Background: Acute uncomplicated cystitis in women is a common reason for antibiotic treatment in the outpatient clinic of family doctors. Microbiological diagnostics is not indicated; treatment is ...generally empirical and based on guidelines and recommendations. Therefore, we do not have representative data on the incidence and sensitivity of pathogens from regular laboratory work. Special targeted research is needed.
Methods: We present the results of the prospective research conducted in four regional laboratories of the Centre for Medical Microbiology NLZOH between 15 September 2017 and 31 December 2019. We included 110 female patients with suspected acute uncomplicated cystitis who completed a questionnaire and submitted urine samples for microbiological examination.
Results: The result of urine examination was positive in 79 patients (71.8%). Among all isolates, the most common bacterium was Escherichia coli (74%), followed by Staphylococcus saprophyticus (10%), and others. The susceptibility of E. coli to trimethoprim with sulfamethoxazole was 85.5%, to nitrofurantoin 98.4%, and to fosfomycin 100%. S. saprophyticus isolates were susceptible to the tested antibiotics except for fosfomycin, against which the bacterium is intrinsically resistant. The total susceptibility of all isolates was 85.8% - 88.2% for trimethoprim with sulfamethoxazole, 88.1% - 95.2% for nitrofurantoin, 73.8% - 80.8% for fosfomycin, 72.6% for ampicillin and amoxicillin, 97.7% for cefadroxil, and 98.9% for amoxicillin with clavulanate acid. A comparison with the results of monitoring bacterial resistance as part of the regular work of microbiological laboratories shows significant differences for most of the tested antibiotics.
Conclusion: The research results show a relatively good susceptibility of the causative agents of acute uncomplicated cystitis to oral antibiotics, the only exception being amoxicillin.
Introduction. In May of 2012, we investigated a food-borne Clostridium perfringens outbreak in Slovenia involving a single kitchen and five venues, with 477 exposed persons.
Methods. In order to ...identify the causative agent, vehicle of infection and source of contamination, we conducted microbiological and environmental investigations and an analytical cohort study (n = 138).
Results. The case definition in the outbreak was met by 104 persons. Predominant symptoms were diarrhoea, nausea and abdominal cramps. Median incubation time and duration of illness were 12 and 22.5 hours respectively. Stool samples were collected from 18 persons and in 13 C. perfringens spores were present; enterotoxin was detected in 9 persons. PCR and PFGE analysis of isolates from a cook with earlier onset time, who did not consume the implicated food, and cases from four venues showed the same strain of C. perfringens type A (with cpe-gene), indistinguishable by PFGE analysis. No food samples could be obtained. An analytical study showed that one food item (French salad) was the most likely vehicle of infection (RR: 6.35; 95% CI: 1.62-24.90).
Conclusions. This was the largest C. perfringens outbreak in Slovenia to date. Proper analytical study in combination with detailed laboratory investigation with genotypisation enabled us to identify a causative agent, vehicle of infection and possible source of contamination. Fast response and interdisciplinary collaboration led to timely implementation of control measures. These have led to the kitchen acquiring new equipment and improving staff knowledge of risks and processes, thus reducing the likelihood of future reoccurrences
Uvod. V maju 2012 smo preiskovali izbruh okužb s Clostridium perfringens, prenesenih s hrano, v katerega so bile vpletene ena kuhinja in pet lokaciji s 477 izpostavljenimi osebami.
Metode. Da bi ugotovili povzročitelja, pot prenosa in vir kontaminacije, smo izvedli laboratorijsko in okoljsko preiskavo ter analitično kohortno raziskavo (n = 138).
Rezultati. Definiciji primera v izbruhu so ustrezale 104 osebe. Prevladujoči simptomi so bili: driska, slabost in trebušni krči. Mediana časa inkubacije in trajanja bolezni je bila 12 ur in 22,5 ure. Vzorci blata so bili odvzeti 18 osebam; pri 13 so bile prisotne spore C. perfringens, enterotoksin je bil zaznan pri 9 osebah. PCR- in PFGE-analiza izolatov kuharja z zgodnejšim časom pojava obolenja, ki ni užival impliciranih živil, in primerov s štirih lokacij sta pokazali enak sev C. perfringens tipa A (s cpe genom), ki se ni razlikoval pri analizi PFGE. Vzorcev živil ni bilo mogoče pridobiti. Analitična študija je pokazala, da je bila najverjetnejša pot prenosa okužbe eno izmed živil (francoska solata) (RT: 6,35; 95% IZ: 1,62-24,90).
Zaključek. To je bil največji izbruh s C. perfringens v Sloveniji do zdaj. Ustrezna analitična raziskava v kombinaciji s podrobno laboratorijsko preiskavo z genotipizacijo nam je omogočila identifikacijo povzročitelja, pot prenosa okužbe in mogoč vir kontaminacije. Hiter odziv in interdisciplinarno sodelovanje je pripeljalo do pravočasne implementacije nadzornih ukrepov. Ti so privedli do nabave nove opreme v kuhinji, izboljšanja znanja osebja o tveganjih in procesih ter s tem zmanjšali verjetnost za ponovitve v prihodnje
Background: Clostridium difficile is an important cause of nosocomial diarrhoea. Strains are further differentiated into PCR ribotypes, and some ribotypes (e.g. 027) are often associated with ...outbreaks, increased disease severity and increased mortality. Here we describe the diversity of C. difficile among human isolates in Slovenia.Methods: All eight microbiological diagnostic laboratories providing C. difficile diagnostics in Slovenia have participated. Isolates from two–month- winter period were collected and ribotyped. The following data were also collected from the laboratories: number of all tested samples, number of all positive samples, and patient age and gender.Results: In a two-month period, altogether 860 samples were tested for C. difficile in all participating laboratories. Of those, 154 (17.9 %) samples from 125 patients were positive. The percentage of positive samples in different laboratories ranged from 13.3 to 43.2 %. Two out of eight laboratories did not have positive samples. C. difficile strains (n= 149) were grouped into 35 ribotypes. However, 57.7 % of all strains belonged only to two PCR ribotypes (027 and 014/020). PCR ribotype 027 was not present in Slovenia until 2010, but was in this study the most prevalent PCR ribotype and present mainly in the northeast region.Conclusions: There is a substantial diversity of C. difficile ribotypes in Slovenia. A high prevalence of ribotype 027 and a high percentage of positive samples in some laboratories indicate the presence of C. difficile outbreaks.
Macrolides and fluoroquinolones are regarded as drugs of choice for the treatment of human Campylobacter infections. The use of antimicrobials for this purpose as well as in food animal production ...has resulted in the resistance of Campylobacter spp. to selected antibiotics. Since poultry is one of the most important sources of human Campylobacter infections the use of antibiotics in animal production can shorten the effective therapeutic life of antibiotics for human use. During 2001-2003, over 220 strains of C. jejuni and C. coli were isolated from 60 poultry meat samples from the retail market in Slovenia and further characterized by phenotypic and molecular methods. In this study, 55 sample-representative strains were tested for susceptibility to eight different antibiotics (ampicillin, amoxycillin/clavulanic acid, ciprofloxacin, erythromycin, gentamicin, nalidixic acid, pefloxacin and tetracycline). Phenotypic procedures (disc diffusion test, E-test) as well as molecular detection of mutations (mismatch amplification mutation assay (MAMA) polymerase chain reaction (PCR)) in case of ciprofloxacin resistance were used. When assuming the results about antibiotic resistance, only 38.2% of strains tested were susceptible to all antibiotics tested. Regarding ciprofloxacin, 58.2% of tested strains were found to be resistant (minimal inhibitory concentration, MIC>4 microg/mL). The occurrence of resistance was much higher in C. coli (75.9%) than in C. jejuni (38.5%) isolates. The resistance rates to pefloxacin, nalidixic acid, erythromycin and tetracycline were 58.2, 49.1, 14.5 and 12.7%, respectively. Eleven percent of strains were resistant to erythromycin and ciprofloxacin and 12.7% of strains were resistant to tetracycline and quinolones. The results show the need for monitoring the prevalence and antibiotic resistance of zoonotic bacteria such as Campylobacter as well as the multiresistance phenomenon of Campylobacter isolates from food in our country.
BACKGROUND Shiga toxin-producing E. coli or Vero cytotoxin-producing E. coli (VTEC) are characterised by the ability to produce either one or both cytotoxins referred to as Shiga toxin 1 (Stx1) and ...Shiga toxin 2 (Stx2). VTEC infection may result in life-threatening conditions such as haemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP). Due to different methods of monitoring and identification of these bacteria in recent years, the existing data on reported cases of VTEC infections probably do not reflect reality. Our study of VTEC strains isolated in different regions of Slovenia, showed serogroups, major virulence factors and specific epidemiological data that can serve as a basis for further laboratory and epidemiological surveillance of VTEC infections. METHODS A total of 66 VTEC strains, isolated from stool samples of patients with diarrhoea from the year 1993 to 2009, were collected at NIPH (National Institute of Public Health). The data of patient's age and gender, onset of illness and clinical manifestation of disease were gathered. The serogroups of isolated strains were determined with antisera following manufacturer's instructions. The ability to produce verocytotoxins was tested using the reversed passive latex agglutination method. The presence of genes for intimin (eae), enterohaemolysin (ehxA) and verotoxins (vtx1 and vtx2) were determined by polymerase chain reaction (PCR). RESULTS Infection with VTEC was encountered throughout the year, but most people were ill in the summer and autumn months. More than half of patients (57.6 %) were younger than five years. Collected VTEC strains belonged to serogroups O17, O26, O91, O103, O111, O113, O126, O128, O145, O148 and O157 (the most frequent were O157 and O26). A high percentage of VTEC strains showed the presence of intimin (86.4 %) and enterohaemolysin (86.4 %) genes. The gene for vtx1 was found in 22.7 % of strains, the vtx2 in 57.6 % of strains, while the presence of both genes was determined in 19.7 % of strains. The presence of the vtx2 gene was determined in all strains associated with HUS and TTP, most of them possessed the eae and ehxA genes too. These patients were mostly older people and young children. CONCLUSIONS Most infections with VTEC occurred in the warmer months of the year, most patient were small children. The severity of VTEC infection is determined by several factors such as the E. coli serogroup, the type of Shiga toxin produced and presence of other virulence genes. The most common serogroups among the study strains were O157 and O26. VTEC O26 has been the most commonly isolated serogroup in recent years, nevertheless more and more different serological groups began to emerge. In all strains associated with HUS and TTP, the vtx2 gene was determined. Further typing of verocytotoxin encoding genes will contribute to assess the risk for complications with VTEC infection. The study provides insights about the age of the patients, seasonal distribution of disease, serogroups and genotypes of the agent.
background Rotaviruses are the major cause of acute watery diarrhea in children up to 5 years of age. In 2007 and 2008 an extensive rotavirus molecular epidemiology study was conducted in Slovenia in ...order to provide information on rotavirus molecular epidemiology in our country. This study is part of the EuroRotaNet, European rotavirus surveillance study. Methods A total of 823 stool samples were collected from children with acute gastroenteritis in seven out of nine healthcare regions in Slovenia. The total RNA was extracted and first amplification of VP7 and VP4 genes was performed in RT-PCR. The RT-PCR product was used for genotyping in multiplex-nested PCR. Untypable strains were included in sequence analysis of VP7 and VP4 genes. Results Genotype distribution similar to that in other European countries was observed. G1P8, G2P4, G3P8, G4P8 and G9P8 were the most prevalent genotypes in 2007 and 2008, except of G3P8, not detected in 2008. Relatively high rate of possible zoonotic strains was detected in 2007 (2.5%). The emerging unusual strain G10P14 was the only potential zoonotic strain detected in 2007 and 2008. conclusions After the vaccine introduction in Slovenia in 2007, no specific changes in molecular epidemiology of rotaviruses was observed. This finding was expected since rotavirus vaccine coverage in 2007 in Slovenia was very low. Genotype G1P8 remains the most prevalent genotype. The rotavirus strain surveillance in Slovenia should be carried on to allow monitoring the spread of some unusual rotavirus genotypes, like G10. The G10 strains should be tracked especially in vaccinated children as no data on vaccine efficiency against infection with G10 strains was presented till now.
•In Slovenia macrolide consumption decreased by 42.4% in the period 1997 to 2017.•The macrolide resistance of invasive pneumococci increased from 5.8% to 12.8%.•Spread of a clone explains the ...increased macrolide resistance among invasive pneumococci.•Reduced consumption of antibiotics is not enough to reverse microbial resistance.
The objective of this study was to investigate the correlation between decreased national consumption of macrolides and resistance of invasive Streptococcus pneumoniae isolates in Slovenia during 1997–2017.
A total of 4241 invasive S. pneumoniae isolates were collected in Slovenia from 1997 to 2017. The presence of erm(B), mef(E), mef(A) and erm(TR) genes was determined by PCR in 612 erythromycin-resistant isolates. Selected isolates carrying the mef(A) gene were further examined by pulsed-field gel electrophoresis (PFGE). Multilocus sequence typing (MLST) was performed for 161 erythromycin-resistant isolates from 2004 to 2009.
Consumption of macrolides decreased by 42.5% between 1997 and 2017, and by 57.0% from the highest consumption during 1999 to 2017. Resistance of S. pneumoniae increased by 120.7% in the same period, from 5.8% in 1997 to 12.8% in 2017. The most prevalent serotypes among macrolide-resistant isolates were 14 (54.9%), 19A (9.0%), 19F (8.3%), 6B (7.2%), 6A (5.2%) and 9V (19; 3.0%). The most prevalent determinant of macrolide resistance in the observed period was erm(B) (43.0%; 263/612), followed by mef(A) (36.3%; 222/612) and mef(E) (14.9%; 91/612). During the study period, an increasing trend in serotype 14, mef(A)-carrying isolates was observed, with a peak in 2011 (P<0.001); 63/71 isolates (88.7%) with the mef(A) gene were clonally related and were related to the international England14-9 clonal cluster.
The reason for the observed increase in macrolide resistance among invasive S. pneumoniae in Slovenia despite decreased macrolide consumption was spread of the England14-9 clonal cluster.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
In May of 2012, we investigated a food-borne Clostridium perfringens outbreak in Slovenia involving a single kitchen and five venues, with 477 exposed persons.
In order to identify the causative ...agent, vehicle of infection and source of contamination, we conducted microbiological and environmental investigations and an analytical cohort study (n = 138).
The case definition in the outbreak was met by 104 persons. Predominant symptoms were diarrhoea, nausea and abdominal cramps. Median incubation time and duration of illness were 12 and 22.5 hours respectively. Stool samples were collected from 18 persons and in 13 C. perfringens spores were present; enterotoxin was detected in 9 persons. PCR and PFGE analysis of isolates from a cook with earlier onset time, who did not consume the implicated food, and cases from four venues showed the same strain of C. perfringens type A (with cpe-gene), indistinguishable by PFGE analysis. No food samples could be obtained. An analytical study showed that one food item (French salad) was the most likely vehicle of infection (RR: 6.35; 95% CI: 1.62-24.90).
This was the largest C. perfringens outbreak in Slovenia to date. Proper analytical study in combination with detailed laboratory investigation with genotypisation enabled us to identify a causative agent, vehicle of infection and possible source of contamination. Fast response and interdisciplinary collaboration led to timely implementation of control measures. These have led to the kitchen acquiring new equipment and improving staff knowledge of risks and processes, thus reducing the likelihood of future reoccurrences.
Abstract Background: Clostridium difficile is an important cause of nosocomial diarrhoea. Strains are further dierentiated into PCR ribotypes, and some ribotypes (e.g. 027) are oen associated with ...outbreaks, increased disease severity and increased mortality. Here we describe the diversity of C. difficile among human isolates in Slovenia. Methods: All eight microbiological diagnostic laboratories providing C. difficile diagnostics in Slovenia have participated. Isolates from two month- winter period were collected and ribo-typed. The following data were also collected from the laboratories: number of all tested samples, number of all positive samples, and patient age and gender. Results: In a two-month period, altogether 860 samples were tested for C. difficile in all participating laboratories. Of those, 154 (17.9 %) samples from 125 patients were positive. The percentage of positive samples in dierent laboratories ranged from 13.3 to 43.2 %. Two out of eight laboratories did not have positive samples. C. difficile strains (n= 149) were grouped into 35 ribotypes. However, 57.7 % of all strains belonged only to two PCR ribotypes (027 and 014/020). PCR ribotype 027 was not present in Slovenia until 2010, but was in this study the most prevalent PCR ribotype and present mainly in the northeast region. Conclusions: There is a substantial diversity of C. difficile ribotypes in Slovenia. A high prevalence of ribotype 027 and a high percentage of positive samples in some laboratories indicate the presence of C. difficile outbreaks.
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