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.

October 24, 2016 at 8:46 am

Med Glas (Zenica). 2015 Aug;12(2):157-68.

Uzunović S1, Bedenić B2, Budimir A3, Ibrahimagić A1, Kamberović F4, Fiolić Z5, Rijnders MI6, Stobberingh EE6.

Author information

1Department of Laboratory Diagnostics, Cantonal Public Health Institute of Zenica-Doboj Canton; Bosnia and Herzegovina.

2School of Medicine, University of Zagreb, Department of Molecular Microbiology, Clinical Hospital Center Zagreb; Croatia.

3Department of Molecular Microbiology, Clinical Hospital Center Zagreb; Croatia.

4Microbiology Department, Biotechnical Faculty, University of Ljubljana, Slovenia.

5Department of Surgery, Clinical Hospital Center Zagreb, Croatia.

6Department of Medical Microbiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Mastricht, The Netherlands.



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.


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.


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.


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.



Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Biología Molecular, Epidemiología, Health Care-Associated Infections, Infecciones en piel y tej blandos, Infecciones nosocomiales, Metodos diagnosticos, Resistencia bacteriana, Sepsis, Update.

Healthcare-Associated Methicillin-Resistant Staphylococcus aureus: Clinical characteristics and antibiotic resistance profile with emphasis on macrolide-lincosamide-streptogramin B resistance. Advances in the prevention, management, and treatment of community-acquired pneumonia.


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