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Introduction: although the term “polytrauma” has been in use for decades, no generally accepted definition exists. Our definition has been until 2010: a combination of injuries where one, or the combination where one, or the combination of injuries himself is directly life threatening, in detail is meant: injury to two body cavities, or injury to one cavity committed by two long bone fractures, where spine and unstable pelvis has counted similarly as an injury to a cavity organ. Since 2013 a new definition has been established, the so-called Berlin definition. "A polytrauma means significant injuries of three or more points (AIS) in two or more different anatomic AIS regions in conjunction with one or more additional variables from 5 physiologic parameters: Hypotension (SBP - Systolic Blood Pressure

Background: Infections are common in patients with liver cirrhosis and increase mortality. We explored the relationship between infection and liver dysfunction in their effects on mortality. ----- Methods: Single-center data on decompensated liver cirrhosis patients hospitalized between March 2014 and December 2017 (index period) were reviewed until death, liver transplantation or 31 December 2018. Infections were classified as community-acquired infection (CAi) or hospital/healthcare associated infection (HCAi). Child-Pugh, model for the end-stage liver disease (MELD) and chronic liver failure-organ failure (CLiF-OF) scores indicated liver (dys)function. ----- Results: We enrolled 155 patients (85% alcoholic liver disease), 65 without infection at first hospitalization, 48 with CAi and 42 with HCAi. Multidrug resistant agents were confirmed in 2/48 (4.2%) CAi and 10/42 (23.8%) HCAi patients. At first hospitalization, infection was independently associated with worse liver dysfunction and vice versa, and with higher 30-day mortality [odds ratio (OR) = 2.73, 95% confidence interval (CI) 1.07-6.94]. The association was reduced with adjustment for MELD/CLiF-OF scores, but mediation analysis detected an indirect (via liver dysfunction) association. Twenty-eight patients were repeatedly hospitalized, 11 with new HCAi. HCAi was independently associated with twice higher risk of medium-term mortality and added an additional risk to any level of liver dysfunction, considering all or patients who survived the first 30 days. In those repeatedly hospitalized, HCAi appeared independently associated with a higher probability of infection and higher MELD scores at subsequent hospitalizations. ----- Conclusion: Infection (particularly HCAi) adds mortality risk to any level of liver dysfunction in decompensated liver cirrhosis patients. Mechanisms of long(er)-term effects (in acute episode survivors) seemingly include enhanced deterioration of liver function.

Background Reliable high-throughput microbial pathogen identification in human urine samples is crucial for patients with cystitis symptoms. Currently employed methods are time-consuming and could lead to unnecessary or inadequate antibiotic treatment. Purpose of this study was to assess the potential of mass spectrometry for uropathogen identification from a native urine sample. Methods In total, 16 urine samples having more than 105 CFU/mL were collected from clinical outpatients. These samples were analysed using standard urine culture methods, followed by 16S rRNA gene sequencing serving as control and here described culture-independent MALDI-TOF/TOF MS method being tested. Results Here we present advantages and disadvantages of bottom-up proteomics, using MALDI-TOF/TOF tandem mass spectrometry, for culture-independent identification of uropathogens (e.g. directly from urine samples). The direct approach provided reliable identification of bacteria at the genus level in monobacterial samples. Taxonomic identifications obtained by proteomics were compared both to standard urine culture test used in clinics and genomic test based on 16S rRNA sequencing. Conclusions Our findings indicate that mass spectrometry has great potential as a reliable high-throughput tool for microbial pathogen identification in human urine samples. In this case, the MALDI-TOF/TOF, was used as an analytical tool for the determination of bacteria in urine samples, and the results obtained emphasize high importance of storage conditions and sample preparation method impacting reliability of MS2 data analysis. The proposed method is simple enough to be utilized in existing clinical settings and is highly suitable for suspected single organism infectious etiologies. Further research is required in order to identify pathogens in polymicrobial urine samples.

Here, we report a retrospective study conducted to elucidate emergence, epidemiology, and molecular mechanisms of resistance underlying the early spread of OXA-48 carbapenemase-producing Enterobacteriaceae in Croatia. Retrospective screening for OXA-48 producers was performed on a collection of 296 nonrepetitive, carbapenem-nonsusceptible enterobacterial isolates collected from January 2011 to December 2012 from 40 participating centers in Croatia. Antimicrobial susceptibility profiles and production of carbapenemases were assessed phenotypically. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing were used for epidemiological analysis. Resistance genes were characterized by polymerase chain reaction (PCR) and sequencing. Plasmid localization of bla(OXA-48) in isolates and transconjugants was investigated by S1-PFGE and Southern hybridization. PCR mapping was used for identification of genetic platform surrounding bla(OXA-48). Out of 296 carbapenem-nonsusceptible isolates, bla(OXA-48) gene was detected in 12 Klebsiella pneumoniae isolates. All OXA-48-producing isolates showed varying resistance to carbapenems and 11 were multidrug resistant. All coproduced additional beta-lactamases, including CTX-M-15, which was detected in eight isolates. Isolates were delineated in five clonal types by PFGE corresponding to five sequence types (STs) assigned ST15, ST16, ST37, ST528, and ST1418. All OXA-48 isolates conjugated successfully and other resistance determinants were not cotransferred. bla(OXA-48) was carried on a approximate to 60kb IncL/M plasmid and was detected within Tn1999.2 composite transposon. OXA-48, a class D carbapenemase, is emerging as a potentially significant contributor among carbapenem-resistant Enterobacteriaceae in Croatia, alongside class A and B carbapenemases. Polyclonal genetic background of K. pneumoniae isolates carrying approximate to 60kb incL/M plasmid indicates that dissemination of the bla(OXA48) gene is not driven exclusively by the spread of a single clone.

OBJECTIVEAn effective treatment of patients in a minimally conscious state (MCS) or vegetative state (VS) caused by hypoxic encephalopathy or traumatic brain injury (TBI) is not yet available. Deep brain stimulation (DBS) of the thalamic reticular nuclei has been attempted as a therapeutic procedure mainly in patients with TBI. The purpose of this study was to investigate the therapeutic use of DBS for patients in VS or MCS.METHODSFourteen of 49 patients in VS or MCS qualified for inclusion in this study and underwent DBS. Of these 14 patients, 4 were in MCS and 10 were in VS. The etiology of VS or MCS was TBI in 4 cases and hypoxic encephalopathy due to cardiac arrest in 10. The selection criteria for DBS, evaluating the status of the cerebral cortex and thalamocortical reticular formation, included: neurological evaluation, electrophysiological evaluation, and the results of positron emission tomography (PET) and MRI examinations. The target for DBS was the centromedian-parafascicular (CM-pf) complex. The duration of follow-up ranged from 38 to 60 months.RESULTSTwo MCS patients regained consciousness and regained their ability to walk, speak fluently, and live independently. One MCS patient reached the level of consciousness, but was still in a wheelchair at the time the article was written. One VS patient (who had suffered a cerebral ischemic lesion) improved to the level of consciousness and currently responds to simple commands. Three VS patients died of respiratory infection, sepsis, or cerebrovascular insult (1 of each). The other 7 patients remained without substantial improvement of consciousness.CONCLUSIONSSpontaneous recovery from MCS/VS to the level of consciousness with no or minimal need for assistance in everyday life is very rare. Therefore, if a patient in VS or MCS fulfills the selection criteria (presence of somatosensory evoked potentials from upper extremities, motor and brainstem auditory evoked potentials, with cerebral glucose metabolism affected not more than the level of hypometabolism, which is judged using PET), DBS could be a treatment option.

We report a case of necrotizing fasciitis of the leg caused by Vibrio cholerae O8 in a 63-year-old immunocompetent man after he had been fishing in a lake on a Croatian island. The strain was cytotoxic, invasive and adhesive and contained a fragment of the gene for El Tor-like hemolysin (El Tor hlyA). After surgical and antibiotic treatment, the patient fully recovered.

STUDY DESIGN: Case report. OBJECTIVE: The nontraumatic cranial epidural hematoma is an extremely rare clinical entity and it commonly occurs in the presence of infectious diseases as complication of sinusitis, coagulopathy, vascular malformation of the dura, hemorrhagic tumor, in patients with sickle cell disease, systemic lupus erythematosus, after open heart surgery, and in patients on hemodialysis. SUMMARY OF BACKGROUND DATA: We reported a case of spontaneous epidural hematoma that occurred after herniated disc surgery. There was no history of preceding head trauma and patient medical history was unremarkable. To date, no report is found of cranial epidural hematoma after lumbar discectomy. METHODS: A 58-year-old woman was operated because of a herniated disc at lumbar L3-L4 level and spinal stenosis. Bilateral L3-L4 interlaminectomies and L3-L4 discectomy were performed. Hemovac drain was placed in epidural space. Four hours after surgery, the patient developed left side weakness accompanied with nausea, vomiting, and severe headache. Urgent computed tomography of the head showed acute cranial epidural hematoma and the patient underwent emergent surgery. There was no evidence of trauma of the scalp or any other anatomical abnormality. Control computed tomography 14 hours after evacuation of the hematoma showed new extradural hematoma at the site of the previous one. Patient underwent second surgery. RESULTS: Nine days after operation of the spine, patient recovered completely with no neurological deficit, but the cerebrospinal fluid showed at the place of spinal wound. Patient was operated once more and a minor dural tear was revealed, which was repaired. The patient was discharged on ninth postoperative and she recovered completely. CONCLUSION: There have been described rare cases of spontaneous subdural, intracerebral, and intracerebellar hematoma caused by intracranial hypotension, but this is the first described case of spontaneous cranial epidural hematoma after lumbar disc surgery caused by intracranial hypotension.

Aspergillosis of the central nervous system (CNS) is a rare, but well described disease in immuno-competent patients. We present a 65-year-old patient who developed neuro-aspergillosis 10 months after severe cranio-facial trauma (Le Fort III). He was treated successfully with surgery including stereotactic drainage and, with Amphotericin B, Liposomal Amphotericin B, and Itraconazol.

Healthcare-associated infections have serious implications for both patients and hospitals. Environmental surface contamination is the key to transmission of nosocomial pathogens. Routine manual cleaning and disinfection eliminates visible soil and reduces environmental bioburden and risk of transmission, but may not address some surface contamination. Automated area decontamination technologies achieve more consistent and pervasive disinfection than manual methods, but it is challenging to demonstrate their efficacy within a randomized trial of the multiple interventions required to reduce healthcare-associated infection rates. Until data from multicenter observational studies are available, automated area decontamination technologies should be an adjunct to manual cleaning and disinfection within a total, multi-layered system and risk-based approach designed to control environmental pathogens and promote patient safety.

Background The current nursing shortage and high turnover is often a problem in many hospitals and is related to job satisfaction and motivation. Aim: The purpose of this study was to investigate if motivation and job satisfaction of nurses are related to work safety, implementing intravenous access guidelines for peripheral venous access ; and the guidelines for the prevention of intravascular catheter-related infections. Methods: A pre-post design was used to administer a questionnaire regarding nurse satisfaction (personally made), and a qustionnaire regarding intravenous access installment and maintenance ( "The Infusion Nurse and Patient Complication Rates of Peripheral - Short Catheters, Journal of Intravenous Nursing, vol. 24, no.2, March/April 2001:113-123" ; "Policies and Procedures for Infusion Nursing. 3rd edition. Norwood: Infusion Nursing Society. 2006."), and a checklist for the practitioners who insert central venous catheters and the persons resposible for the surveillance and control (Center for Disease Control, 1996). Results: After implementing a series of measures to develop nursing practice in peripheral intravenous and central venous access from October 2010 - May 2014, we found a decrease in complication rates related to vascula access. Nurses also expressed improved levels of job satisfaction, stated that they took pride in improved safety and had higher levels of motivation. Conclusion: The study found a strong positive relationship between improvements in patient treatment , guideline implementation, decrease in catheter-related blood stream injuries (CBRSI), safe working enviroment and job satisfaction and motivation. It is possible that the Hawthorne Effect may have had an influence on these findings, but that with standing we have demonstrated the positive benefits to staff motivation and job satisfaction from implementing a programme of practice development within high dependency cardiac unit.

Plasmid-encoded resistance to broad-spectrum cephalosporins and aztreonam is becoming a widespread phenomenon in clinical medicine. These antibiotics are inactivated by an array of different extended-spectrum beta-lactamases (ESBLs) which have evolved by point mutations of parental TEM or SHV beta-lactamases. In a previous study conducted during 1994-1995, SHV-2, SHV-2a and SHV-5 beta-lactamases were found among Klebsiella pneumoniae isolates in Dubrava University Hospital. High prevalence of ESBLs among K. pneumoniae strains in this hospital (20%) required further investigation. In this investigation, beta-lactamases from 42 K. pneumoniae strains collected in 1997 and 15 in 2004 from Dubrava University Hospital, were characterized in order to study the evolution of plasmid-encoded resistance to extended-spectrum cephalosporins and aztreonam in that hospital over a prolonged study period. Susceptibility to antibiotics was determined by disk-diffusion and broth microdilution method. beta-lactamases were characterized by isoelectric focusing, determination of hydrolysis of beta-lactam substrates, polymerase chain reaction and sequencing of bla(SHV) genes. All K. pneumoniae strains and their Escherichia coli transconjugants produced beta-lactamase with an isoelectric point of 8.2. Based on sequencing of bla(SHV) genes enzymes of all transconjugants were identified as SHV-5 beta-lactamase which conferred on the producing isolates high level of ceftazidime and aztreonam resistance. In this study, an outbreak of nosocomial infections caused by SHV-5 producing K. pneumoniae was described in 1997 which evolved to endemic spread of SHV-5 producing K. pneumoniae due to multiple plasmid transfer in the Dubrava University Hospital. The strains from 1997 and 2004 were not clonally related. Hospital hygiene measures should be applied in order to control the spread of epidemic strains through the hospital wards and the consumption of the broad-spectrum cephalosporins needs to be restricted to reduce the selection pressure which enables the proliferation of ESBL producers in hospital.

The paper provides the results of the microbiological analysis of samples taken from the mummified remains of St. Marcian. Microorganisms found belong to bacteria and fungi of the genera Aspergillus, Bacillus, Penicillium, Sarcina, and Shewanella which are all a part of the common air, soil, and human microbial flora and therefore present no health hazard.

Smjernice za perioperativnu profilaktičku primjenu antimikrobnih lijekova (u nastavku teksta Smjernice) sastavljene su na inicijativu Interdisciplinarne sekcije za kontrolu rezistencije na antibiotike (ISKRA) Ministarstva zdravstva i socijalne skrbi RH. Pri sastavljanju Smjernica primijenjena je tzv. metodologija AGREE (engl. Appraisal of Guidelines for Research and Evaluation), što podrazumijeva konsenzus svih zainteresiranih stručnih društava. Izradi Smjernica pristupilo se kako bi se unaprijedila primjena antimikrobnih lijekova u kirurškim strukama. Podaci opservacijskih studija pokazuju da upravo u kirurškim strukama primjena antimikrobnih lijekova ne zadovoljava, a kako oko 50% propisanih lijekova u kirurškim strukama otpada na perioperativnu profilaksu, ovakve smjernice značajno bi mogle popraviti trenutačno nezadovoljavajući trend i smanjiti infekcije u kirurških bolesnika te usporiti selekciju rezistentnih bakterija. U uvodnom dijelu Smjernica prikazani su principi perioperativne profilakse. Navode se prednosti i rizici profilakse te čimbenici koji određuju učinkovitost profilakse. U svrhu lakšeg snalaženja kirurške su struke podijeljene na osnovna operativna područja. U svakom je području prvo navedena specifičnost područja, a zatim slijede tablice koje su jednoobrazno strukturirane i uz svaki navedeni kirurški zahvat stoji najvjerojatniji uzročnik infekcije, prvi izbor profilaktičkog lijeka, alternativa, napomena za pojedini kirurški zahvat i na kraju razina preporuke. Smjernice ne obuhvaćaju perioperativnu profilaksu u imunokompromitiranih bolesnika niti perioperativnu profilaksu u djece. Smjernice ne obuhvaćaju sve moguće kirurške zahvate i procedure, ali mogu služiti kao osnova za postupak za većinu takvih zahvata koji se izvode u našim bolnicama. Na kraju Smjernica opsežan popis literaturnih referenci omogućava zainteresiranima da se orijentiraju i o detaljima koji zbog ograničenog prostora nisu mogli biti navedeni u tekstu Smjernica. Predviđeno je da se Smjernice revidiraju za 3 godine., The development of the Guidelines for perioperative prophylactic use of antimicrobial agents (further on Guidelines) was initiated by the Interdisciplinary Section for Antibiotic Resistance Control (ISKRA) of the Croatian Ministry of Health and Social Welfare in accordance with the principles of AGREE (Appraisal of Guidelines for Research and Evaluation) methodology which means that the guidelines are the result of a consensus between all involved professional societies. Guidelines were composed in order to improve antibiotic use in surgical professions. Data obtained from observational studies have shown that the use of antimicrobials in surgical professions is unsatisfactory, and since around 50% of all prescribed drugs in surgical professions refer to perioperative prophylaxis, such guidelines could significantly improve current negative trend and reduce the occurrence of infections in surgical patients as well as slow down the selection of resistant bacteria. In the introductory part of the guidelines, principles of perioperative prophylaxis are presented. The advantages and risks of prophylaxis are listed as well as factors that determine prophylaxis effectiveness. For easier orientation, surgical professions have been divided into basic surgical fields. In each field, the specificity of the field has been described followed by uniform structured tables and with every listed surgical procedure there is the most probable cause of infection, the drug of choice for prophylaxis, alternative drug, remark for particular surgical procedure and finally the grade of recommendation. The Guidelines do not cover perioperative prophylaxis in immunocompromised patients nor perioperative prophylaxis in children. The Guidelines do not cover all possible surgical interventions, but can be used as a basis for most surgical procedures performed in our hospitals. At the very end of these Guidelines, a comprehensive list of references enables all those interested to find further information and details about this topic. The revision of the Guidelines is planned in three years’ time.

OBJECTIVES: To evaluate the impact of oral health on the evolution of nosocomial infections and to document the effects of oral antiseptic decontamination on oral health and on the rate of nosocomial infections in patients in a surgical intensive-care unit (ICU). DESIGN: A prospective, randomized, double-blind, placebo-controlled clinical trial. SETTING: Surgical ICU in University Hospital Dubrava. PATIENTS: The study included 60 nonedentulous patients consecutively admitted to the surgical ICU and requiring a minimum stay of three days. MAIN OUTCOME MEASURES: After randomization, the treatment group underwent antiseptic decontamination of dental plaque and the oral mucosa with chlorhexidine gel. The control group was treated with placebo gel. Dental status was assessed using a caries-absent-occluded (CAO) score, and the amount of plaque was assessed using a semi-quantitative score. Samples of dental plaque, oral mucosa and nasal and tracheal aspirates were collected for bacterial culture, and nosocomial infections were assessed. RESULTS: The plaque score significantly increased in the control group and decreased in the treated patients. Patients who developed a nosocomial infection had higher plaque scores on admission and during their ICU stay. The control group showed increased colonization by aerobic pathogens throughout their ICU stay and developed nosocomial infections (26.7%) significantly more often than the treated patients (6.7%); the control group also stayed longer in the ICU (5.1 ± 1.6 vs. 6.8 ± 3.5 days, P = 0.019). Furthermore, a trend in reduction of mortality was noted in the treated group (3.3% vs. 10%). CONCLUSIONS: Among surgical ICU patients, poor oral health had a significant positive correlation with bacterial colonization and the evolution of nosocomial infections. Oral decontamination with chlorhexidine significantly decreased oropharyngeal colonization, the incidence of nosocomial infections, length of ICU stay, and mortality in these patients.

SAŽETAK Nedavni napredak u medicini koji uključuje razvoj snažnih antimikrobnih lijekova, suvremenu dijagnostiku i poboljšane operacijske metode, smanjio je postotak bolesti i smrtnost od infekcija kralježnice. Međutim, još uvijek ima dvojbi vezanih uz čim bržu ciljanu dijagnostiku i pravilno liječenje. Prikazana su sadašnja iskustva u strategiji liječenja infekcija kralježnice na Odjelu za ortopediju Kliničke bolnice Dubrava, Zagreb., SUMMARY Recent progress in medical technologies including the development of potent antimicrobial drugs, advanced imaging, and improved surgical methods, have reduced morbidity and mortality rates for spinal infections; however, debate still exists on the general diagnostic and proper management principles of the disease. Review of the experience about current treatment strategy for eradications of the spine infections at the Department of Orthopaedic Surgery Dubrava University Hospital Zagreb.

Three Escherichia coli isolates resistant to third-generation cephalosporins but negative for extended-spectrum beta-lactamase production were isolated from hospitalised patients in Zagreb, Croatia, during June 2003 to February 2004. Resistance was due to the inducible production of a DHA-1 cephalosporinase. Each isolate contained an integron-associated bla(DHA-1)-ampR sequence carried by similar-sized plasmids, of which one was self-transferable. Serotyping and polymerase chain reaction typing using ERIC2 primer indicated that the isolates were distinct. This is the first description of DHA beta-lactamase production in E. coli.

Bacterial contamination of blood products cause significant patient morbidity and mortality. Contaminated platelet transfusion ia a frequent cause of bacteremia and sepsis because of the storage conditions of platelets. A fatal case of Morganella morganii platelet transfusion associated with sepsis is described, along with procedures traced back to the isolation of M.morganii from a donors stool. Molecular typing was performed (Pulse Field Gel Electrophoresis-PFGE) and the same M. morganii strain was found in blood and post mortem organ cultures of platelet recipient and platelet bag and in the donor's stool. The route of contamination is unknown. The contamination could be due to either insufficient venipuncture site disinfection or the donor's transient bacteriemia. Patient died five days after transfusion.

Svrha ove studije bio je istražiti mikrobnu floru periapikalnih ostitičkih lezija kod jednokorijenskih zuba. Posebno su analizirani periapikalni procesi kod kojih je kanal zuba bio otvoren i oni kod kojih je kanal bio zatvoren (nadogradnja). Uzorci za mikrobiološku raščlambu uzimani su tijekom operativnoga zahvata - apikotomije. Dobiveni rezultati većim se dijelom uklapaju u dosadašnje spoznaje o mikrobnoj flori odontogene infekcije. Polimikrobijalni sastav flore sa znatnim udjelom anaerobnih bakterija te reducirana mikrobna flora u zatvorenim ostitičkim lezijama osnovne su značajke periapikalne infekcije. Najčešći izolati bili su iz skupine streptokoka, a najčešći anaerob Veillonela. Utvrđeno je da se streptokoki češće javljaju u zatvorenim ostitičkim procesima., The aim of this study was to investigate the microbial flora of periapical ostitic lesions in single rooted teeth. Periapical processes in which the root canal was open and those in which the canal was closed (reinforcement) were analysed. Samples for microbiological analysis were taken during the operation - apicotomy. On the whole the results obtained agree with current knowledge of the microbial flora in odontogenic infection. The polymicrobial composition of the flora with a significant share of anaerobic bacteria and reduced microbial flora in closed ostial lesions are the basic characteristics of periapical infection. The most frequent isolates found were from the streptococci group, and the most frequent anaerobe, Veillonela. It was determined that streptococci occur more frequently in closed ostial processes.

The subject of this research is the nutritive effect that different quantities (10 and 20%) of dried olive cake had on total proteins and the proportion of individual proteins, on triacylglycerols, on total cholesterol, HDL and glucose in the serum of fattened rabbits following a 56-day experiment. The experiment involved 60 rabbits, divided into three groups: a control group (C) and two test groups (E1 and E2), each comprising 10 males and 10 females. Throughout the experiment, rabbits in group C received no olive cake in their feed; group E1 rabbits were fed a feed mixture containing 10% of dried olive cake; group E2 rabbits received a feed mixture containing 20% of dried olive cake. After the 56th day of the experiment, blood samples were obtained by cardiac puncture, and specific heamatological variables, total proteins and their fractions, triglycerides, total cholesterol, HDL and glucose were established in the serum. The results obtained show no significant differences in the concentration of total proteins, albumin, alpha1, alpha2, beta and gamma globulin in the serum of rabbits in control group and in the two test groups. Similarly, no significant differences were found in the concentration of serum triacylglycerols and glucose between group C rabbits and the two test groups. However, group E1 rabbits did show a significantly lower concentration of cholesterol compared with those in group E2; group E1 rabbits also had a significantly (P

SIR, -Although mites of the genus Demodex were described as parasites of hair follicles and sebaceous glands in man more than 150 years ago and the first reports suggesting a connection with skin lesions were recorded at the very beginning of this century, their pathogenicity/innocuity remains controversial. One reason for this uncertainty has been that uncomfortable, invasive diagnostic methods (scarification, biopsy) have limited epidemiological inquiry. Since 1976 scotch-tape swabs of suspected areas have been used increasingly2.3 but this non-invasive technique has yet to be tested against classical methods on a large scale. We have tested the tape method on 177 patients with facial demodicosis proved by scarification. The tape test was positive in 165 (932%). We then extended the investigation to 87 dermatologically healthy individuals and found the mites in 11 of them (13%). In mite-infested individuals D folliculorum alone was identified in 703%, D brevis in 24-1 %, and both species in 5-6%. Since facial demodicosis has most often been associated with facial skin disease we also included in our observations 57 patients with acne vulgaris and 79 with rosacea. In the acne vulgaris group the prevalence of demodicosis was 12% (as in the group with healthy skin) but of the patients with rosacea 64 (81%) had demodicosis. In no group was there any influence from age. Nor did sex influence the infestation rate in rosacea group and controls. All the patients have been clinically verified and followed up at the clinic for skin and venereal diseases, Zagreb Medical School. We are not suggesting a straight cause-and-effect relation between demodicosis and rosacea. There are other factors to be analysed, such as immune status and current therapy, before firm conclusions are drawn. Nevertheless, our findings may be of interest to dermatologists and parasitologists.

Mystic (Meropenem Yearly Susceptibility Test Information Collection) je međunarodno istraživanje rezistencije bakterija izoliranih iz uzoraka hospitaliziranih bolesnika na određenu paletu antimikrobnih lijekova (meropenem, imipenem, ceftazidime, ceftazidim+klavulanska kiselina, piperacilin+tazobaktam, ciprofloksacin, gentamicin ili tobramicin). Provodi se metodom određivanja MIK-ova, u rad se uzima jedan soj po bolesniku, radi se NCCLS metodologijom sa 6 uvijek i svuda istih sojeva za kontrolu kvalitete, tako da su rezultati iz svih centara usporedivi. U Hrvatskoj smo započeli s tim istraživanjem u 2002. godini, u dva centra: U Kliničkom bolničkom centru Zagreb i u Kliničkoj bolnici Split. Ovdje iznosimo prve rezultate osjetljivosti nekih uzročnika izoliranih u KBC-u Zagreb i KB-u Split. Do sada je potpuno obrađeno 38 sojeva Pseudomonas aeruginosa, 28 sojeva Acinetobacter baumannii, 40 sojeva Escherichia coli i 31 soj Klebsiella pneumoniae. Rezultati pokazuju potpunu osjetljivost E. coli na sve ispitane antibiotike, osim što je 6 sojeva imalo MIK>16 mg/L, a jedan 8 mg/L. Jedan je soj bio ESBL, ujedno i rezistentan na gentamicin. Sličnu dobru osjetljivost pokazuje i K. pneumoniae osim jednog soja s MIK >128 mg/L na ciprofloksacin te 8 ESBL sojeva koji su imali MIK na gentamicin >16 mg/L. MIK-ovi meropenema uglavnom su za nekoliko razrijeđenja niži nego MIK-ovi imipenema, no na oba antibiotika su svi ispitani sojevi osjetljivi. Sojevi P. aeruginosa nisu tako homogeni u svojoj osjetljivosti: dva soja su visoko rezistentna na karbapeneme (>128 mg/L), jedan je soj rezistentan na imipenem (16 mg/L) a osjetljiv na meropenem, a 4 su intermedijarno osjetljiva na impenem (8 mg/L) a osjetljiva na meropenem. Jedan je soj bio intermedijarno osjetljiv na imipenem ( 8 mg/L) a rezistentan na meropenem (16 mg/L). Osjetljivost na druge antibiotike vrlo je nejednolika u dosada ispitanih sojeva. Među ispitanim sojevima A. baumannii nije dokazana rezistencija na karbapeneme.