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Objectives: The objectives of this study were (i) to investigate the genetic background of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates from Croatia and (ii) to monitor the prevalence of Panton-Valentine leucocidin (PVL) and toxic shock syndrome toxin-1 (TSST-1) among these isolates.Methods: Eighty-two hospital-acquired MRSA bloodstream isolates, collected in 2001 and 2002 in Croatia, were characterized by PFGE, staphylococcal cassette chromosome mec (SCCmec) typing and multilocus sequence typing (MLST). The presence of genes encoding PVL and TSST-1 was investigated by real-time PCR.Results: All strains were multiresistant and were distributed among 16 different similarity groups as determined by PFGE. Two of the groups, groups H and K, harboured the majority of the MRSA strains with 52 and 12%, respectively. The predominant SCCmec type found among the isolates was type I (89%). Eleven per cent of the strains harboured a modified SCCmec type III, which contained, in contrast to the regular type III, an additional dcs region. One strain harboured a novel SCCmec type, containing the ccrC gene in combination with the mecI gene, the dcs region, the locus between pI258 and Tn554 (locus E) and the locus between Tn554 and orfX (locus F). MLST showed the presence of ST111-MRSA-I and ST247-MRSA-I among Croatian MRSA isolates. All isolates were negative for both PVL and TSST-1.Conclusions: These results indicate the emergence of ST111-MRSA-I and ST247-MRSA-I in Croatia among MRSA bloodstream isolates. The virulence factors PVL and TSST-1 were not present among these isolates. [ABSTRACT FROM AUTHOR]

Objectives For the empirical treatment of cystitis, clinicians are often guided by susceptibility data taken from urinary samples that sent to regional microbiological laboratories, which are not representatives for uncomplicated urinary tract infections (UTIs). To offer adequate recommendations, the distribution and susceptibility pattern of uropathogens in uncomplicated UTIs in women were compared with those obtained 10 years ago in our uropathogen surveillance in a primary healthcare setting. Methods Sixty-six general practitioners in the region of the city of Ghent were asked to inoculate a dipslide with midstream urine from every adult female patient with complaints suggestive for cystitis, during a period of 1 year. The dipslides were further processed in a central microbiological laboratory, where counting, identification and susceptibility testing were performed. Results Three hundred specimens were collected, of which 187 (62.3%) yielded a positive culture of 105 cfu/mL. In the age group of 18–54 years, Escherichia coli was the most frequently isolated uropathogen (77.5%), followed by Staphylococcus saprophyticus (13.5%) and Proteus spp. (2.7%). There were no statistically significant differences when compared with the data from 1996. In 2006, susceptibility of E. coli to nitrofurantoin was 100%, to quinolones 100%, to ampicillin 62.8% and to co-trimoxazole 86%, compared with 99.3%, 99.3%, 73.2% and 83.3%, respectively, in 1996 (no statistically significant differences). Conclusions Over a period of 10 years, a systematic surveillance of uropathogens in female patients with uncomplicated UTI in general practice could not demonstrate a significant change in species distribution or antimicrobial susceptibility. [ABSTRACT FROM AUTHOR]

Objectives An increase in antibiotic resistance of Escherichia coli, the most common pathogen in urinary tract infections (UTIs), is encountered worldwide. Optimal treatment of UTIs will contribute substantially to limit antibiotic use and antimicrobial resistance. This study determined trends in antimicrobial resistance of uropathogenic E. coli, which can be of use to optimize UTI guidelines. Methods During 1998–2005, E. coli from urine samples of patients attending urology services were collected in three regions in The Netherlands: north-east (NE, n = 1084), west (W, n = 1064) and south (S, n = 1212). The antibiotic susceptibility was determined using microbroth dilution following CLSI guidelines. E. coli ATCC 35218 and ATCC 25922 were used as reference strains. Results Amoxicillin resistance remained stable over time (37% to 47%), but was higher in the south (44%) compared with the other regions (40%; P P P P P P Conclusions Antibiotic resistance was fairly constant over time for most agents tested, except for piperacillin and the fluoroquinolones. Regional differences were observed for several compounds. National and regional surveillance of antibiotic resistance is important to keep therapeutic guidelines up-to-date and adequate for the treatment of resistant microorganisms. [ABSTRACT FROM AUTHOR]