Standards bestimmt. Methicillin-Resistenz wurde durch die Anwesenheit des mecA Gens durch PCR bestätigt. Die genetische Charakterisierung von S. aures erfolgte mittels spa-Typisierung und den algorithm based upon repeat pattern (BURP). Die ESBL-Produktion wurde anhand vom Doppelt-synergetischen Test, und die bla ESBL –Allele wurden durch PCR bestimmt. Genetische Verwandtschaft der Stämme wurde durch Puls-Feld-Gelelektrophorese (PFGE) getestet.

Ergebnisse

Unter 23 MRSA wurden 12 (52,2 %) von Neugeborenen erhalten. MLST CC152 (spa-CC 355–595) (Balkan-Klon) war mit 20 Fällen (87 %) der häufigste. Unter 24 Beta-Laktamasen produzierenden gram-negativen Bakterien wurden jeweils 10 (41,7 %) bei den Neugeborenen und den Einjährigen isoliert. 14 (58,3 %) stammten aus dem Urin. Unter 11 Klebsiella-Stämmen aus dem Urin waren 8 (73 %) CTX-M-15 und einer CTX-M-3 Beta-Laktamase. Zwanzig CTX-M Hersteller (83 %) produzierten auch andere Arten von Beta-Laktamasen. Fünfzehn MRSA-Isolate (65,2 %) gehörten demselben Klon. Unter 13 K. pneumoniae Isolate wurden fünf Klone erkannt, wodurch klonale Ausbreitung der die Beta-Laktamasen produzierenden gram-negativen Bakterien suggeriert wird.

Schlussfolgerung

Die Ergebnisse dieser Studie zeigten, wie wichtig die Einführung von Screening auf MRSA und ESBL-produzierende gram-negative Bakterien bei der Krankenhausaufnahme ist. Es ist notwendig, geeignete Maßnahmen zur Infektionskontrolle zu implementieren, um die Ausbreitung von Infektionen und Seuchen zu verhindern

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Acknowledgments

This work was supported by a grant from the Federation Ministry of Education and Science, Bosnia and Herzegovina.

Conflict of interest

Selma Uzunović, Branka Bedenić, Ana Budimir, Farah Kamberović, Amir Ibrahimagić, Sabina Delić-Bikić, Sara Sivec, Tomislav Meštrović, Dijana Varda Brkić, Michelle I. A. Rijnders, and Ellen E. Stobberingh declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Laboratory Diagnostics, Cantonal Public Health Institute of Zenica, Fra I. Jukića 2, 72000, Zenica, Bosnia and Herzegovina

    Selma Uzunović & Amir Ibrahimagić B.Sc

  2. Faculty of Health Care and Nursing, University ’’VITEZ’’, Školska 23, 72270, Vitez, Bosnia and Herzegovina

    Selma Uzunović

  3. School of Medicine, University of Zagreb, Zagreb, Croatia

    Branka Bedenić

  4. University Clinical Center of Zagreb, Laboratory of Molecular Microbiology, Kišpatićeva 12, 1000, Zagreb, Croatia

    Branka Bedenić &  Ana Budimir

  5. Microbiology Department, Biotechnical faculty, University of Ljubljana, Jamnikarjeva 101, 1000, Ljubljana, Slovenia

    Farah Kamberović

  6. Department of Neonatology, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

    Sabina Delić-Bikić

  7. Faculty of Natural Sciences, University of Zagreb, Horvatovac 102a, Zagreb, Croatia

    Sara Sivec

  8. Dispensary ’’Dr. Zora Profozic’’, Bosutska 19, 10000, Zagreb, Croatia

    Tomislav Meštrović

  9. University Hospital of Lung Disease Jordanovac, Clinical Hospital Center of Zagreb, Jordanovac 104, 1000, Zagreb, Croatia

    Dijana Varda Brkić

  10. Department of Medical Microbiology, The School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Minderbroedersberg 4–6, 6211 LK, Mastricht, The Netherlands

    Michelle I. A. Rijnders Ph.D &  Ellen E. Stobberingh

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  1. Selma Uzunović
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Correspondence to Selma Uzunović.

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Uzunović, S., Bedenić, B., Budimir, A. et al. 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. Wien Klin Wochenschr 126, 747–756 (2014). https://doi.org/10.1007/s00508-014-0597-2

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  • DOI: https://doi.org/10.1007/s00508-014-0597-2

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