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

Selma Uzunović, Branka Bedenić, Ana Budimir, Amir Ibrahimagić, Farah Kamberović, Zlatko Fiolić, Michelle I A Rijnders, Ellen E Stobberingh

Research output: Contribution to journalArticleAcademicpeer-review


AIM: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Original languageEnglish
Pages (from-to)157-68
Number of pages12
JournalMedicinski Glasnik
Issue number2
Publication statusPublished - Aug 2015


  • Adult
  • Ampicillin
  • Bosnia and Herzegovina
  • Child, Preschool
  • Drug Resistance, Multiple, Bacterial
  • Female
  • Gram-Negative Bacteria
  • Humans
  • Infant
  • Inpatients
  • Male
  • Methicillin-Resistant Staphylococcus aureus
  • Middle Aged
  • Skin Diseases
  • Soft Tissue Infections
  • Surgical Wound Infection

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