Staphylococcal sepsis and frequency of metastatic foci.

INTRODUCTION: Staphylococcal sepsis is one of the most serious bacterial infections in the world, in most cases accompanied by metastatic foci in various organ systems. OBJECTIVE: analyze the metastatic foci patients suffering from staphylococcal sepsis. PATIENTS AND METHODS: we analyzed the patients treated for staphylococcal sepsis during the ten year period. RESULTS: 67 patients were included, of which 45 (67,2%) with the outpatient acquired infection and 22 (32.8%) hospital acquired. Male was present in higher percentage 58.2% and the average age of patients was 39 years. Meticillin-sensitive strains are present in 73.1% and resistant isolates in 26.9%. Chi square test of independence showed a dependence isolated pathogens in relation to the place of infection p = 0,003. From the total number of metastatic foci, 39 was in the lung, 32 in the skin and subcutaneous tissue, 24 in the abdomen, 15 in the bones and joints, 11 heart and brain 2. CONCLUSION: The greatest number of metastases was in the lung. Significantly large number of patients had outpatient infection with predominance of meticillin sensitive strains while in hospital infections in a greater percentage were meticillin rezistent strains. Proven dependence of isolated pathogens in relation to the place of infection (outpatient/hospital).

Cellulitis--epidemiological and clinical characteristics.

INTRODUCTION: Cellulitis is acute skin infection and/or infection of subcutaneous tissue, mostly caused by Streptococcus pyogenes and Staphylococcus aureus. Clinical preview is usually obvious and enough for diagnosis. Tretment is antimicrobial therapy. In recurrent cases a prophylaxis is very often needed. OBJECTIVES: Analysis some of the epidemiological and clinical characteristics of cellulitis. PATIENTS AND METHODS: Retrospective analysis of medical documentation of patients with clinical preview of cellulitis who were hospitalized in Clinic for infective diseases of Clinical Center of University of Sarajevo in last three years. RESULTS: In period of three years 123 patients were hospitalized with clinical preview of cellulitis in the broadest sense of the word. In 123 of cellulitises, 35/123 (28.45%) were erisipelases-superficial type and 88/123 (71,55%) were deep cellulitises. Men were more affected 56,09%, average of age was 50.22 years. Before hospitalization patients had ambulance treatment in average of 5.12 days, and hospitalization was long in average of 13.33 days. Risk factors wich contributes to the disease were found in 71.54% of cases. Due to localisation, skin disorders on lower limb were the most frequent 71.56%, cellulitis of upper limb were found in 12.19%, head and/or neck in 13.08%, trunk in 3.25%. Repetition of disease were found in 4.8% in patients wtih risk factors. Bacteremic isolats were confirmed in 27.64% of cases. In all patients empirical antibiotic treatment were started, in the 62.60% the first choice of medicine was antibiotic from the group of lincosamides. CONCLUSION: Cellulitis is very serious disease that can be prevented.

Serratia marcescens meningitis following spinal anaesthesia and arthroscopy.

We present case of nosocomial bacterial meningitis, caused by Serratia marcescens (ESBL), occurred following spinal anaesthesia. Although very rare bacterial meningitis is serious complication of spinal anaesthesia and early diagnosis as well as effective treatment is extremely important. Previously healthy individual, admitted to Orthopaedic Department for routine arthroscopy, approximately within 24 hours after operation was performed complained of headache and fever. Infectious Diseases physician was consulted, lumbar puncture was performed and purulent meningitis was confirmed. Cerebrospinal fluid and blood cultures of patient confirmed Serratia marcescens (ESBL), resistant pathogen and important nosocomial agent. Patient was successfully treated. Cases of spinal meningitis caused by Serratia marcescens are rare. Local resistance pattern is important and should be always considered when starting therapy. Infection control team was appointed because of similar case of meningitis one month before in the same Department, and after investigation discovered Serratia in anaesthetic vial used in procedures. New measures and recommendations regarding infection control were implemented at Orthopaedic Department. Meningitis as a complication should always be considered as a possible differential diagnosis with patients after spinal anaesthesia complaining on headache and fever. Early diagnosis and early treatment is extremely important. Knowledge and practice of infection control measures is mandatory and should be always emphasized to performing staff.

The development of infectology in bosnia and herzegovina, with special emphasis on the development and history of infectious clinic, clinical center of sarajevo university.

CONFLICT OF INTEREST: none declared There is a relatively low amount of historical data about development of infectology in Bosnia and Herzegovina, but that does not mean that these medical disciplines didn't have important events and actors that are important for the development of this medical discipline in B&H. In this review we intent to show your several characteristic events and important persons, which left a lasting impression in the development of infectology service in BIH and especially in Sarajevo. Development center for this discipline was in Sarajevo. Experts on infectious diseases were sent from Sarajevo to other health centers to organize new ministry there. Infectology as an organized health care dates back to the Austro-Hungarian period, when a part of the State Hospital in Sarajevo formed a separate Department of Infectious Diseases. Thanks to the competent professional and later teaching staff in this discipline and the importance of health care of patients with infectious diseases, in Sarajevo and other cities in Bosnia, infectious diseases care has experienced expansion and increasing importance and quality. Infectious disease specialists were very quick in organizing their professional association and with exchange of knowledge and experience have contributed substantially to the above assertion. The "Association of infectious diseases of Bosnia and Herzegovina" was founded during the aggression on BIH, in 1994 and in 1997 they organized the first scientific congress of the Association of the infectious disease specialist with international participation. Improving the health of the population in the area of infectious diseases was significantly helped by infectious diseases clinics at clinical centers in BIH and departments for infectious diseases within the hospitals in B&H. Association of the infectious disease is a significant coordinator for scientific and professional activities, but also the environment in which infectious disease specialists are able to share their knowledge and experiences.

Analysis of comorbidity of the patients affected by staphylococcal bacteremia/sepsis in the last ten years.

CONFLICT OF INTEREST: none declared. INTRODUCTION: Staphylococcal bacteremia/sepsis is one of the most serious bacterial infections around the world. In individuals with pre-existing diseases, there is always an increased risk of infections occurring due to impaired immune system, a variety of drug therapy, exposure to a diagnostic and therapeutic procedure and frequent hospitalizations. OBJECTIVES: To analyze the prevalence of comorbidity in a patient with the staphylococcal bacteremia/sepsis according to the diagnosis, the site of infection and according to the isolated agent. PATIENTS AND METHODS: We analyzed the patients affected by the staphylococcal bacteremia/sepsis and treated in the Clinic for Infectious Diseases during a ten-year period. RESULTS: 87 patients were included, out of whom 20 (23%) with clinical signs of the bacteremia and 67 (77%) of sepsis. In the analyzed sample, in 36 (41.4%) were not registered comorbidity. Hospital infections are represented by the previous antibiotic, corticosteroid and chemo therapy, pressure ulcers, and different implants. In all comorbidity, the most common isolated bacteria was S. aureus primarily strain MSSA followed by MRSA strain which is more frequent in patients who were surgically treated (comorbidity-various implants). CONCLUSION: The results suggest the importance of being mindful of the staphylococcal etiology of the bacteremia/sepsis in patients with comorbidities due to the selection of an adequate initial empirical therapy and reducing the risks of the septic shock.

Varicella Pneumonia in a 39-year-old Female in Third Trimester Twin Pregnancy.

CONFLICT OF INTEREST: none declared. INTRODUCTION: Chickenpox is disease caused by varicella-zoster virus (VZV), with possibly devastated consequences during pregnancy, for mother and neonate. Pneumonia is most common complication in pregnancy with very high mortality. CASE REPORT: A 39-year-old female in third trimester twin pregnancy, referred to Clinic for infectious diseases in Sarajevo, with five days history of illness. Before the admission her condition get worse, with fatigue, exhaustion, and shortness of breath. In a first three days patient was febrile, tachydispnoic and ortopnoic. We started therapy with acyclovir and antibiotic. After four days we had detoriation in patient's condition. Chest X-ray revealed infiltrative shadows in basal parts of lung. Antimicrobial therapy was changed and corticosteroids were associated. Significant improvement was noticed after five days of therapy. CONCLUSION: Varicella pneumonia during third trimester may have serious consequences for mother and child, with possible fatal outcome.

On the occasion of the 4th congress of infectiologists of bosnia and herzegovina with international participation.

The 4th Congress of Infectiologists of Bosnia-Herzegovina with international participation was held in Konjic, on 30. May to 02. June 2012. In addition to the prominent infectious disease experts from almost all university centers in B&H, the teachers at medical schools in Bosnia-Herzegovina, infectious disease specialists who work in health institutions in B&H, this Congress was attended by infectious disease experts from Serbia (12 participants), Turkey (3 participants), Croatia (3 participants), Macedonia (3 participants), Germany (2 participants) and Montenegro (2 participants). Topics included: Infections of the skin, soft tissue and bones, Sepsis and endocarditis, Infectious diseases emergencies and pediatric infectology, Emerging and reemerging infectious diseases, Hospital infections, Sexualy transmitted diseases, Infectious diagnostic and therapeutic protocols. Participating invited speakers were following professors: Salih Hosoglu (Turkey), Hakan Leblebicioglu (Turkey), Resat Ozaras (Turkey), Karsten Plötz (Germany), Ilija Kuzman (Croatia), Bruno Barsic (Croatia), Goran Tesovic (Croatia). In addition to experts in infectious diseases at this Congress, their works were presented by experts from other medical disciplines, but with infectious character issues (Professors: Sead Ahmetagic, Ismet Gavrankapetanovic, Zora Vukobrat-Bijedic, Senija Rasic, Halima Resic, Adnan Kapidzic, Ivo Curic, Jelena Ravlija, Amela Begic, Izet Masic, Sadeta Hamzic, and others). Some of the papers that were presented at this Congress have been published in extenso, in the Medical Archives and Materia Socio Medica. One part as abstracts (both journals are indexed in over 10 databases), and will be electronically available to the general scientific community in Bosnia-Herzegovina, Europe and worldwide. In this way, the Bosnian infectious disease experts, as a science and profession, will be worthily represented to the colleagues from other countries in the region and beyond.