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Review paper
Received: 28.04.2015. >> Accepted: 19.06.2015. >> Published: 18.04.2015. Biochemistry
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https://doi.org/10.17392/816-15

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

By
Selma Uzunović ,
Selma Uzunović
Contact Selma Uzunović

Department of Laboratory Diagnostics, Cantonal Public Health Institute of Zenica-Doboj Canton, Zenica, Bosnia and Herzegovina

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Branka Bedenić ,
Branka Bedenić

School of Medicine, University of Zagreb, Zagreb, Croatia

Department of Molecular Microbiology, Clinical Hospital Center Zagreb, Zagreb, Croatia

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Ana Budimir ,
Ana Budimir

Department of Molecular Microbiology, Clinical Hospital Center Zagreb, Zagreb, Croatia

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Amir Ibrahimagić ,
Amir Ibrahimagić

Department of Laboratory Diagnostics, Cantonal Public Health Institute of Zenica-Doboj Canton, Zenica, Bosnia and Herzegovina

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Farah Kamberović ,
Farah Kamberović

Microbiology Department, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia

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Zlatko Fiolić ,
Zlatko Fiolić

Department of Surgery, Clinical Hospital Center Zagreb, Zagreb, Croatia

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Michelle I. A. Rijnders ,
Michelle I. A. Rijnders

Department of Medical Microbiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Mastricht, Netherlands

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Ellen E. Stobberingh
Ellen E. Stobberingh

Department of Medical Microbiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Mastricht, Netherlands

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Abstract

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 Gramnegative 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 CTXM 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. 

Keywords:

surgical wound infections,
CTX-M beta-lactamase,
MLST CC152,
antibiotic resistance

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