Knjiga Sazetaka CROCMID2016 PDF

11.
HRVATSKI KONGRES KLINIČKE MIKROBIOLOGIJE

8. HRVATSKI KONGRES O INFEKTIVNIM BOLESTIMA
s međunarodnim sudjelovanjem
pod pokroviteljstvom
Ministarstva zdravlja Republike Hrvatske
11th CROATIAN CONGRESS OF CLINICAL MICROBIOLOGY

8th CROATIAN CONGRESS ON INFECTIOUS DISEASES
with international participation
under the auspices of

Ministry of Health of the Republic of Croatia
KNJIGA SAŽETAKA
ABSTRACT BOOK
ORGANIZATORI / ORGANIZERS
Hrvatski liječnički zbor
Croatian Medical Association
Hrvatsko društvo za kliničku mikrobiologiju

Croatian Society of Clinical Microbiology
Hrvatsko društvo za infektivne bolesti

Croatian Society for Infectious Diseases
Poreč, Hrvatska / Croatia

20.-23. listopada 2016. / October 20-23, 2016
ORGANIZACIJSKI ODBOR / ORGANIZING COMMITTEE
Predsjednici / Presidents
Arjana Tambić Andrašević, Hrvatsko društvo za kliničku mikrobiologiju HLZ-a / Croatian
Society of Clinical Microbiology of the CMA
Bruno Baršić, Hrvatsko društvo za infektivne bolesti HLZ-a / Croatian Society for Infectious
Diseases of the CMA
Maja Abram, Rijeka Maja Sabolić, Zagreb

Ljiljana Betica Radić, Dubrovnik Marija Santini, Zagreb
Mirna Ladavac, Pula Edita Sušić, Šibenik
Ivana Mareković, Zagreb Biserka Trošelj Vukić, Rijeka
Marina Payerl Pal, Čakovec Adriana Vince, Zagreb
ZNANSTVENI ODBOR / SCIENTIFIC BOARD
Josip Begovac, Zagreb Vesna Mađarić, Koprivnica

Ana Budimir, Zagreb Alemka Markotić, Zagreb
Suzana Bukovski, Zagreb Gordana Mlinarić-Galinović, Zagreb
Boris Dželalija, Zadar Nenad Pandak, Slavonski Brod
Oktavija Đaković Rode, Zagreb Mario Poljak, Ljubljana (SLO)
Ivo Ivić, Split Jasenka Škrlin, Zagreb
Vera Katalinić-Janković, Zagreb Marija Tonkić, Split
Ilija Kuzman, Zagreb Goran Tešović, Zagreb
Davorka Lukas, Zagreb Jasmina Vraneš, Zagreb
Boris Lukšić, Split Dubravka Vuković, Osijek
ADMINISTRATIVNI TAJNIK / ADMINISTRATIVE SECRETARY

Jasminka Blaha
PRIPREMA KNJIGE SAŽETAKA / ABSTRACT BOOK PREPARATION

Marija Fijucek
IZDAVAČI / PUBLISHERS
Hrvatski liječnički zbor / Croatian Medical Association
Hrvatsko društvo za kliničku mikrobiologiju / Croatian Society of Clinical Microbiology
Hrvatsko društvo za infektivne bolesti / Croatian Society for Infectious Diseases
Autori su odgovorni za stručnu i jezičnu ispravnost objavljenog sažetka.

Authors are solely responsible for the content of the abstracts published.
SADRŽAJ / CONTENTS Str. br. / Page no.
Plenarna predavanja / Plenary lectures
PL-1 – PL-5 1-6
Predavanja / Lectures
O-1 – O-91 7 - 138
Racionalna primjena antibiotika
Rationalizing the use of antibiotics 1 - 12
Virusni hepatitisi
Viral hepatitis 13 - 18
Infekcije u trudnica i novorođenčadi
Iinfections in newborns and pregnancy 19 - 27
Infektivne bolesti djece
Pediatric infectious diseases 28 - 34
Izazovi u bakteriološkoj dijagnostici
Challenges in bacteriological diagnostics 35 - 39
ESCMID radionica: Upravljanje antimikrobnim lijekovima
ESCMID WORKSHOP: Antimicrobial stewardship 40 - 44
Infekcije respiratornog sustava i tuberkuloza
Respiratory tract infections and tuberculosis 45 - 52
Tropska i putnička medicina
Tropical and travel medicine 53 - 61
Infekcije povezane sa zdravstvenom skrbi
Healthcare-associated infections 62 - 71
Infekcije i upalne bolesti središnjeg živčanog sustava
Central nervous system infections and inflammations 72 - 76
Slobodne teme
Free communications 77 - 84
Emergentne infektivne bolesti
Emerging infectious diseases 85 - 90
Zoonoze
Zoonotic infectious diseases 91 - 103
Importirane arbovirusne infekcije u Hrvatskoj
Imported arboviral infections in Croatia 104 - 110
Infekcije mokraćnog i spolnog sustava
Urogenital tract infections 111 - 117
Sepsa i endokarditis
Sepsis and endocarditis 118 - 122
Infekcije koje uzrokuje Clostridium difficile
Clostridium difficile infections 123 - 130
Infekcije u imunokompromitiranih (uključujući i HIV)
Infections in immunocompromised & HIV 131 - 138
Posteri / Posters
PO-1 – PO-59 139 - 233
Kratice /Abbreviations:
PL – plenarno predavanje / plenary lecture
O – usmena predavanja / oral lecture
PO – poster / poster presentation
PLENARNA PREDAVANJA
PLENARY LECTURES
11. hrvatski kongres kliničke mikrobiologije i 8.hrvatski kongres o infektivnim bolestima
Poreč, Hrvatska, 20.–23. listopada 2016.
PL-1 ESCMID 2016

Mario Poljak
Laboratory for Molecular Microbiology and Diagnostics of Hepatitis and
HIV/AIDS, Faculty of Medicine University of Ljubljana, Ljubljana, Slovenia
11th Croatian Congress of Clinical Microbiology and the 8th Croatian Congress for Infectious Diseases
Poreč, Croatia, October 20–23, 2016
2
PL-2 Carbapenem resistant enterobacteriaceae, a worldwide overview

Giuseppe Cornaglia
Department of Diagnostics and Public Health, Verona University, Verona,
Italy
3
PL-3 Recent advances in the treatment of parasitic diseases

Nicholas J. White
Faculty of Tropical Medicine, Mahidol University, Bangkok
and Nuffield Department of Medicine, Oxford University, UK
Most parasitic diseases of humans occur in low-income tropical countries. There is

little financial incentive for pharmaceutical companies to invest in antiparasitic
drug research and, with the exception of antimalarials, few new drugs. Albendazole
is over forty years old and many antiparasitic drugs still in common use are even
older. There have not been many recent advances in the management of infections
by multicellular parasites. The repurposed vetinary drugs ivermectin (filarial
infections, strongyloidiasis) and triclabendazole (fascioliasis) are now well
established treatments. In contrast for protozoal diseases, there have been
significant developments. Human African trypanosomiasis (HAT) treatment is
changing with the replacement of arsenicals by nifurtimox-eflornithine treatment
in T. gambiense infections, and the development by the Drugs for Neglected
Diseases initiative (DNDi) of fexinidazole (now in late phase 3 studies). The orally
bioavailable oxaboroles (in phase 2) may provide a single dose treatment.
Benznidazole regimens have been improved in Chagas disease. Visceral
leishmaniasis treatment in the Indian subcontinent has been revolutionised by
liposomal amphotericin. Oral miltefosine and parenteral paromomycin
(aminosidine) are also both valuable additions to treatment, particularly in patients
with HIV infection. The antimalarial drug development pipeline has never been
healthier with several new classes of antimalarial in development. Synthetic
peroxides (arterolane and artefenomel) have been developed as less expensive
alternatives to artemisinin. Piperaquine and pyronaridine are highly effective
slowly eliminated partner drugs in artemisinin combination treatments. Ferroquine
has structural similarities to chloroquine but is active against multidrug resistant
parasites (in phase 3 studies). Cipargamin (a PfATPase 4 inhibitor) and KAF 156
(unknown mechanism of action) are both very potent novel antimalarials
discovered by the Novartis Institute for Tropical Diseases which produce rapid
parasite clearance. Both are in phase 2 studies. Tafenoquine, a slowly eliminated 8-
aminoquinoline drug for the radical cure of vivax malaria, is in late phase 3 studies.
Several other potential new antimalarial compounds are at an earlier stage of
development.
4
PL-4 Clostridium difficile infection: a collatera

l effect of antibiotic prescribing
Nicola Petrosillo
National Institute for Infectious Diseases “L. Spallanzani”, IRCCS-ome, Italy
Clostridium difficile (CD) is a Gram-positive, anaerobic, spore-forming, toxin

producing bacillus. Clostridium difficile infection (CDI) is the most common cause of
healthcare-related infection in hospitals and is thus a leading cause of morbidity
and mortality. Furthermore, asymptomatic carriage of C. difficile is believed to
occur in about up to 7% of healthy adults and in about 11–25% of hospitalized
patients; and may therefore contribute to nosocomial transmission. Despite
antibiotic therapy, approximately 15–25% of patients will develop recurrence of
CDI.
CD can change into its vegetative disease causing state when it reaches the
intestine of humans. This anaerobic bacterium is well suited to the anaerobic
environment of the colon, and the presence of glycine and cholate derivatives
facilitates the germination of C difficile spores. In healthy intestines with a normal
microbiota, cholate derivatives are further processed by other bacteria preventing
germination of CD spores. Patients receving broad-spectrum antibiotic treatment
have much of their intestinal microflora disruptyed or killed, preventing the
metabolism of cholate which in turn facilitate CD germination and overgrowth. The
distraction of host microbes by the antibiotic treatment gives C difficile more space
in the intestine.
Programs for antimicrobial stewardship have clearly demonstrated the the
optimization of antimicrobial treatment achieves also a reduction of CDI in the
hospital setting.
5
PL-5 Clinical presentation and diagnostics of autoimmune encephalitis

Maarten Titulaer
Erasmus Medical Center, Rotterdam, The Netherlands
6
RACIONALNA PRIMJENA ANTIBIOTIKA

RATIONALIZING THE USE OF ANTIBIOTICS
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O-1 Dvadeset godina praćenja rezistencije na antibiotike

Arjana Tambić Andrašević
Klinika za infektivne bolesti „Dr. Fran Mihaljević“, Zagreb, Hrvatska
U Hrvatskoj je sustavno praćenje rezistencije bakterija na antibiotike započelo

1996.g. osnivanjem Odbora za praćenje rezistencije pri Kolegiju javnog zdravstva
Akademije medicinskih znanosti Hrvatske (AMZH). Odbor je u početku uključivao
voditelje 17 laboratorija, odabranih da svojim podacima zastupaju pojedine regije
Hrvatske. Danas Odbor okuplja 35 centara i svojim podacima pokriva više od 90%
hrvatske populacije. Od samog početka edukacija i vanjska kontrola testiranja
osjetljivosti na antibiotike su bili ključni u osiguranju visoke kvalitete podataka.
Ovako organizirana mreža za praćenje rezistencije se lako uključila u europske
projeke European Antimicrobial Resistance Surveillance System (EARS, EARS-Net) i
European Surveillance of Antimicrobial Consumption (ESAC, ESAC-Net), a 2003.g.
osnovana je i hrvatska podružnica The Alliance for the Prudent Use of Antibiotics
(APUA). Daljnje jačanje mreže praćenja rezistencije u Hrvatskoj predstavljalo je
osnivanje Referentnog centra Ministarstva zdravlja za praćenje rezistencije na
antibiotike pri Klinici za infektivne bolesti „Dr. Fran Mihaljević“ 2003.g., koji je
preuzeo sve zahtjevnije zadatke laboratorijske podrške. Najveći poticaj u daljnjem
radu na kontroli širenja rezistencije u Hrvatskoj predstavljalo je osnivanje
Interdisciplinarne sekcije za kontrolu rezistencije na antibiotike (ISKRA) 2006.g. pri
Ministarstvu zdravlja RH. Ovo tijelo (engl. „intersectorial coordination mechanism“,
ICM) koordinira sve aktivnosti na području kontrole rezistencije na antibiotike te su
tako rezultati praćenja rezistencije i potrošnje antibiotika u Hrvatskoj postali
podloga za razvijanje drugih aktivnosti poput pisanja nacionalnih smjernica o
uporabi antibiotika i provođenja javnih kampanja. Dvadeset godina kontinuiranog
praćenja omogućilo nam je uočavanje kretanja rezistencije u pojedinih uzročnika
koje je ponekad imalo tijek polaganog, ali kontinuiranog rasta (npr. rezistencija na
kinolone u E.coli), ponekad naglog uspona (npr. rezistencija A.baumannii na
karbapeneme), a ponekad i laganog pada (npr. pad učestalosti meticilin
rezistentnog S.aureus, MRSA). U okviru kontinuiranog praćenja posebno je bitno
rano uočavanje sojeva s novim mehanizmima rezistencije (npr. enterobakterije
rezistentne na karbapeneme) čime se može usporiti njihovo širenje.
Twenty years of antibiotic resistance surveillance

University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, Zagreb,
Croatia
In Croatia continuous antibiotic resistance surveillance at national level started in

1996 when the Croatian Committee for Antibiotic Resistance Surveillance was
founded at the Croatian Academy of Medical Sciences. At the beginning the
Committee gathered heads of 17 laboratories selected to represent different
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regions of the country. Today the Committee includes 35 centers and provides data
with more than 90% of population coverage. Since the very beginning of antibiotic
resistance surveillance education and external quality control of sensitivity testing
were recognized as essential in ensuring high quality data. The Croatian network
readily joined the European Antimicrobial Resistance Surveillance System (EARSS,
EARS-Net) and the European Surveillance of Antimicrobial Consumption (ESAC,
ESAC-Net) projects and in 2003 the Croatian Chapter of The Alliance for the
Prudent Use of Antibiotics (APUA) was founded. Foundation of the Croatian
Ministry of Health Reference Centre for Antibiotic Resistance at the University
Hospital for Infectious Diseases in 2003 further strengthened the network by
providing ever more challenging laboratory backup. The most important
contribution to national resistance surveillance was the establishment of the
Croatian intersectorial coordination mechanism (ICM) at the Ministry of Health, the
so called „Interdisciplinarna sekcija za kontrolu rezistencije na antibiotike” (ISKRA)
in 2006. ISKRA coordinates all the activities related to antibiotic resistance control
and thus antibiotic resistance and antibiotic consumption data became the basis
for developing national guidelines on antibiotic use and public campaigns. Twenty
years of continuous surveillance enabled monitoring of trends in resistance.
Resistance in some pathogens showed slow but continuous rise (e.g. quinolone
resistance in E.coli), in some sudden rise (e.g. carbapenem resistance in
A.baumannii) and sometimes slight decrease (e.g. methicillin resistant S.aureus,
MRSA rates). Especially important aspect of continuous surveillance is early
detection of novel resistance mechanisms (e.g. carbapenem resistance in
enterobacteriaceae) as this can slow down the spread of such organisms.
O-2 Potrošnja antibiotika u Hrvatskoj

Marina Payer Pal
Zavod za javno zdravstvo Međimurske županije, Čakovec, Hrvatska
Antibiotici pripadaju skupini lijekova neophodnih za uspješno i učinkovito liječenje

gotovo u svim granama suvremene medicine. Problem rezistencije bakterija na
antibiotike ključan je problem s kojim se suočava ,ne samo medicinska, već
cjelokupna javnost. Glavni razlog nastanka rezistenciji leži u potrošnji antibiotika.
Za analizu potrošnje antibiotika, kao i mogućnosti usporedbe potrošnje kako
između bolničkih ustanova u našoj zemlji, ali i s drugim zemljama nužno je sustavno
i standardizirano praćenje. Praćenje potrošnje antibiotika u Hrvatskoj se provodi od
2000. godine, u početku u sklopu European Surveillance of Antibiotic Consumption
(ESAC), a od 2012. kroz ESAC-Net u sklopu European Centre for Disease Prevention
and Control (ECDC). Od samog početka podaci o potrošnji antibiotika prikupljani su
putem veledrogerija, dok se od 2011. godine, za praćenje bolničke potrošnje,
koriste podaci dobiveni iz bolničkih ljekarni. Za izvanbolničku potrošnju, od 2012.
9
godine se koriste podaci od Hrvatskog zavoda za zdravstveno osiguranje (HZZO).

Također, od iste godine se promijenio denominator, kojeg koristimo u izračunu
potrošnje, a u skladu s popisom stanovništva iz 2011. godine. Potrošnja antibiotika
se prati odvojeno, bolnička i ambulantna potrošnja.
Prikupljeni podaci iskazuju se u definiranim dnevnim dozama na tisuću stanovnika
po danu (DDD/TID). Podaci o potrošnji antibiotika prikupljaju se na petom nivou, a
prikazuju na trećem i četvrtom u skladu s Anatomsko-terapijsko-kemijskom
klasifikacijom (ATK) Svjetske zdravstvene organizacije (SZO).
Po potrošnji antibiotika, Hrvatska pripada krugu zemalja s višom potrošnjom, u
2014. godini ambulantna potrošnja je iznosila 21,4 DDD/1000 stanovnika/dan (TID);
dok je bolnička bila
1,87 DDD/TID. Istovremeno raspon potrošnje u Europi se kretao od 10,6 DDD/TID u
Nizozemskoj do 34,0 DDD/TID u Grčkoj.
Razlike postoje i u strukturi potrošnje antibiotika, to jest između klasa i njihovog
udjela u ukupnoj potrošnji. U Hrvatskoj , najveći udio u izvanbolničkoj potrošnji
antibiotika čini beta-laktamska skupina klase penicilina (J01C) s oko 50%, na
drugom mjestu je također beta-laktamska skupina klase cefalosporina (J01D) s
udjelom od 16%, dok je na trećem mjestu skupina makrolid-linkozamid-
streptogramin (J01F) s 14%. U bolničkoj potrošnji poredak je identičan za prva dva
mjesta, ali s podjednakim udjelima u potrošnji penicilina J01C (33%) i cefalosporina
J01D (29%), dok je na trećem mjestu skupina kinolona (J01M) s udjelom od 11%.
Ambulantna potrošnja antibiotika iznosi preko 90% ukupne potrošnje antibiotika u
svim godinama praćenja potrošnje. Jedan od indikatora kvalitete u izvanbolničkoj
potrošnji je relativna potrošnja uskospektralnih (J01CE) te širokospektralnih
penicilina (J01CR) u odnosu na cjelokupnu potrošnju antibiotika. To je vrlo
nepovoljni pokazatelj za Hrvatsku, jer ukazuje da prevladava potrošnja
širokospektralnih penicilina (35%), u odnosu na potrošnju uskospektralnih
penicilina od svega 3,8%. Za razliku od nas, u Švedskoj relativni udio
širokospektralnih penicilinskih antibiotika u ukupnoj izvanbolničkoj potrošnji iznosi
svega 1,7%.
Prema podacima koje dobivamo iz bolničkih ljekarni o potrošnji antibiotika,
bolnička potrošnja se može izraziti u DDD/bolničkoopskrbni dan (DDD/BOD ), što
omogućava podrobniju analizu potrošnje antibiotika za svaku bolnicu.
Izvanbolnička potrošnja, u zadnje četiri godine, se kreće iznad 21 DDD/TID s malim
varijacijama od 21,10 do 21,84 DDD/TID. U istom razdoblju, bolnička potrošnja
bilježi raspon od 1,80 do 1,98 DDD/TID.
Nepravilna uporaba antibiotika ubrzava pojavu i širenje rezistencije, stoga je od
velike važnosti pridržavati se smjernica o pravilnoj uporabi, kako bi se primjenom
dobre prakse korištenja antibiotika u medicini oni uspjeli sačuvati.
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Antibiotic Consumption in Croatia

Marina Payer Pal
Institute of Public Health of Međimurje County, Čakovec, Croatia
Antibiotics belong to a group of medicines necessary for a successful and effective

treatment in almost all branches of modern medicine. The problem of bacterial
resistance to antibiotics is the key problem which not only medical, but also the
general public is faced with. The main reason for the bacterial resistance lies in the
consumption of antibiotics.
For the analysis of antibiotic consumption and the possibility of its comparison
between different hospitals in our country as well as to those in other countries,
systematic and standardised monitoring is needed. Monitoring of antibiotic
consuption has been carried out in Croatia since 2000, at first as part of the
European Surveillance of Antibiotic Consumption (ESAC), and then, since 2012,
through ESAC-Net as part of the European Centre for Disease Prevention and
Control (ECDC). From the very beginning, the data on antibiotic consumption have
been gathered through wholesale drug companies, while the data provided by
hospital pharmacies, for the purpose of monitoring hospital consumption, have
been used since 2011. For outpatient consumption, the data provided by the
Croatian Health Insurance Fund (CHIF) have been used since 2012. Also, that same
year the denominator used to calculate the consumption, in accordance with the
2011 Population Census, was changed. The consumption of antibiotics is monitored
separately, in hospitals and ambulatory care.
Collecting data on the hospital antibiotic consumption from hospital pharmacies
enabled antibiotic consumption to be calculeted and expressed in defined daily
doses (DDD) per 100 bed deys (BD), which is a more accurate indicator of
consumption compared to the consumption expressed in 1,000 inhabitants per
day (TID).
Croatia belongs to the group of countries with greater antibiotic consumption; in
2014 ambulatory consumption was 21.4 DDD/ TID, while the hospital consumption
was 1.87 DDD/TID. At the same time, the antibiotic consumption in Europe ranged
from 10.6 DDD/TID in the Netherlands to 34.0 DDD/TID in Greece.
There are also differences in the structure of antibiotic consumption, evident for
different classes and their relative frequencies in the total consumption. In Croatia,
the largest share of outpatient antibiotic consumption is that of the beta-lactam
group, class of penicillin (J01C), with about 50%, followed again by the beta-lactam
group, class of cephalosporin (J01D) with a share of 16%, while the group of
macrolide-lincosamide-streptogramin (J01F) comes third with 14%. In hospital
consumption, the order is identical for the first two, with similar shares in the
consumption of penicillin J01C (33%) and cephalosporin J01D (29%), while the
group of quinolones (J01M) comes third (11%).
The outpatient antibiotic consumption makes up more than 90% of the total
consumption of antibiotics in all the years that consumption monitoring has been
11
carried out. One quality indicator for outpatient consumption is the relative
consumption of narrow-spectrum (J01CE) and broad-spectrum penicillins (J01CR) in
relation to the total consumption of antibiotics. This indicator is unfavourable,
because it points to the dominant consumption of broad-spectrum penicillins with
relative frequencies of 35%, compared to the narrow-spectrum penicillin
consumption of only 3.8%. In contrast, Sweden's relative frequencies of broad-
spectrum penicillin antibiotics in the total outpatient consumption is no higher than
1.7%.
Outpatient consumption has in the last four years remained above 21 DDD/TID,
with slight variations from 21.10 to 21.84 DDD/TID. In the same period, the hospital
consumption ranges from 1.80 to 1.98 DDD/TID.
Inproper use of antibiotics accelerates the occurrence and spreading of resistance.
It is, therefore, very important to follow the guidelines on proper use so as to
preserve antibiotics through good practice when it comes to their use.
O-3 Prescribing antibiotics in elderly – the same dosing regime for all?
Federico Pea
Institute of Clinical Pharmacology, Azienda Ospedaliero-Universitaria Santa
Maria della Misericordia, Udine, Italy.
Department of Experimental and Clinical Medical Sciences, University of
Udine, Udine, Italy
O-4 Are antibiotic dosage regimens used in third phase clinical trials realistic?
Francesco Scaglione
Department of Medical Biotechnologies and Translational Medicine,
University of Milan, Milan, Italy
O-5 Treatment for MDR gram-negative bacteria

Matteo Bassetti
Infectious Diseases Division, Santa Maria della Misericordia University
Hospital, Udine, Italy
12
VIRUSNI HEPATITISI
VIRAL HEPATITIS
13
O-6 Akcijski plan za kontrolu virusnih hepatitisa

Adriana Vince
Action plans to control viral hepatitis

Adriana Vince
Croatia
O-7 Molekularna dijagnostika u eri liječenja hepatitisa C bez interferona

Snježana Židovec Lepej
Metode molekularne dijagnostike, posebice lančana reakcija polimerazom u

stvarnom vremenu (real-time polymerase chain reaction, PCR), metode
hibridizacije nukleinskih kiselina i sekvenciranje pojedinih regija genoma virusa
hepatitisa C (HCV), imaju značajnu ulogu u dijagnostičkoj obradi osoba s HCV
infekcijom. Molekularne se metode koriste pri postavljanju dijagnoze akutnoga i
kroničnoga hepatitisa C, tijekom predterapijske obrade bolesnike te praćenja tijeka
liječenja kao i tijekom procjene uspješnosti trajnog virusološkog odgovora tj.
eradikacije virusa nakon završetka liječenja. U eri liječenja hepatitisa C bez
interferona (IFN-free terapija), zamjetne su novosti u pristupu molekularnoj
dijagnostici HCV infekcije. Najznačajnije promjene u molekularnoj dijagnostici HCV-
infekcije u eri novih lijekova jesu; (1) promjene u algoritmu kvantifikacije HCV RNA
tijekom liječenja kroničnoga hepatitisa C primjenom IFN-free terapija, uvođenje
obvezne subtipizacije genotipa 1 u svrhu procjene potrebe za pred-terapijskom
analizom primarne rezistencije na antivirusne lijekove i (3) uvođenje analize
rezistencije HCV-a na inhibitore NS3 proteaze i inhibitore NS5A proteina u
pojedinim skupinama bolesnika.
Molecular diagnostics of hepatitis C infection in the „interferon free“ era

Croatia
Molecular methods including real-time PCR, nucleic acid hybridisation as well as
nucleic acid sequencing are an important part of diagnostic workup in HCV-infected
individuals. Molecular methods are an important part of routine diagnostic workup
in acute and chronic hepatitis C. They are also used in the pre-therapeutic
assessment of patients and for the monitoring of treatment outcome. Introduction
of new therapeutic options (particularly IFN-free therapy) lead to new approaches
in molecular diagnostics of HCV infection. The most recent developments in the
14
field include: (1) changes in the algorithm of HCV RNA quantification during
treatment of chronic hepatitis C with IFN-free protocols, (2) clinical significance of
HCV genotype 1 subtyping and (3) resistance testing to NS3 protease inhibitors and
inhibitors of NS5A protein in selected patient groups.
O-8 Liječenje bolesnika s ekstrahepatalnim manifestacijama kroničnog

hepatitisa C
Ivan Kurelac, Adriana Vince
Hepatitis C virusna infekcija ima utjecaj na multiple organske sustave. HCV infekcija
direktno dovodi do stvaranja krioglobulina a odlaganje krioprecipitata u malim
krvnim žilama uz aktivaciju komplementa do vaskulitisa i simptomatske bolesti .
Simptomatski vaskulitis javlja se u 10% bolesnika s HCV i krioglobulinemijom.
Miješana krioglobulinemija, monoklonalne gamapatije, i hematološke su
manifestacije češće u bolesnika s kroničnim hepatitisom C, potom od autoimunih
poremećaja bolesti štitnjače, idiopatska trombocitopenička purpura i autoimuna
hemolitička anemija. Leukocitoklastični vaskulitis kožna je manifestacija u sklopu
krioglobulinemije. Povezanost postoji i sa dijabetesom, kožnom porfirijom,
membrano proliferativnim glomerulonefritisom i perifernom neuropatijom.
Kronični umor može također biti ekstrahepatana manifestacija HCV infekcije, kao i
neki neurološki i neuropsihijatrijski poremećaji npr. smetnje pamćenja i
koncentracije. Svi se ti poremećaji mogu javiti neovisno o stadiju progresije same
jetrene bolesti, i oni koji su klinički značajni predstavljaju indikaciju za prioritetno
liječenje takvih bolesnika, što je i naglašeno u smjernicama za liječnje kronične HCV
infekcije. Dok su eri terapije interferonom takvi bolesnici imali slab terapijski
uspjeh, novi direktni antivirusni lijekovi pružaju im vrlo visoku vjerojatnost
izlječenja uz malo nuspojava.
Treatment of extrahepatic manifestations of HCV infection

Ivan Kurelac, Adriana Vince
Croatia
Hepatitis C virus infection has an effect on multiple organ systems. HCV infection
directly leads to the formation of cryoglobulins and disposal of cryoprecipitate in
small blood vessels and with the activation of the complement to vasculitis and
symptomatic disease. Symptomatic vasculitis occurs in 10% of patients with HCV
and cryoglobulinemia. Mixed cryoglobulinemia, monoclonal gammopathy, and
hematologic manifestations are more common in patients with chronic hepatitis C,
followed by autoimmune disorders of thyroid disease, idiopathic thrombocytopenic
15
purpura and autoimmune hemolytic anemia. Leukocytoclastic vasculitis is

cutaneous manifestation within cryoglobulinemia. The association also exists with
diabetes, porphyria cutanea tarda, membranoproliferative glomerulonephritis and
peripheral neuropathy. Debilitating fatigue can also be extrahepatic manifestation
of HCV infection, as well as some neurological and neuropsychiatric disorders eg.
cognitive impairment, depression, deficit in concentration and memory. All of these
disorders can occur regardless of the stage of progression of liver disease itself, and
those patients who have clinically significant extrahepatic disease shold be
prioritised for treatment, which is outlined in the guidelines for the treatment of
chronic HCV infection. While in the era of interferon therapy these patients had
such bad therapeutic success, a new direct antiviral drugs provide them a very high
probability of cure with few side effects.
O-9 Smjernice za dijagnostiku i liječenje hepatitisa E

Oktavija Đaković Rode
Hepatitis E (HE) u Hrvatskoj dokazan je 2012. godine kao autohtona bolest koju
uzrokuje Orthohepevirus A genotipa 3 (HEV-3). HEV-3 ima zoonotski potencijal i
visoku prevalenciju posebno među domaćim i divljim svinjama. Simptomi i klinička
slika su najčešće blagi, netipični i brzo prolaze, pa infekcije ostanu neprepoznate i
nedijagnosticirane. HEV-3 u imunosuprimiranih osoba može progredirati u kroničnu
bolest. Od 2011.-2014. godine 117 (10.6%) bolesnika s povišenim transaminazama
imalo je pozitivna protutijela anti-HEV kao znak akutne ili prošle bolesti. Akutni HE
dokazan je u 25 (2.3%) bolesnika. Dijagnoza HE postavlja se određivanjem
protutijela anti-HEV IgM i IgG. Svaki inicijalno pozitivni rezultat potrebno je
potvrditi metodom Western blota te po potrebi određivanjem HEV RNK. Prevencija
HE moguća je izbjegavanjem konzumiranja nedovoljno termički obrađenog mesa
posebno svinjskog. Terapija ribavirinom provodi se u imunosuprimiranih bolesnika.
Guidelines for diagnostics and treatment of hepatitis E

Croatia
In 2012 hepatitis E (HE) in Croatia has been proven as an indigenous disease caused
by Orthohepevirus A genotype 3 (HEV-3). HEV-3 has a zoonotic potential and high
prevalence especially among domestic and wild pigs. Symptoms and clinical
features are usually mild, atypical and fast disappearing, so infections remain
unrecognized and undiagnosed. HEV-3 in immunosuppressed persons may progress
to chronic disease. From the year 2011-2014, 117 (10.6%) patients with elevated
16
transaminases had positive anti-HEV antibodies as a sign of acute or previous

illnesses. Acute HE was detected in 25 (2.3%) patients. HE is diagnosed by
determining anti-HEV IgM and IgG. Each initially positive result needs to be
confirmed by Western blot and if required by HEV RNA determining. HE may be
prevented by avoiding the consumption of undercooked meat especially pork.
Ribavirin therapy is used only in immunosuppressed patients.
O-10 Hepatitis C u Splitsko-dalmatinskoj županiji – epidemiologija i liječenje

Boris Lukšić1, Boris Dželalija2, Nikica Kuzmičić1, Svjetlana Karabuva1,
Robert Glavinić1, Edita Dražić1, Ivana Vrkić1
1
Klinika za infektologiju, Klinički bolnički centar Split, Split, Hrvatska
2
Odjel za infektologiju, Opća bolnica Zadar, Zadar, Hrvatska
Od početka 1993. do 1. rujna 2016. godine u Splitsko-dalmatinskoj (SD) županiji

prijavljeno je 1495 osoba s HCV infekcijom. Incidencija novootkrivenih HCV
pozitivnih osoba u SD županiji od 1993. do 2007. godine pokazuje manje godišnje
varijacije, a nakon 2008. godine, kao i u ostalim županijama dolazi do postupnog
pada broja prijava. Za razliku od drugih županija u Hrvatskoj, u SD županiji dominira
genotip 3 (49%) u odnosu na genotip 1 (46%), dok su genotipovi 2 i 4 rijetki (5%).
Dobna raspodjela ukazuje da je najugroženija skupina ona od 20-29 godina (43%) te
ona od 30-39 godina (32%). U 71% slučajeva postoje podatci o mogućim izvorima
HCV infekcije. Intravenska ovisnost, kao mogući rizik nastanka infekcije, zabilježena
je u 62% zaraženih, a različiti medicinski postupci (dijaliza, transfuzije krvi i krvnih
pripravaka, operativni zahvati) u 7% bolesnika. Budući da je procjena da u SD
županiji ima barem još 3000 osoba sa HCV infekcijom koje nisu prijavljene, poduzet
je aktivniji pristup u pronalaženju ovih bolesnika. Sastavljen je tim koji se sastoji od
djelatnika Klinike za infektologiju i Klinike za unutarnje bolesti KBC Split, Službe za
epidemiologiju Zavoda za javno zdravstvo SD županije i udruge Hepatos. Poduzet je
niz aktivnosti usmjerenih prema skupinama s većom incidencijom HCV infekcije
koje uključuju: intravenske ovisnike, branitelje izložene riziku od HCV infekcije zbog
ranjavanja i primanja krvi ili krvnih pripravaka prije 1993. godine, te osobe lišene
slobode u zatvorima. Zahvaljujući ovim aktivnostima broj novootkrivenih osoba s
kroničnom HCV infekcijom porastao je u SD županiji 2015. godine na 33% od
ukupno prijavljenih HCV infekcija u Hrvatskoj.
Od 1495 prijavljenih osoba sa HCV infekcijom u SD županiji liječeno je njih 52%. U
Klinici za infektologiju KBC Split liječeno je 235 osoba konvencionalnim
interferonom i ribavirinom (RBV), 580 pegiliranim interferonom-α i RBV, te 32
bolesnika direktnim antivirusnim lijekovima.
17
Hepatitis C in Split-Dalmatian County - epidemiology and treatment

Boris Lukšić1, Boris Dželalija2, Nikica Kuzmičić1, Svjetlana Karabuva1, Robert
Glavinić1, Edita Dražić1, Ivana Vrkić1
1
Clinical Department of Infectious Diseases, University Hospital Centre
Split, Split, Croatia
2
Department of Infectious Diseases, General Hospital Zadar, Zadar, Croatia
From the beginning of 1993 through the 1st September 2016 in Split-Dalmatian
County (SDC) 1495 persons with HCV infection were reported. The incidence of
newly-discovered positive anti-HCV cases in SDC shows smaller annual variations in
the period from 1993 to 2007, and there has been a gradual decline in reported
persons following 2008, as it was in other regions of Croatia. In contrast to other
parts of Croatia, in SDC predominates genotype 3 (49%) vs. genotype 1 (46%), while
genotypes 2 and 4 are rare (5%). Distribution by age shows that the most
vulnerable groups are people aging 20-29 (43%) and 30-39 years (32%). In 71% of
subjects there are accurate data about the possible way of HCV transmission.
Intravenous drug abuse, as a possible risk of developing HCV infection, was
registered in 62% infected, and different medical procedures (dialysis, blood
transfusions, and surgical treatments) in 7% patients. Since the estimation is that at
least 3000 more persons with HCV infection remained unreported, a more active
approach has been taken to discover these patients. A team has been gathered
involving medical staff from the Clinical Department of Infectious Diseases and
Internal Medicine in the University Hospital Centre Split, along with the Split
Epidemiologic Centre in SDC, and also with non-medical staff from the association
Hepatos. Heterogeneous activities were performed towards the groups with a
higher incidence for HCV infections: drug abusers, war veterans where soldiers with
history of war wounds, surgical treatments and blood transfusion prior to 1993,
and persons detained in custody. As a result of these activities the number of
newly-discovered HCV infections in SDC increased in 2015 up to 33% of total
registered number of HCV infections in Croatia.
Of all the 1495 reported subjects with HCV infection in SDC, 52% of them
underwent antiviral treatment. In the Clinical Department of Infectious Diseases in
the University Hospital Centre Split 235 patients received conventional interferon
and ribavirin (RBV), 580 pegylated interferon-α and RBV, and 32 patients received
direct antiviral agents.
18
INFEKCIJE U TRUDNICA I NOVOROĐENČADI

INFECTIONS IN NEWBORNS AND PREGNANCY
19
O-11 Infekcije uzrokovane citomegalovirusom

Goran Tešović
Zavod za infektivne bolesti djece, Klinika za infektivne bolesti „Dr. Fran
Mihaljević“, Zagreb, Hrvatska
Medicinski fakultet Sveučilišta u Zagrebu, Zagreb, Hrvatska
Konatalna citomegalovirusna (CMV) infekcija najčešća je vertikalno prenosiva

infekcija u razvijenim zemljama. CMV infekcija uzrok je značajnom morbiditetu
novorođenčadi, a danas je vodeći uzrok oštećenja sluha u male djece nastalog
uslijed djelovanja nekog živog uzročnika. U nedostatku univerzalnog prenatalnog
skrininga, kao i učinkovitog cjepiva, opće higijenske mjere jedina su dostupna
profilaksa vertikalnog prijenosa CMV infekcije. Obzirom da se na preživljenje
najteže bolesne novorođenčadi, kao i na stupanj neurološkog morbiditeta u
konatalno inficirane novorođenčadi, može utjecati primjenom antivirusnog
liječenja ganciklovirom/aciklovirom, osobito je važno rano posumnjati na konatalnu
CMV infekciju i primijeniti liječenje u one djece u koje je to indicirano.
Congenital cytomegalovirus infection

Goran Tešović
Pediatric Infectious Diseases Department, University Hospital for Infectious
Diseases „Dr. Fran Mihaljević“, Zagreb, Croatia
University of Zagreb School of Medicine, Zagreb, Croatia
Congenital cytomegalovirus (CMV) infection is the commonest mother-to-child

transmitted infection in developed world. CMV infection causes significant
morbidity among neonates, and is nowadays the leading cause of infection-
associated sensorineural hearing loss. Since no universal prenatal screening nor
effective active immunization against CMV is currently available, simple precaution
measures are the unique modality for reduction of congenital infection prevalence.
Presently available data support the use of antivirals (gancyclovir/valgancyclovir) in
the treatment of neonates with severe symptomatic congenital infection in order
to prevent unfavorable disease outcome as well as in reducing the amount of
permanent sequellae in chidren with central nervous system involvement and in
children with sensorineural hearing loss.
O-12 Liječenje i prevencija HIV-infekcije kod trudnica i novorođenčadi

Josip Begovac
20
Treatment and prevention of HIV-infection in pregnant women and

newborns
Josip Begovac
Croatia
O-13 Javnozdravstveni značaj infekcija u trudnica

Tatjana Nemeth Blažić1, Mirjana Lana Kosanović2 Ličina, Manuela Miletić3,
Ivanka Mihaljević3
1
Hrvatski zavod za javno zdravstvo, Zagreb, Hrvatska
2
Nastavni zavod za javno zdravstvo „Dr. Andrija Štampar“, Zagreb, Hrvatska
3
Hrvatski zavod za transfuzijsku medicinu, Zagreb, Hrvatska
Spolno prenosive infekcije u trudnica mogu uzrokovati brojne nepovoljne

zdravstvene ishode trudnoće i kod djeteta. U Hrvatskoj je prema prema zakonskim
propisima jedino obvezno testirati trudnice na prisutnost HBsAg i o tome sustavno
prikupljati podatke, iako preporuke postoje i za testiranje na ostale uzročnike
(TORCH, sifilis, HIV, hepatitis C). Cilj rada je prikazati recentne podatke o
prevalenciji seroloških markera sifilisa i hepatitisa B (HBsAg) među trudnicama u
Hrvatskoj i javnozdravstveni značaj njihovog epidemiološkog praćenja.
Retrospektivno su analizirani i prikazani metodama deskriptivne epidemiologije
podaci rutinske zdravstvene statistike Hrvatskog zavoda za javno zdravstvo – podaci
o testiranju na nosilaštvo HBsAg prikupljeni iz svih rodilišta u Hrvatskoj temeljem
zakonskih akata te podaci o testiranjima trudnica na sifilis iz Hrvatskog zavoda za
transfuzijsku medicinu, u razdoblju 2011. do 2015. godine. U navedenom periodu
uočava se kontinuirano nizak broj HbsAg pozitivnih trudnica, kao i vrlo niska
učestalost pozitiviteta seroreakcije na sifilis. Zaključak: Iako imamo vrlo nisku
učestalost seroprevalencije hepatitisa B i sifilisa u trudnica (vidljivi učinci sustavnog
cijepljenja protiv hepatitisa B uvedenog u obvezni program cijepljenja 1999. godine,
kao i do sada povoljne epidemiološke situacije), novi trendovi u društvu (jačanje
antivakcinalnih stavova među pučanstvom, migracije) vrlo brzo mogu promijeniti
pozitivni trend niske učestalosti. Smatramo da bi svakako u redovitu perinatalnu
skrb trebalo uvrstiti i praćenje ostalih uzročnika (TORCH,HIV, hepatitis C) s obzirom
da danas trudnice imaju mogućnost pravovremenog uključivanja u svobuhvatan i
učinkoviti program prevencije prijenosa infekcije s majke na dijete, kao i
mogućnost liječenja. Također, izazov je poboljšati epidemiološko praćenje
podataka o testiranjima trudnica na sifilis i HIV, budući da su javnozdravstveni
pokazatelji pojavnosti infekcija kod trudnica ključni za donošenje odluka o
poboljšanju antenatalne skrbi, što je i jedan od ciljeva strategije Svjetske
zdravstvene organizacije u okviru postizanja eliminacije prijenosa sifilisa i HIV-a s
majke na dijete.
21
The public health significance of infections in pregnant women

Tatjana Nemeth Blažić1, Mirjana Lana Kosanović2 Ličina, Manuela Miletić3,
Ivanka Mihaljević3
1
Croatian Institute of Public Health, Zagreb, Croatia
2
Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
3
Croatian Institute for Transfusion Medicine, Zagreb, Croatia
Sexually transmitted infections among pregnant women can cause numerous

adverse health outcomes on the pregnancy and the child. In Croatia, according to
the legal regulations, it is only mandatory to test pregnant women for the presence
of HBsAg and to systematically collect data on the results, although there are
recommendations for testing on other agents (TORCH, syphilis, HIV, hepatitis C).
The aim of this paper is to show recent data on the prevalence of syphilis and
hepatitis B (HBsAg) serological markers among pregnant women in Croatia, as well
as to show the public health importance of their epidemiological surveillance. It
presents data analyzed retrospectively and presented using descriptive
epidemiology method derived from routine health statistics of Croatian Institute of
Public Health - data on HBsAg carriers’ testing collected from all maternity wards in
Croatia based on legislation in force, as well as data on pregnant women’s syphilis
testing derived from the Croatian Institute of Transfusion Medicine, in the period
2011 - 2015. During this period, we can see a continuous low number of HBsAg
positive pregnant women, as well as a very low frequency of positive syphilis
serology. Conclusion: Although we have a very low incidence and seroprevalence of
hepatitis B and syphilis among pregnant women (visible effects of systematic
vaccination against hepatitis B introduced in the mandatory vaccination program in
1999, as well as so far favorable epidemiological situation), the new trends in
society (strengthening antivaccination attitudes among the population, migration)
can quickly change the positive trend of low frequency. Therefore, the regular
perinatal care should include the monitoring of other causes (TORCH, HIV, hepatitis
C) considering the fact that pregnant women today have the option to be timely
included in a comprehensive and effective program dealing with prevention of
mother-to-child infection transmission, as well as a treatment options. Also, the
challenge is to improve the epidemiological surveillance data on testing pregnant
women for syphilis and HIV, since the public health indicators of the infection
incidence among pregnant women are the key in decision-making on improving
antenatal care, which is one of the objectives of the World Health Organization’s
strategy in the context of achieving the elimination of mother-to-child transmission
of syphilis and HIV.
22
O-14 Seroprevalencija TORCH infekcija uzrokovanih virusima u žena

generativne dobi na području Hrvatske
Tatjana Vilibić-Čavlek1, Irena Tabain1, Branko Kolarić2, Pavle Jeličić1, Ivka
Djaković3, Vesna Košec3, Nataša Janev-Holcer1, Ljubo Barbić4, Vladimir
Stevanović4, Gordana Mlinarić-Galinović1
1
2
Nastavni zavod za javno zdravstvo "Dr. Andrija Štampar", Zagreb, Hrvatska
3
Klinički bolnički centar "Sestre milosrdnice", Zagreb, Hrvatska
4
Veterinarski fakultet Sveučilišta u Zagrebu, Zagreb, Hrvatska
Najznačajniji uzročnici infekcija u trudnoći obuhvaćeni su kraticom TORCH koja uz

T. gondii uključuje virus rubele, citomegalovirus (CMV), herpes simpleks virus (HSV)
tip 1 i 2, ali i brojne druge viruse kao varicella-zoster virus (VZV), parvovirus B19,
viruse hepatitisa B (HBV) i C (HCV), HIV-a i dr. Nadalje, i neki virusi uzročnici
zoonoza mogu uzrokovati infekcije u trudnica i novorođenčadi. Virus hepatitisa E
(HEV) u trudnoći može uzrokovati težu kliničku sliku s fatalnim ishodom. Infekcija
Zika virusom (ZIKV) u trudnoći povezana je s nastankom mikrocefalije, dok su virus
dengue (DENV), Chikungunya virus (CHIKV) i West Nile virus (WNV) znatno rjeđi, ali
mogući uzročnici kongenitalnih/perinatalnih infekcija.
U razdoblju od 2005-2015. godine, u Hrvatskom zavodu za javno zdravstvo
provedeno je više istraživanja seroprevalencije na viruse uzročnike TORCH infekcija.
U skupini žena generativne dobi, ukupni IgG seropozitivitet je iznosio 75,3% na
CMV; 96,4% na virus rubele; 69,4-78,7% na HSV-1; 6,8-10,2% na HSV-2; 63,5% na
parvovirus B19 te 84,3% na VZV. HBsAg dokazan je u 0,5%, anti-HBc u 3,8% te anti-
HCV protutijela u 0,5% ispitanica. U pilot studijama određivanja seroprevalencije
emergentnih i re-emergentnih arbovirusa nađen je seropozitivitet od 0,38% na
DENV te 0,76% na CHIKV. Nedavno provedena pilot studija u skupini trudnica
(2015-2016. godine) pokazala je seroprevalenciju na HEV od 1%. Na ZIKV do sada je
testirano ukupno šest asimptomatskih trudnica povratnica iz endemskih područja
koje su bile seronegativne.
Tijekom ispitivanog razdoblja, akutna je CMV te VZV infekcija (IgM protutijela uz
nizak IgG aviditet) potvrđena u 0,09% ispitanica. HSV-1 i HSV-2 IgM protutijela
nađena su u 1,2%, a parvovirus B19 IgM protutijela u 6,9% ispitanica. U 0,36%
ispitanica dokazana je nedavna asimptomatska WNV infekcija (IgM protutijela uz
graničan IgG aviditet). Akutne infekcije uzrokovane ostalim TORCH uzročnicima
nisu dokazane.
Prikazani rezultati ističu značaj praćenja, ali i potrebu za proširivanjem dijagnostike
TORCH infekcija uključivanjem emergentnih virusnih zoonoza čije je prisutnost
dokazana na području Hrvatske.
23
Seroprevalence of TORCH infections caused by viruses in childbearing-

aged women in Croatia
Tatjana Vilibić-Čavlek1, Irena Tabain1, Branko Kolarić2, Pavle Jeličić1, Ivka
Djaković3, Vesna Košec3, Nataša Janev-Holcer1, Ljubo Barbić4, Vladimir
Stevanović4, Gordana Mlinarić-Galinović1
1
2
3
Clinical Hospital Center "Sisters of Mercy", Zagreb, Croatia
4
Faculty of Veterinary Medicine University of Zagreb, Zagreb, Croatia
The TORCH acronym includes the most common etiological agents of infections
during pregnancy: T. gondii, rubella virus, cytomegalovirus (CMV), herpes simplex
virus (HSV) type 1 and 2, as well as numerous other viruses such as varicella-zoster
virus (VZV), parvovirus B19, hepatitis B and C viruses (HBV, HCV), HIV etc. In
addition, several zoonotic viruses can cause infections in pregnant women and
newborns. Hepatitis E virus (HEV) in pregnancy may be severe disease with fatal
outcome. Zika virus (ZIKV) infection during pregnancy is associated with
microcephaly, while dengue virus (DENV), Chikungunya virus (CHIKV) and West Nile
virus rarely cause congenital/perinatal infections.
In the period from 2005 to 2015, several seroprevalence studies on TORCH
infections were conducted at the Croatian National Institute of Public Health.
Among childbearing-aged women, the overall IgG seropositivity was 75.3% to CMV,
96.4% to rubella virus, 69.4-78.7% to HSV-1, 5.8-10.2% to HSV-2, 63.5% to
parvovirus B19 and 84.3% to VZV. HBsAg was detected in 0.5%, anti-HBc in 3.8%
and anti-HCV antibodies in 0.5% participants. Pilot studies on the seroprevalence of
emerging and re-emerging arboviruses found seropositivity of 0.38% to DENV and
0.76% to CHIKV. Recently conducted pilot study (2015-2016) showed
seroprevalence rate of 1% to HEV. A total of six asymptomatic pregnant women
who returned from endemic areas were tested for ZIKV, of whom all were negative.
During the tested period, acute CMV and VZV infection (IgM antibodies with low
IgG avidity) was confirmed in 0.09% participants. HSV-1 and HSV-2 IgM antibodies
were found in 1.2%, and parvovirus B19 IgM antibodies in 6.9% participants. In
0.36% women, recent asymptomatic WNV infection (IgM antibodies with
borderline IgG avidity) was confirmed. Acute infections caused by other TORCH
agents were not detected.
Presented results highlight the importance of surveillance, as well as a need for
expanding of TORCH diagnostics including emerging viral zoonoses which are
detected in Croatia.
24
O-15 Laboratorijska dijagnostika infekcije parazitom Toxoplasma gondii u

trudnica i novorođenčadi
Mario Sviben, Tomislav Meštrović
Širom svijeta prošireni jednostanični organizam Toxoplasma gondii uzročnik je

toksoplazmoze. Do infekcije najčešće dolazi jedenjem sirovog mesa koje sadrži ciste
s bradizoitima, ingestijom oocisti iz mačjeg izmeta koje sadrže infektivne sporozoite
ili kongenitalno s inficirane trudnice na dijete. Uvjet za razvoj kongenitalne
toksoplazmoze je akutna infekcija majke tijekom trudnoće prilikom koje dolazi do
prolazne parazitemije koja može dovesti do infekcije djeteta. U inficiranog djeteta
moguća je pojava brojnih simptoma od onih blagih do ozbiljnijih. Za izbjegavanje
nepovoljnog ishoda trudnoće iznimno je važna rana dijagnostika infekcije kako u
majke, tako i u djeteta, kao i terapijska intervencija u slučaju potrebe. Brojni testovi
za direktnu odnosno indirektnu laboratorijsku dijagnostiku generalno su dostupni
kako u rutinskim, tako i u referentnom laboratoriju. Prevencija kongenitalne
toksoplazmoze uključuje izbjegavanje kontakta sa parazitom higijenskim mjerama,
kao i većom brigom o hrani koju se jede. Žene bi bilo preporučljivo testirati na
toksoplazmozu prije planiranja trudnoće, tijekom trudnoće ako infekcija nije
dokazana te mjesec dana nakon poroda. Pravilnom i pravovremenom
dijagnostikom, kao i adekvatnom terapijskom intervencijom moguće je izbjeći
nepovoljan utjecaj ove infekcije na dijete kao i društvo u cjelini.
Laboratory diagnosis of Toxoplasma gondii infection in pregnant women

and the newborn
Mario Sviben, Tomislav Meštrović
Globally pervasive single-celled organism Toxoplasma gondii is the causative agent

of toxoplasmosis. Infection usually occurs by eating raw meat that contains cysts
with bradyzoites, by ingestion of oocysts from cat faeces laden with infectious
sporozoites, or congenitally during pregnancy. A prerequisite for congenital
toxoplasmosis development is an acute infection of the mother during pregnancy,
which results in a transient parasitaemia responsible for the infection of the child.
The infected child can present with a myriad of symptoms, ranging from mild to
severe. To avoid such adverse outcomes of pregnancy, early diagnosis of infection
(in both mother and child) and therapeutic intervention (where warranted) are
pivotal. Numerous tests for direct or indirect laboratory diagnostics are generally
available in the routine and reference laboratories. The prevention of congenital
toxoplasmosis includes avoiding the contact with the parasite, adequate hygiene
measures, as well as special care when preparing food. Women should ideally be
25
tested for toxoplasmosis before pregnancy planning, during pregnancy if the

infection has not been proven, and one month after birth. A proper and timely
diagnosis, in conjunction with an adequate therapeutic intervention, can mitigate
the adverse impact of the infection on the child and the society as a whole.
O-16 Značaj infekcije listerijom u trudnica i novorođenčadi

Blaženka Hunjak, Zdenka Peršić, Diana Brlek-Gorski, Anamarija Pejnović,
Andy Erega
Listerioza je često neprepoznata i nedovoljno dijagnosticirana bolest. Uzrokovana

je bakterijom Listeria monocytogenes (LM) koja se smatra najpatogenijim izolatom
iz roda listerija za humanu populaciju, a nalazi se u sirovoj i obrađenoj hrani,
mlijeku, mliječnim proizvodima, mesu, povrću i hrani iz mora. Sposobnost listerije
da preživi i umnoži se u uvjetima temperature hladnjaka (+4 °C) i bez prisutnosti
kisika, omogućava širenje listerije u hrani, posebno u vakuumiranim proizvodima i
gotovoj brzoj hrani. Listerioza podliježe obaveznom prijavljivanju u RH prema
Zakonu o zaštiti pučanstva od zaraznih bolesti, a godišnje je prosječno manje od 10
prijava oboljelih. Najveći rizik za razvoj listerioze postoji kod trudnica, koje mogu
infekciju prenijeti na novorođenče. Trudnice predstavljaju 60% svih slučajeva
infekcije bakterijom LM u populaciji mlađoj od 40 godina. Smatra se da oko 22%
perinatanih infekcija završava smrću neonatusa ili rođenjem mrtvorođenčeta. U
neonatusa, smrtnost iznosi oko 50%. Kasnija pojava listerioze u trudnica,
manifestira se kao meningitis novorođenčeta u 2-4 tjednu života. U Hrvatskom
zavodu za javno zdravstvo provodi se dijagnostika listerioze u humanim uzorcima i
uzorcima hrane. U razdoblju od 2014. do 2016. godine zaprimljena su 54 uzorka sa
zahtjevom za serološko testiranje na listeriju. Najviše (25/54) je ustanovljeno
antijela klase IgG tipa 1/2a i 4b. Iako je u 13/54 uzoraka ustanovljena prisutnost
antitijela klase IgM, nije bilo moguće sa sigurnošću potvrditi akutnu infekciju. Niti
kod jednog uzorka dobivenog iz urogenitalnog sustava trudnica LM nije potvrđena
kultivacijom, ali su na potvrdu dobivena 2 izolata LM koja su prethodno
dijagnosticirana u uzorcima novorođenčadi. U skladu s HRN EN ISO 11290-
2:1999/A1:2008 provedeno je mikrobiološko ispitivanje hrane na 2817 uzoraka, a
LM je potvrđena u 3 uzorka. Najvažnije preporuke za sprječavanje listerioze u
trudnica su: izbjegavanje hrane koja je potencijalno izvor listerije, temeljita
termička obrada hrane životinjskog podrijetla, te izbjegavanje nepasteriziranog
mlijeka i proizvoda od sirovog mlijeka.
26
The significance of Listeria infection in pregnant women and newborns

Blaženka Hunjak, Zdenka Peršić, Diana Brlek-Gorski, Anamarija Pejnović,
Andy Erega
Listeriosis is often unrecognized and under-diagnosed infection. It is caused by

Listeria monocytogenes (LM), which is considered as the most pathogen isolate in
the genus of Listeria in human population. Certain food have been described as
„high risk“ such as: raw (unpasteurised) milk, foods made from milk, uncooked
meats, vegetable, seafood and processed food. Psychotrophic (temperature of
refrigerator +4°C) and anaerobic characteristic give LM ability to survive, grow and
spread in contaminated food, especially Ready To Eat foods (RTE) and vacuum
products. In Croatia, annual average is less than 10 case reports. Pregnant women
represent 60% of all cases of infection in the population under the age of 40.
According to literature, about 22% perinatal infections end with neonathal death or
stillborn. In neonates, mortality rate approaches around 50%. Late onset listeriosis
in pregnant women occurs particulary as newborn meningitis in 2 - 4 weeks after
delivery.The Croatian Institute of Public Health (CIPH) conducted serological
testing, cultivation or automated identification in human and non- human samples.
In the period from 2014 to 2106, 54 samples were received for serological testing.
Out of 54, in 25 samples was confirmed presence of antibodies IgG types 1/2a and
4b. Although in 13/54 was confirmed presence of antibodies IgM types, acute
infection was not confirmed. CIPH received 2 LM isolates to confirm, previously
diagnosed in samples of newborns. In this period, listeriosis was not confirmed nor
in one sample obtained from the urogenital system of pregnant women. Out of
2817 food samples, LM was confirmed in 3 samples, in accordance with ISO 11290-
2: 1999/A1: 2008.The most important recommendations for the prevention of
listeriosis in pregnant women are avoiding food that is potentially a source of
listeria, thorough heat treatment of animal products, and avoiding unpasteurized
milk and products made from raw milk.
27
INFEKTIVNE BOLESTI DJECE

PEDIATRIC INFECTIOUS DISEASES
28
O-17 The main characteristic of meningococcal meningitis in Italy

Paola Stefanelli
Department of Infectious, Parasitic, and Immune-Mediated Diseases,
Istituto Superiore di Sanità, Rome, Italy
O-18 Incidencija i etiologija gnojnog meningitisa u djece liječene u Klinici za

infektivne bolesti KBC Split 1999.-2015. godine
Žana Ljubić, Ivo Ivić, Boris Lukšić, Dragan Ledina, Dominko Carev, Mirela
Pavičić-Ivelja, Irena Jeličić
Klinika za infektologiju, KBC Split, Split, Hrvatska
U razdoblju od 1999.-2015. godine liječeno je 99 djece u dobi 0-5 godina s

dijagnozom gnojnog meningitisa. Najveći broj bolesnika, 19/99, zabilježen je 1999.
godine, dok 2008. i 2012. godine nije liječeno nijedno dijete s ovom dijagnozom.
Neisseria meningitidis bila je uzročnik u 41 (41%), Haemophilus influenzae u 22
(22%), te Streptococcus pneumoniae u12 (12%) bolesnika. U 24 (25%) djece
uzročnik nije dokazan. Od 2002. godine smanjuje se učestalost gnojnih meningitisa,
pretežno na račun opadanja slučajeva uzrokovanih s Haemophilusom influenzae,
zahvaljujući uvođenju cjepiva protiv Hib-a u kalendar obveznog cijepljenja. Od
2008. godine nije bilo slučajeva gnojnog meningitisa uzrokovanih ovim
uzročnikom.
The incidence and etiology of purulent meningitis in children treated at

the Clinic for Infectious Diseases Clinical Hospital Split in the period 1999-
2015
Žana Ljubić, Ivo Ivić, Boris Lukšić, Dragan Ledina, Dominko Carev, Mirela
Pavičić-Ivelja, Irena Jeličić
Clinic for Infectious Diseases, Clinical Hospital Split, Split, Croatia
In the period between 1999 and 2015 we treated 99 children aged 0-5 years with
the diagnosis of purulent meningitis. The majority of patients, 19/99, were
recorded in 1999, while in 2008 and 2012 no child was treated with this diagnosis.
Neisseria meningitidis was the causative agent in 41 (41%), Haemophilus influenzae
in 22 (22%), and Streptococcus pneumoniae in 12 (12%) patients. In 24 (25%)
children the cause has not been proven. Since 2002, the incidence of purulent
meningitis has been reduced, mainly because of decline in cases caused by
Haemophilus influenzae, thanks to the introduction of Hib vaccine in the
mandatory vaccination schedule. Since 2008, no case of purulent meningitis was
caused by this agent.
29
O-19 Kliničke značajke akutnih crijevnih infekcija u djece liječene u Klinici za

infektivne bolesti KBC Split 2012.-2014. godine
Perina Granić, Ivo Ivić, Boris Lukšić, Dragan Ledina, Mirela Pavičić-Ivelja,
Dominko Carev, Irena Jeličić
Cilj ovog rada bio je prikazati kliničke osobine akutnih crijevnih infekcija 1367 djece
starosti do 5 godina obrađenih na Klinici za infektologiju KBC Split u dvogodišnjem
razdoblju od 1. siječnja 2012. do 31. prosinca 2013. godine. Značajno više
pregledane djece bilo je u dobnim skupinama 13-24 mjeseci (32.26%) i 24-36
mjeseci (22.31 %) nego drugih dobnih skupina. Značajno veći broj obrađene djece
je parenteralno rehidriran putem dnevne bolnice (74.63%), samo 6.84% je
hospitalizirano, dok je kod 18.53% djece bio dovoljan samo savjet o oralnoj
rehidraciji. Rotvirus je bio značajno najčešći dokazani uzročnik u hospitalizirane
(43.96%) i u djece liječene u dnevnoj bolnici (58.34%). Većina hospitaliziranih, kao i
liječenih u dnevnoj bolnici prema Vesikari skali imala je klinički tešku bolest (96.7,
odnosno 79.17%), ali većina njih je bila blago dehidrirana (61.54, odnosno 83.33%).
Statistički značajno veći udio umjereno dehidrirane djece (37.36% bio je među
hospitaliziranom djecom nego među onima liječenim putem dnevne bolnice
(8.33%), dok niti jedno dijete nije procijenjeno kao teško dehidrirano. Nije bilo
razlike između virusne i bakterijske etiologije s obzirom na stupanj dehidracije, a ni
dojenje se nije pokazalo kao zaštitni faktor što se tiče trajanja bolesti ili stupnja
dehidracije. Unatoč većoj zastupljenosti teške kliničke slike bolesti, većina bolesnika
nije imala većih odstupanja u laboratorijskim parametrima upale i dehidracije.
Najveći broj komplikacija javljao se u djece čija je bolest uzrokovana Rotavirusom, a
najčešća komplikacija konvulzije (5 djece).
Clinical features of acute intestinal infections of children treated in the

Clinic for Infectious Diseases Clinical Hospital Split in the period 2012-
2014
Perina Granić, Ivo Ivić, Boris Lukšić, Dragan Ledina, Mirela Pavičić-Ivelja,
Dominko Carev, Irena Jeličić
Clinic for Infectious Diseases, University Hospital Split, Split, Croatia
The aim of this study was to present clinical characteristics of acute intestinal
infections in 1367 children under 5 years of age treated at Infectology Clinic of
University Hospital Split in a two years period from january 2012. till december
2013. Children aged 13-24 months (32.26%) and 24-36 months (22.31 %) were
significantly more frequently examined then other age groups. Significantly greater
number of children were parenteraly rehydrated in the day-care hospital (74.63%),
only 6.84% were hospitalized and in 18.53% cases advice about peroral rehydration
was enough. Rotavirus diarrhea was the most common proven reason for
hospitalization (43.96%) and for therapy in day-care hospital (58.34%). According to
30
Vesicar score assessment majority of hospitalized, as well as day-care hospital

treated children, had severe disease (96.7, 79.17% respectively), but most of them
had a mild degree of dehydration (61.54, 83.33% respectively). There were
significantly more moderately dehydrated children among those who were
hospitalized (37.36%) than those treated through day-care hospital (8.33%). There
were no children with severe degree of dehydration. There was no difference
between viral and bacterial disease etiology according to the degree of
dehydration. Breastfeeding was not proven as a protective factor, nor in terms of
disease severity or a milder degree of dehydration. Despite higher representation
of severe disease, most of our patients had no major abnormalities in laboratory
parameters of infection or dehydration prameters. Majority of the complications
occured in children with Rotavirus infection, with febrile convulsions being most
often (5 children).
O-20 Infekcije uzrokovane respiratornim sincicijskim virusom: dvogodišnji

periodicitet u Zagrebu i okolici
Irena Tabain, Tatjana Vilibić-Čavlek, Vlatko Jelić, Gordana Mlinarić-Galinović
Respiratorni sincicijski virus (RSV) glavni je uzročnik hospitalizacija u dojenčadi i

male djece u razvijenim zemljama te u zemljama u razvoju. Procjenjuje se da RSV
godišnje uzrokuje milijune hospitalizacija male djece širom svijeta te 66.000-
199.000 smrtnih slučajeva.
Cilj istraživanja bio je opisati epidemiološke značajke RSV infekcija u djece s
akutnom infekcijom dišnog sustava (IDS), na području Grada Zagreba, tijekom dvije
uzastopne godine listopada 2012- rujna 2014. godine, odrediti epidemijske vrhunce
te ih usporediti s dosadašnjim spoznajama o periodičkim ciklusima pojavljivanja
RSV epidemija.
Istraživanje je obuhvatilo 3276 bolesnika u dobi 0-5 godina, sa simptomima
akutnog IDS-a. Od svakog bolesnika uzet je nazofaringealni sekret ili obrisak
nazofarinksa u kojem je RSV dokazan metodom izravne imunofluorescencije.
RSV infekcija zabilježena je u 565-ero (17,3%) djece, među kojima je bilo 309
(54,7%) dječaka te 256 (45,3%) djevojčica. Tijekom 2012/13. godine bila su 322
(19,9%) bolesnika s dokazanom RSV infekcijom, a 2013/14. bilo ih je 243 (14,7%).
Najveći broj oboljele djece bio je u dobi 0-12 mjeseci (366; 64,8%), a među njima je
najčešće zabilježen bronhiolitis (212; 57,9%).
Vrhunac RSV epidemije tijekom 2012./2013. bio je u siječnju/veljači 2013. godine
(92/98 oboljelih), a u 2013./2014. bio je u veljači/ožujku 2014. godine (87/82
oboljela). Zimsku epidemiju pratio je veći broj RSV dokazanih slučajeva (320) te
veća učestalost bronhiolitisa u dojenčadi (61,2%) nego proljetnu (236 slučajeva,
odnosno 52,6% bronhiolitisa u dojenčadi).
31
Naši rezultati su u skladu s prethodnim zapažanjima koja su pokazala da RSV

epidemije u Hrvatskoj imaju dvogodišnji ciklus. RSV je čest uzročnik akutnog IDS-a,
posebno u dojenačkoj dobi i tijekom zimskih mjeseci. Stoga RSV i dalje, predstavlja
značajan javnozdravstveni problem te je važno svake godine nadzirati pojavu RSV-a
kako bi se na vrijeme prepoznalo razdoblje s visokim rizikom pojave infekcije.
Respiratory syncitial virus infections: Biennial cycle in Zagreb and

surrounding region
Irena Tabain, Tatjana Vilibić-Čavlek, Vlatko Jelić, Gordana Mlinarić-Galinović
Respiratory syncytial virus (RSV) is the main cause of hospitalization in infants in

industrialized and developing countries. Millions of children are hospitalized and an
estimated 66,000–199,000 die every year worldwide due to RSV disease.
The paper investigate the epidemic pattern of RSV outbreaks in children with acute
respiratory tract infections (ARTI), in Zagreb and surrounding region, during two
consecutive years October 2012- September 2014, define peaks of outbreaks and
to compare them with previous observation that RSV epidemics occur in two-year
cycles.
The investigation included 3276 patients, aged 0-5 years with ARTI symptoms.
Samples of nasopharingeal aspirate and/or swab were collected from each patient.
The virus was detected using commercial monoclonal antibodies in direct
immunofluorescence assay.
Of 565 (17.2%) RSV infection identified in children, there were 309 (54.7%) boys
and 256 girls (45.3%). During 2012/2013 and 2013/2014 season RSV infection was
diagnosed in 322 (19.9%) and 243 (14.7%) patients, respectively. RSV infection was
the most prevalent among infants aged 0-12 months (366; 64.8%). Of the RSV-
positive patients in this age group, 212 (57.9%) had bronhiolitis.
Outbreak peaks during winter season 2012/2013 and 2013/2014 were in
January/February 2013 (92/98 patients), and February/March 2014 (87/82
patients), respectively. There were 320 RSV cases and higher incidence of
bronchiolitis in infants (61.2%) during major RSV outbreak in contrast to minor
outbreak (236 cases and 52.6% cases of bronchiolitis, respectively).
Our results are consistent with previous observations that RSV outbreaks in Croatia
have biennial cycles. RSV is a common causative viral agent of ARTI, especially in
infants and in winter months. Therefore, RSV is still significant public health issue
and it is necessary to monitor RSV activity every year to define period with high risk
of infection.
32
O-21 Tuberkuloza centralnog nervnog sistema u djece: dvadesetogodišnji

pregled
Arnela Smriko-Nuhanović, Sead Ahmetagić
Klinika za infektivne bolesti, Univerzitetski klinički centar Tuzla, Tuzla,
Bosna i Hercegovina
CILJ: Napraviti pregled iskustva u liječenju tuberkuloze centralnog nervnog sistema

(CNS) u djece na Klinici za infektivne bolesti Univerzitetskog kliničkog centra Tuzla,
Bosna i Hercegovina.
METODE: Učinjena je retrospektivna analiza medicinske dokumentacije pacijenata
<18 godina dijagnostikovanih kao CNS tuberkuloza, koji su liječeni u Klinici za
infektivne bolesti Univerzitetskog kliničkog centra Tuzla, Bosna i Hercegovina,
tokom dvadesetogodišnjeg perioda (1996.-2016.). Prikupljeni su klinički,
laboratorijski i demografski podaci, kao i rezultati radioloških pretraga i podaci o
kliničkom ishodu bolesti.
REZULTATI: U navedenom periodu liječeno je 10 djece sa tuberkulozom CNS, u svim
slučajevima radilo se o tuberkuloznom meningitisu, prosječne dobi 10,2 godine, u
rasponu od 5 mjeseci do 16,9 godina, 6 (60,0%) nije imalo dokaz o ranijoj BCG
vakcinaciji, sva djeca su dolazila iz ruralnih područja i siromašnih porodica. Izvan
dojenačkog perioda kod sve djece na prijemu su bili prisutni simptomi gubitka
apetita, iritabilnost, povišena temperatura, glavobolja i povraćanje (prosječnog
trajanja 10,0 ± 1,5 dana). Na prijemu 3 pacijenta (30,0%) su bili u prvom stadiju
bolesti, 6 (60,0%) u drugom stadiju i 1 (10,0%) u trećem. Osam pacijenata (80,0%)
je imalo promjene na rendgenskom snimku pluća. Mycobacterium tuberculosis je
identifikovan u likvoru acidorezistentnim bojenjem u jednom slučaju (10,0%), a
uzgojen kulturom likvora u 4 (40,0%) slučaja. Pogrešna dijagnoza na prijemu i
odgađanje uključenja antituberkulozne terapije su zapaženi u 8 (80,0%) pacijenata,
prosječno vrijeme odgađanja 5,9 ±2,5 dana. Ukupna smrtnost je bila 30%.
Antituberkulozna terapija je data u skladu sa za period važećim preporukama,
dodatnu kortikosteroidnu terapiju su primali svi pacijenti, za jednog pacijenta sa
hidrocefalusom bila je potrebna neurohirurška intervencija.
ZAKLJUČAK: Tuberkuloza centralnog nervnog sistema u djece javlja se sa
nespecifičnom kliničkom slikom, te ju je potrebno razmotriti kod sve djece sa
neurološkim simptomima i znacima koja imaju faktore rizika za tuberkulozu. Osnov
uspješnog liječenja su brza dijagnoza i što ranije uključenje terapije.
33
Tuberculosis of the central nervous system in children: a 20-year survey

Arnela Smriko-Nuhanović, Sead Ahmetagić
Public Health Institution University Clinical Center Tuzla, Tuzla, Bosnia and
Herzegovina
OBJECTIVE: To review experience of central nervous system (CNS) tuberculosis in

children at The Clinic for Infectious Diseases, University Clinical Centre Tuzla, Bosnia
and Herzegovina.
METHODS: This was a retrospective case survey of patients <18 years of age
admitted at a Clinic for Infectious Diseases, University Clinical Centre Tuzla, Bosnia
and Herzegovina, over a 20-year period (1996-2016), who fulfilled criteria for a
diagnosis of CNS tuberculosis. Data were collected with regard to the clinical,
laboratory and demographic characteristics of patients, as well as results of
radiological investigations and data on clinical outcome.
RESULTS: We identified 10 children with CNS tuberculosis, all presenting as
tuberculous meningitis, mean age 10,1 years, ranging from 5 months to 16,9 years,
6 (60%) had no evidence of previous BCG vaccination, all children came from rural
areas and low-income families. Beyond infancy clinical symptoms present on
admission in all were anorexia, irritability, fever, headache and vomiting (mean
duration 10, 0 ± 1, 5 days). At presentation three patients (30, 0%) were in the first
stage of the disease, 6 (60, 0%) in the second and 1 (10, 0%) in third. Eight patients
(80, 0%) had abnormal chest X-ray findings. Mycobacterium tuberculosis was
identified by acid-fast stain from cerebrospinal fluid (CSF) in one case (10, 0%), but
cultured from CSF in 4 cases (40, 0%). Misdiagnosis on admission and delay in the
initiation of anti-tuberculosis treatment was observed in 8 (80, 0%) patients, mean
delay 5, 9 ±2, 5 days. The overall mortality rate was 30%. Anti-tuberculosis therapy
was administered according to current recommendations of the period, concurrent
steroids were given to all patients, one patient with hydrocephalus had surgical
intervention.
CONCLUSIONS: Childhood CNS tuberculosis presents with nonspecific clinical
features, the diagnosis should be considered in all children with neurologic signs
and symptoms, and risk factors for tuberculosis. Early diagnosis and prompt
initiation of treatment are essential to improve the poor outcome.
34
IZAZOVI U BAKTERIOLOŠKOJ DIJAGNOSTICI

CHALLENGES IN BACTERIOLOGICAL DIAGNOSTICS
35
O-22 Susret sa stručnjacima - radni dan kliničkog mikrobiologa i infektologa u

inozemstvu
Vjeran Čajić
Klinička bolnica Coventry i Warwickshire, Coventry, Velika Britanija
UHCW je jedna od najvećih akutnih bolnica u UK. Sastoji se od Sveučilišne bolnica

Coventry i bolnice St. Cross u Rugby-u i pokriva populaciju nešto veću od milijun
ljudi. Coventry ima veliku incidenciju tuberkuloze od 26 na 100000 stanovnika u
2015. i prevalenciju HIV infecije od 3 na 1000 stanovnika. Unatoč tim činjenicama
odjel infektologije je jedan od manjih u UK i trenutno se sastoji od samo dva
specijalista. ID odjel ima 16 kreveta i jednu sobu s negativnim tlakom. Redovne
obaveze uključuju: vizite, konziliarne preglede, ID i TB ambulante, ID/TB MDT
sastanke, Journal Club sastanke, sastanke s mkrobiolozima i pulmolozima, sastanke
s ciljem unapređenja kvalitete, endokarditis MDT vizite, sastanke TB CRG, odgovori
na upite liječnika opće prakse i upite TB tima izvan bolnice. Prikazan će biti uvid u
svakodnevne izazove.
Infectious Diseases Consultant’s Job in University Hospitals Coventry and

Warwickshire, Coventry, UK
Vjeran Čajić
University Hospitals Coventry and Warwickshire, Coventry, UK
University Hospitals Coventry and Warwickshire NHS Trust is one of the largest
acute teaching hospitals in the UK, comprising University Hospital in Coventry and
the Hospital of St Cross in Rugby, and serving a population of over a million people.
Coventry has a high annual incidence of TB of 26 per 100000 and a prevalence of
HIV of almost 3 per 1000. Contravene to this fact the Infectious Diseases
Department is one of the smallest in the UK with only two ID consultants. Duties on
a regular basis include: Ward Rounds, Inpatients referrals, ID Clinic, TB Clinic, ID/TB
MDT meetings, Journal Club meetings, Meetings with Microbiology Team,
Respiratory/ID Consultants meetings, Quality Improvement and Patients Safety
meetings, Endocarditis Ward Rounds, TB Clinical Reference Group meetings, Advice
and Guidance letters to GPs, Queries from Community TB Team, Meetings with
inpatient’s relatives. A selection of daily challenges will be presented.
O-23 Phenotypic next generation antimicrobial susceptibility testing

Alex van Belkum
bioMérieux, Microbiology R&D, La Balme les Grottes, France
36
O-24 Automation in clinical bacteriology

Katja Seme
Laboratory for Diagnostics of Respiratory Infections, Faculty of Medicine
University of Ljubljana, Ljubljana, Slovenia
O-25 Brza dijagnostika u bakteriologiji

Uzgoj bakterija, nakon čega slijedi njihova identifikacija i određivanje osjetljivosti na

antibiotike još je uvijek zlatni standard u kliničkoj bakteriologiji, no sve su veći
zahtjevi za bržom dijagnostikom, pogotovo kod teških bakterijskih infekcija, gdje
zakašnjela primjena pravilne antimikrobne terapije može imati pogibeljne
posljedice. Nadalje, brza dijagnostika je izuzetno bitna pri kontroli širenja bakterija
s visokim epidemijskim potencijalom, od kojih su danas najznačajniji
multiplorezistentni patogeni i hipervirulentni Clostridium difficile. Brza dijagnostika
u bakteriologiji se zasniva na mikroskopiranju, detekciji antigena, molekularnoj
dijagnostici te novim fenotipskim testovima koji koriste MALDI-TOF (eng. Matrix-
Assisted Laser Desorption/Ionization - Time of Flight) tehnologiju. Dokaz antigena
u urinu se koristi u dijagnostici legioneloze i invazivne pneumokokne bolesti, a
dokaz antigena streptokoka grupe A u brisu grla pomaže razlikovanju virusnih od
bakterijskih infekcija čime se racionalizira uporaba antibiotika u zemljama s
visokom potrošnjom antibiotika. Molekularna dijagnostika se isprva koristila
uglavnom za detekciju teško uzgojivih bakterija poput mikoplazmi, klamidija te
bakterija Mycobacterium tuberculosis i Bordetella pertussis, a danas je orjentirana
ne toliko na pojedinačne patogene nego više na kliničke sindrome. Uz istovremenu
detekciju niza patogena često se istovremeno mogu odrediti i geni odgovorni za
rezistenciju i čimbenike virulencije. Metode amplifikacije nukleinskih kiselina (engl.
“nucleic acid amplification techniques”, NAATs) su danas prilagođene primjeni i
izvan laboratorija te skupa s testovima dokazivanja antigena čine paletu testova
koji se mogu izvoditi na mjestu skrbi pacijenta (engl. “point of care”, POC testovi).
Metode sekvenciranja genoma (engl. “whole genome sequencing”, WGS i “next
generation sequencing”, NGS) omogućuju detaljniju analizu genoma jedne bakterije
ili svog genetskog materijala prisutnog u uzorku. Primjena tih metoda postaje sve
prihvatljivija i u kliničkim laboratorijima. Uz pojeftinjenje opreme glavni izazov
predstavlja bioinformatička obrada nalaza i tumačenje odnosa između genotipa i
njegove fenotipske ekspresije. Uz sve osjetljivije dijagnostičke testove stručno
tumačenje nalaza u sklopu kliničke slike postaje još veći imperativ kliničke
mikrobiologije.
37
Rapid diagnostics in bacteriology

Croatia
Culture with subsequent identification and sensitivity testing still represent a

golden standard in clinical bacteriology, but requirements for more rapid
diagnostics are increasing especially in serious bacterial infections where delayed
antibiotic therapy could lead to deadly consequences. Rapid diagnostic is also very
important in detection of bacterial pathogens wit high epidemic potential such as
multiresistant pathogens and hypervirulent Clostridium difficile. Rapid diagnostics
in bacteriology is based on microscopy, antigen detection, molecular methods and
novel phenotypic tests based on MALDI-TOF (Matrix-Assisted Laser
Desorption/Ionization - Time of Flight) technology. Urine antigen tests are used to
diagnose invasive pneumococcal and legionella disease and Group A streptococcus
antigen test is used to differentiate viral from bacterial disease with impact on
antibiotic prescribing in high prescribing countries. Molecular methods were first
used for detection of difficult to culture bacteria such as mycoplasmae, chlamydiae,
Mycobacterium tuberculosis and Bordetella pertussis and today molecular
diagnostics is moving away from pathogen specific tests towards syndrome specific
tests detecting several pathogens and/or resistance and virulence determinants
simultaneously. Initially labour intensive nucleic acid amplification techniques
(NAATs) are today adjusted for use outside laboratories and together with antigen
tests are commercially available for point of care (POC) testing. Whole genome
sequencing (WGS) and next generation sequencing (NGS) methods enable detailed
analysis of bacterial genome and all genomic material present in the sample. These
methods are becoming more and more affordable in clinical laboratories. As the
equipment is becoming cheaper bioinformatics and understanding relation
between genotype and its phenotypic expression presents major challenges. With
diagnostic methods of increasing sensitivity clinical interpretation of laboratory
findings will be an even more important aspect of clinical microbiology in the
future.
38
O-26 Molekularna detekcija enterobakterija i acinetobaktera otpornih na

karbapeneme u trogodišnjem razdoblju u Kliničkom bolničkom centru
Zagreb
Zrinka Bošnjak, Tamara Bošnjak, Ana Budimir, Ivana Mareković
Klinički zavod za kliničku i molekularnu mikrobiologiju, KBC-a Zagreb,
Zagreb, Hrvatska
Molecular detection of carbapenem-resistant Enterobacteriaceae and

Acinetobacter in the three-year period in the Clinical Hospital Centre
Zagreb
Zrinka Bošnjak, Tamara Bošnjak, Ana Budimir, Ivana Mareković
Department of Clinical and Molecular Microbiology, University Hospital
Centre Zagreb, Zagreb, Croatia
39
ESCMID RADIONICA: UPRAVLJANJE ANTIMIKROBNIM LIJEKOVIMA

ESCMID WORKSHOP: ANTIMICROBIAL STEWARDSHIP
40
O-27 How to improve antimicrobial prescribing?

Jan Prins
Department of Internal Medicine, Division of Infectious Diseases, Academic
Medical Center, University of Amsterdam, Amsterdam , The Netherlands
O-28 The role of a clinical microbiologist in antimicrobial stewardship

Heiman Wertheim
Nuffield Department of Medicine, University of Oxford, UK
Department of Medical Microbiology, Radboud University Nijmegen
Medical Centre, Nijmegen, The Netherlands
O-29 Strategije za poboljšanje propisivanja antibiotika u bolnicama u Hrvatskoj

Ljiljana Betica Radić
Opća bolnica Dubrovnik, Dubrovnik, Hrvatska
Živimo u doba sve veće otpornosti bakterija na antibiotike i nestašice razvoja novih
antibiotika. Poznato je da jedna trećina svih hospitaliziranih bolesnika prima
antibiotike, a istraživanja pokazuju kako je čak 25% -68% antibiotika u bolnicama
neadekvatno propisano.
Rezultati brojnih istraživanja dokazuju kako intervencije za smanjenje prekomjerne
primjene antibiotika u bolnicama mogu smanjiti razvoj antimikrobne rezistencije ili
nastanak bolničkih infekcija, a intervencije koje povečavaju efikasno propisivanje
mogu poboljšati klinički ishod.
Najvažnije strategije koje poboljšavaju racionalno propisivanje antibiotika u
bolnicama su: dostupnost tima stručnjaka za propisivanje antibiotika, dostupnost i
praćenje podataka o vrsti patogena, otpornosti i potrošnji antibiotika; primjena
lokalnih terapijskih smjernica, bolnički popis antibiotika, lista rezervnih antibiotika
koji se propisuju samo uz odobrenje; kreiranje i implementacija edukacije,
osposobljavanja i informiranja; indikatori kvalitete; posebni programi za
optimizaciju liječenja: de-eskalacija, trajanje liječenja, switch terapija sa
parenteralne na oralnu, optimizacija doze, prekid antibiotika; posebna pravila za
interpretaciju i izvještavanje mikrobioloških nalaza; posebna pravila za skrb
bolesnika s multirezistentnim mikroorganizmima i C.difficile; korištenje
kompjuterizirane informacijske tehnologije. Ove bi se strategije trebale sprovoditi u
svim bolnicama.
Kontinuirano praćenje rezistencije na antibiotike na nacionalnoj razini, u Hrvatskoj
je počelo 1996. godine kada je osnovan Hrvatski odbor za praćenje rezistencije
bakterija na antibiotike. U 2006. godini Ministarstvo zdravstva utemeljilo je
Interdisciplinarnu Sekciju za kontrolu rezistencije na antibiotike" (ISKRA). ISKRA
41
koordinira sve aktivnosti vezane uz antibiotsku kontrolu otpornosti bakterija na

antibiotike, na području humane, veterinarske medicine i poljoprivrede.
Također je važno naglasiti utjecaj kulturnih i bihevioralnih odrednica, društvenih
normi, stavova i uvjerenja na ponašanje kod antibiotskog propisivanja. To rezultira
različitom praksom propisivanja na lokalnoj, nacionalnoj i međunarodnoj razini. Pri
dizajniranju i evaluaciji intervencija o antimikrobnom propisivanju, navedeni
utjecaji općenito nisu dovoljno uzeti u obzir.
Strategies to improve antimicrobial prescribing in Croatian hospitals

Ljiljana Betica Radić
General Hospital Dubrovnik, Dubrovnik, Croatia
We live in the time of increasing antibiotic resistance and insufficiency of new drug
development. Up to one-third of all hospitalized patients receive antimicrobials,
and studies show that 25%–68% of hospital antimicrobial prescribing is suboptimal.
The results of numerous studies show that interventions to reduce excessive
antibiotic prescribing to hospital inpatients can reduce antimicrobial resistance or
hospital-acquired infections, and interventions to increase effective prescribing can
improve clinical outcome.
The most important strategies to enhance rational use of antibiotics in hospitals
are: availability of a team of ABS experts, availability of surveillance data on
pathogens, resistance and antimicrobial consuption; application of local treatment
guidelines/pathways, hospital antiinfective formulary, formulary restrictions and
approval requirements; design and implementation of education, training and
information; quality indicators; special programmes for treatment optimisation: de-
escalation, duration of treatment, parenteral-to-oral conversion, dose
optimisation, scheduled switch of antimicrobials; special rules for communication
of microbiology results; special rules for management of patients with multidrug-
resistant microorganisms and C.difficile; computerised information technology.
These strategies should be implemented in all hospitals.
Continuous antibiotic resistance surveillance at the national level started in 1996.
in Croatia, when the Croatian Committee for Antibiotic Resistance Surveillance
(CARS) was founded. In 2006. Ministry of Health founded Croatian intersectorial
coordination, the so called „Interdisciplinarna sekcija za kontrolu rezistencije na
antibiotike” (ISKRA). The ISKRA coordinates all the activities related to antibiotic
resistance control in the field of human and veterinary medicine and agriculture.
It is important to emphasize significant influence of cultural and behavioral
determinants, social norms, attitudes, and beliefs on antimicrobial prescribing
behavior. These result in variation in practice locally, nationally, and internationally.
When designing and evaluating interventions in antimicrobial prescribing, these
influences on prescribing are generally not enough considered.
42
O-30 Ispitivanje indikatora kvalitete propisivanja antibiotika u Hrvatskoj

Vera Vlahović Palčevski
Odjel za kliničku farmakologiju, KBC Rijeka, Rijeka, Hrvatska
Implementation of antibiotic prescribing quality indicators in Croatia

Vera Vlahović Palčevski
Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka,
Croatia
O-31 Što smo naučili iz studija prevalencije o propisivanju antimikrobnih

lijekova
Irina Pristaš
Neprimjerena potrošnja antibiotika usko je povezana s porastom rezistencije

bakterija na antibiotike, što je dovelo do nemogućnosti liječenja infekcija
uzrokovanih multiplorezistentnim bakterijama. Neprimjerena potrošnja antibiotika
uzrokom je povećanog morbiditeta, što produljuje boravak pacijenata u bolnici, te
povećava troškove liječenja.
Upravo su ovi podaci pokazatelji povećane potrebe za nadzorom nad potrošnjom
antibiotika. Jednostavna i praktična metoda kojom se mogu pratiti trendovi
potrošnje antibiotika, kao i uspješno implementiranje „stewardship“ inicijativa je
provođenje studija prevalencije o potrošnji antibiotika (PPS). Redovitim
provođenjem studija prevalencije u bolnici ili na određenom odjelu, moguće je
procijeniti kvalitetu propisivanja antibiotika. Neki od indikatora postupaka koji se
mogu uspješno pratiti, su pridržavanje propisivanja antibiotika prema nacionalnim
ili lokalnim smjernicama, ili trajanje kirurške profilakse. Indikator ishoda, kao
prevalencija bolničkih infekcija, također se može uspješno pratiti ovim studijama.
Klinika za infektivne bolesti sudjelovala je u europskim projektima o potrošnji
antibiotika 2006, 2008 i 2009 godine (European Surveillance of Antibiotic
Consumption (ESAC) Hospital Care Subproject). Studije prevalencije provedene
2012. i 2015. bile su provedene pod vodstvom European Centre for Disease
Prevention and Control (ECDC). Dobiveni podatci o raspodjeli učestalih dijagnoza
koje su bile liječene antibioticima, postotak pacijenata na antibioticima kao i
raspodjela učestalosti potrošnje antibiotika bili su konzistentni u svim provedenim
studijama.
Najpropisivaniji antibiotici u svim studijama bili su ceftriakson, ko-amoksiklav i
ciprofloksacin. Većina liječenih infekcija bile su vanbolničke infekcije. Najučestalije
dijagnoze bile su infekcije mokraćnog sustava, kože, mekih česti i zglobova, te
infekcije dišnog sustava. Rezultati svake pojedine studije pouzdani su i
43
reprezentativni za našu bolnicu. Studije prevalencije vrijedan su i učinkovit alat za

procjenu indikatora kvalitete antimikrobne potrošnje u bolnicama.
What did we learn from the point prevalence studies on antimicrobial

prescribing
Irina Pristaš
Croatia
Inappropriate antimicrobial use has been associated with an increase in

antimicrobial resistance which left us with only a few therapeuthic options for
severe infections caused by multidrug resistant organisms. Thus, inappropriate use
has also been associated with increased lenght of stay in the hospital, increased
morbidity and hospital costs.
These data show the importance of surveillance of antimicrobial use. The practical
and useful way how to monitor trends and effectivness of antimicrobial
stewardship initiatives is through repeated point-prevalence surveys (PPS). When
PPSs are done repeatedly in the same institution or ward, these can be used to
assess the quality of antimicrobial prescribing, and therefore improve the selected
quality indicators. The quality indicators that can be successfully monitored by PPSs
are performance indicators, like compliance with the guidelines or duration of
surgical prophylaxis, and outcome indicators, like prevalence of hospital acquired
infections (HAI).
The University Hospital for Infectious Diseases was participating in the European
Surveillance of Antibiotic Consumption (ESAC) Hospital Care Subproject where
data on antimicrobial prescribing was collected on the European level in 2006,
2008 and 2009. European Centre for Disease Prevention and Control (ECDC) -
coordinated PPSs were done in 2012 and 2015. The data from all of the PPSs were
consistent, showing the similar patterns of predominant diagnoses, similar
percentage of patients on antibiotics, and similar patterns of antibiotic use. In all
PPSs the most commonly prescribed antibiotics were ceftriaxone, co-amoxiclav,
and ciprofloxacin. Most of the treated infections were community acquired
infections. The predominating diagnoses were urinary tract infections, skin, soft
tissue and bone and joint infections and respiratory tract infections. The results of
an individual point prevalence survey provided reliable and representative data for
the hospital. Point-prevalence surveys proved to be a valuable method for
detecting targets for antibiotic prescribing improvement.
44
INFEKCIJE RESPIRATORNOG SUSTAVA I TUBERKULOZA

RESPIRATORY TRACT INFECTIONS AND TUBERCULOSIS
45
O-32 Hrvatske smjernice za liječenje pneumonija iz opće populacije – nikad

završena priča
Ilija Kuzman, Rok Čivljak
Klinika za infektivne bolesti “Dr. Fran Mihaljević” Zagreb, Hrvatska
Pneumonija i danas ima vrlo važan udio u pobolu i smtnosti pučanstva s rastućim
troškovima liječenja u cijelom svijetu, zato je poboljšanjem skrbi i racionalnim
liječenjem bolesnika bave različite institucije. Postoje brojne razlike između država i
regija, bolnica i pojedinih liječnika u dijagnostičkim postupcima, procjeni težine
bolesti, rješavanju problema rezistencije bakterija na antibiotike, ulozi makrolida i
fluorokinolona, duljini liječenja, prijelazu s parenteralne na peroralnu primjenu
antibiotike te sprječavanju bolesti. Osnovna je zadaća smjernica da sustavno i jasno
prikažu brojne informacije te postanu prihvaćen nacionalni standard za liječenje
pneumonija iz opće populacije.
Poput najpoznatijih smjernica za liječenje pneumonija (američke, britanske,
europske), naše preporuke se baziraju na procjeni težine bolesti, dobi bolesnika,
pratećim kroničnim bolestima i rizičnim čimbenicima, epidemiološkim podatcima te
osobito prema mjestu liječenja bolesnika: ambulantno, na bolničkom odjelu,
odnosno u jedinici intenzivnog liječenja.
Naše smjernice preporučuju dva sustava za procjenu težine bolesti te kliničku
klasifikaciju pneumonija na bakterijske i atipične, a to rezultira empirijskom
odlukom o liječenju atipičnih uzročnika u mlađih bolesnika s klinički blagim oblikom
bolesti. Ako postoji sumnja na Q-vrućicu mi preporučujemo doksiciklin kao
antibiotik prvog izbora. Hospitalizirane bolesnike s pneumonijom treba liječiti
monoterapijski fluorokinolonom (levofloksacin, moksifloksacin) ili beta-laktamskim
antibiotoikom u kombinaciji s makrolidom (azitromicin) ako postoji sumnja na
legionarsku bolesti ili druge atipične uzročnike. Bolesnike s pneumonijom u jedinici
intenzivnog liječenja treba liječiti kombinacijom beta-laktamskog antibiotika s
azitromicinom ili fluorokinolonom, a pneumonije uzrokovane pseudomonasom
kombinacijom antipseudomonasnog beta-laktama i ciprofloksacina.
Liječenje pneumonija antibiotikom treba započeti odmah, odnosno unutar četiri
sata nakon postavljanja kliničke dijagnoze. Parenteralna primjena antibiotika može
se zamijeniti peroralnom najčešće 48-96 sati od početka liječenja, čak i u bolesnika
s težim oblikom bolesti ako su zadovoljeni kriteriji. Cijepljenje protiv influence i
pneumokoknih bolesti preporučuje se svim osobama s povećanim rizikom.
46
Croatian guidelines for the management of community – acquired

pneumonia – never ending story
Ilija Kuzman, Rok Čivljak
University of Zagreb, School of Medicine, Zagreb, Croatia
University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, Zagreb,
Croatia
Community-acquired pneumonia (CAP) remains a significant cause of morbidity,

mortality and costs worldwide and improving the care of patients has been the
focus of many different organizations. Numerous variations of diagnostics, scoring
systems, resistance problem, role of macrolides and fluoroquinolons, shorter
treatment, switch therapy and prevention exist among countries, hospitals and
physicians. The purpose of guidelines is to organize in a concise way a large amount
of information, leading to national standards for the treatment of CAP.
Similar to the most important guidelines (North American, British, European), our
recommendations are based on disease severity, patient’s age, comorbidity and
risk factors, epidemiological data, and especially the treatment setting: outpatient,
hospital ward or intensive care unit (ICU).
Our guidelines recommend two scoring systems and clinical classification into
bacterial and atypical pneumonia. They include empiric approach to treatment
atypical pathogens in younger patients with milde CAP. If Q fever is suspected, a
doxycycline is antibiotic of choice. For inpatients preferred options are either
fluoroquinolone (levofloxacin, moxifloxacin) or beta-lactam plus macrolide
(azithromycin) if the suspicion of legionnaires’ disease or other atypical pathogens
is present. For ICU treatment we recommend a beta-lactam plus either
azithromycin or fluoroquinolone, and for Pseudomonas infection antipseudomonal
beta-lactam plus ciprofloxacin.
Antibiotic treatment for CAP should be started as soon as possible, recommended
within 4 hours after the diagnosis. Switch from parenteral to oral antibiotics is safe
at 48-96 hours even in patients with severe CAP who meet criteria for clinical
stability. Vaccination against influenza and pneumococcal diseases is
recommended in all individuals at increased risk.
47
O-33 Veno-venska ekstrakorporalna membranska oksigenacija – naših prvih

100 bolesnika
Marko Kutleša
Tijekom predavnja će biti prikazane fiziologija, principi te indikacije za primjenu

veno-venske ekstrakorporalne membranske oksigenacije. U drugom djelu
predavanja prikazati ćemo rezultate naših sto bolesnika liječenih ovom metodom
zbog teškog akutnog respiratornog distres sindroma te varijable povezane s
ishodom.
Veno-venous extracorporeal membrane oxygenation – our first 100

patients
Marko Kutleša
Croatia
Lecture will present physiology, fundamental principles and indications for the use
of veno-venous extracorporeal membrane oxygenation. During the second part of
the lecture the results of our referral center for respiratory extracorporeal
membrane oxygenation will be disclosed along with the variables associated with
the outcome of the treated patients.
O-34 Invazivna pneumokokna bolest

Iva Butić
Streptococcus pneumoniae često kolonizira sluznicu gornjeg dišnog sustava zdrave

djece i odraslih. Također može uzrokovati niz infekcija, od blažih infekcija srednjeg
uha do teških infekcija: upala pluća, bakterijemija, meningitis i sepsa. Rizične
skupine su djeca do 2 godine starosti i osobe starije životne dobi, >65 godina. Teške
invazivne pneumokokne bolesti (IPB) su veliki globalni zdravstveni problem.
Svjetska zdravstvena organizacija (WHO) procjenjuje da više od 1,6 milijuna ljudi,
uključujući > 800.000 djece do 5 godina starosti godišnje umire od posljedica IPB,
dominantno u najsiromašnijim zemljama svijeta. Većina invazivnih serotipova su
uključeni u cjepiva kao i oni otporni na antibiotike. 2007godine WHO preporučuje
upotrebu pneumokoknih konjugiranih cjepiva u svim zemljama, s naglaskom na
zemlje s visokom incidencijom obolijevanja od upale pluća i najvećom stopom
mortaliteta kod djece do 5 godina starosti. Zahvaljujući dobro organiziranoj mreži
mikrobioloških laboratorija u Hrvatskoj postoji dugogodišnja tradicija prikupljanja
invazivnih sojeva pneumokoka u Referentnom centru za praćenje rezistencije
bakterija na antibiotike gdje se vrši provjera osjetljivosti, određivanje minimalnih
48
inhibitornih koncentracija i serotipizacija. U periodu od 2005.g. do 2015.g.

prikupljen je ukupno 1251 izolat. Najčešće izolirani serotipovi kod djece do 5 g. su
14, 19A i 6B, a kod osoba starijih od 65 g. su 3, 14, 1 i 19A. U Hrvatskoj
pneumokokno cjepivo nije uvršteno u Nacionalni Imunizacijski Program (NIP) te se
cijepe samo rizične skupine. Trenutno su na našem tržištu dostupna dva
konjugirana cjepiva (10-valentno i 13-valentno) te 23-valentno polisaharidno
cjepivo. Kod djece do 18 g. se 10-valentnim cjepivom IPB mogla prevenirati u 71%
slučajeva, a 13-valentnim u 85% slučajeva. Osobe starije od 65 godina 23-valentnim
polisaharidnim cjepivom su zaštićene u 91% slučajeva, a 13-valentnim cjepivom ista
populacijska skupina je pokrivena 79%. Na osnovu nacionalnih podataka bilo bi
potrebno razmisliti da li bi uvođenje pneumokoknog cjepiva u NIP pridonijelo
smanjenju morbiditeta i mortaliteta.
Invasive pneumococcal disease

Iva Butić
Croatia
Streptococcus pneumoniae is frequently found in the upper respiratory tract of

healthy children and adults. This bacterium can also cause a range of infections-
from mild ear infections to severe infections: pneumonia, bacteriemia, meningitis
and sepsis. Children under 2 years and the elderly, >65 years are at the highest risk.
Severe pneumococcal infections are a major global health problem. World Health
Organization (WHO) estimates that more than 1.6 million people, including >800
000 children less than 5 years old die every year from invasive pneumococcal
disease (IPD) mostly in the world’s poorest countries. The majority of invasive
serotypes are included in the vaccines, also the most resistant ones. In 2007, the
WHO recommended use of pneumococcal conjugate vaccines in all countries with
the highest priority for countries with high pneumonia and high mortality rate for
children <5 years. In Croatia, owing to a well-organized network of microbiological
laboratories, there is a long tradition of collecting invasive pneumococcal strains in
the Reference Center for Antimicrobial Resistance Surveillance where additional
susceptibility test are performed including serotyping. In the period from 2005 to
2015 total of 1251 isolate were collected. The most dominate serotypes isolated in
children <5 years were 14, 19A and 6B, and in elderly 3, 14, 1 and 19A. In Croatia,
pneumococcal vaccine is not included in the National Immunization Program (NIP)
but only risk groups are vaccinated. Currently two conjugate vaccines are available
(10-valent and 13-valent) and 23-valent polysaccharide vaccine. IPB in children <18
years can be prevented in 71% of cases using 10-valent vaccine, while 13-valent
vaccine coverage is 85%. Elderly are protected in 91% of cases with 23-valent
polysaccharide vaccine, while 13-valent vaccine coverage is 79%. On the basis of
national data it is necessary to consider whether the introduction of pneumococcal
vaccines in the NIP would contribute to reducing the morbidity and mortality.
49
O-35 Novi pogled na tuberkulozu

Vera Katalinić Janković
New spotlight on tuberculosis

Vera Katalinić Janković
O-36 Mjesto novih testova u dijagnostičkom algoritmu tuberkuloze

Ljiljana Žmak
New tests in the diagnostic algorithm of TB

Ljiljana Žmak
O-37 Na putu prema eliminaciji tuberkuloze, gdje je mjesto cijepljenja BCG

cjepivom
Anamarija Jurčev Savičević1, Ivana Goić-Barišić2, Maja Mikas2
1
Nastavni zavod za javno zdravstvo Splitsko-dalmatinske županije, Split,
Hrvatska
2
Klinički bolnički centar Split, Split, Hrvatska
Prikazati sheme BCG-cijepljenja, kriterije SZO-a za promjenu sheme besežiranja i

poziciju Hrvatske sa svojim epidemiološkim podatcima te osnovna obilježja cjepiva.
Metode: Analiza europskih baza podataka te izračun hrvatskih epidem ioloških
podataka vezano uz kriterije SZO-a te novijih radova o BCG- cijepljenju.
Rezultati: U Europi su prisutne različite sheme cijepljenja BCG-om, od univerzalnog
cijepljenja, cijepljenja rizičnih skupina do ukinutog cijepljenja. Pitanje imunogenosti
cjepiva još je uvijek otvoreno, dok je reaktogenost općenito niska. Zaštita nakon
BCG-iranja u novorođenačkoj dobi vjerojatno se gubi nakon 10-20 godina. Smatra
se da revakcinacija nije učinkovita. Novija istraživanja baziranja na testovima
otpuštanja interferona gamma navode određenu zaštitu i od infekcije.
Incidencija tuberkuloze u Hrvatskoj u 2015. godini iznosila je 10 oboljelih na 100
000 stanovnika. Najviše stope se bilježe u dobnoj skupini 65+. Najčešća lokalizacija
je u plućima, a tuberkuloza je većinom potvrđena kultivacijom. Vezano uz kriterije
SZO-a, u Hrvatskoj je incidencija oboljelih s direktno pozitivnim plućnim
tuberkulozama u 2014. godini iznosila 5,6/100 000, a prosječna u zadnje tri godine
50
5,1/100 000. Zadnjih 10 godina nije prijavljen tuberkulozni meningitis u djece ispod
5 godina, dok godišnji rizik od tuberkulozne infekcije nije poznat.
Zaključak: Cjepivo ima ograničeni učinak u prevenciji plućnog oblika bolesti, koji je
najčešći oblik tuberkuloze i s najvećim javnozdravstvenim značenjem. Zemlje niske
incidencije, kao što je sada i naša, uglavnom cijepe novorođenčad i dojenčad
unutar prepoznatih rizičnih skupina ili tuberkulin negativnu stariju djecu. U nekima
od tih zemalja cijepljenje je zamijenjeno intezivnijim otkrivanjem tuberkuloze i
nadziranim liječenjem. U Hrvatskoj incidencija tuberkuloze polako pada i ulazimo
među zemlje niske incidencije. Epidemiološki pokazatelji tuberkuloze su na tragu
kriterija za ukidanje univerzalnog cijepljenja. Kako je to prvenstveno preporuka,
konačna odluka ovisi o stavu nacionalnih stručnjaka. Ako se odluči za selektivno
cijepljenje, treba dobro identificirati rizične skupine u kojima bi se moralo osigurati
postizanje visokih cjepnih obuhvata.
On the way to the elimination of tuberculosis, where is a place of BCG

vaccination?
Anamarija Jurčev Savičević1, Ivana Goić-Barišić2, Maja Mikas2
1
Teaching Institute of Public Health Split-Dalmatian County, Split, Croatia
2
University Hospital Center Split, Split, Croatia
Objective: To describe the schemes of BCG vaccination, the WHO criteria for
changes of BCG schemes, Croatian epidemiological data and the basic
characteristics of the vaccine.
Methods: Analysis of European databases and calculation of Croatian
epidemiological data related to the WHO criteria and the recent papers of the BCG
vaccination.
Results: In Europe, different schemes of BCG vaccination have been present, from
universal vaccination, vaccination of risk groups to no vaccination at all.
Immunogenicity of the vaccine is still subject of discussion, while the reactogenicity
is generally low. It is commonly believed that duration of protection after neonatal
BCG vaccination declines gradually to non-significant levels after 10–20 years. It is
believed that a booster dose is not effective. Recent papers based on interferon
gamma release assays cite some protection from infection.
The incidence of tuberculosis in Croatia in 2015 was 10/100 000 population. The
highest rates were recorded in the age group 65+. Tuberculosis was most
commonly localized in the lungs and confirmed by cultivation. Regarding the WHO
criteria, Croatian incidence of patients with smear-positive pulmonary tuberculosis
in 2014 was 5.6/100 000, and the average in the last three years, 5.1/100 000. In
the last 10 years tuberculous meningitis in children under 5 years was not reported,
while the annual risk of tuberculosis infection is not known.
Conclusion: The vaccine has a limited effect in preventing pulmonary disease,
which is the most common form of tuberculosis and with the greatest public health
significance. Low-incidence countries mainly limit BCG vaccination to neonates and
51
infants of recognized high-risk groups for tuberculosis or to tuberculin-negative

older children. In some of these countries, BCG vaccination is largely replaced by
intensified case detection and supervised treatment. In Croatia, the incidence of
tuberculosis has been declining and Croatia has been placed among the low-
incidence countries. Epidemiological data are close to the WHO criteria for BCG
vaccination schemes changes. Considering that it is primarily a recommendation,
the final decision depends on the conclusions of national experts. In case of
selective vaccination, risk groups should be well-identified and high coverage
should be ensured.
52
TROPSKA I PUTNIČKA MEDICINA

TROPICAL AND TRAVEL MEDICINE
53
O-38 Zanemarene tropske bolesti

Davorka Lukas
Zanemarene tropske bolesti (NTDs) su prvenstveno raširene u tropskim i

subtropskim, siromašnim, nerazvijenim zemljama svijeta u kojima nema primjerene
vodoopskrbe, higijene, sanitacijskog sustava te dostupne zdravstvene skrbi. Prema
procjenama Svjetske zdravstvene organizacije (WHO), u svijetu, više od 1,6 milijardi
ljudi boluje od NTDs, od čega 875 milijuna djece, uzrokujući patnju i kronični
invaliditet. Procjenjuje se da od ovih bolesti umre više od pola milijuna ljudi
godišnje. NTDs imaju značajan utjecaj na životni vijek, edukaciju i ekonomske
mogućnosti oboljelih osoba te sredina u kojima one žive. Ove su bolesti povezane
sa siromaštvom, one su uzrok i posljedica siromaštva. Nazivaju se “zanemarene
tropske bolesti” zbog činjenice da im se povijesno u svijetu nije pridavao značaj kao
ostalim bolestima. NTDs čini grupa zaraznih bolesti čiji su uzročnici helminti,
protozoe, bakterije, virusi i gljive. Većina ovih bolesti se može liječiti primjenom
postojećih lijekova i spriječiti preventvnim mjerama, a neke od njih samo
osiguravanjem dostupnosti čiste vode, primjerenom pripremom hrane i
provođenjem higijenskih mjera. Mnoge od ovih bolesti se mogu dijagnosticirati u
laboratorijima primjenom jednostavnih, jeftinih mikroskopskih metoda,
serologijom i tehnikama kultivacije. Sa svrhom postizanja bolje kontrole, eliminacije
pa i moguće eradikacije ovih bolesti u budućnosti, tijekom proteklih desetljeća, se
provode mnoge intervencije od strane raznih organizacija, posebno odjela SZO za
kontrolu zanemarenih tropskih bolesti. Ove intervencije se temelje na
omogućavanju liječenja kroz tzv. masovnu primjenu lijeka, suradnjom s
farmacetskom industrijom (donacije lijekova) te ukljućivanjem lokalne zajednice.
Strategija SZO se temelji na ostvarenju slijedećih ciljeva do konca 2020. godine
(Londonska deklaracija, 2012.):
1. kontrola limfatičke filarioze, onkocerkoze, shistosomoze, nekih helminta i

trahoma distribucijom i primjenom sigurnih i učinkovitih lijekova kod svih
osoba koje žive u visoko rizičnim endemskim krajevima
2. kontrola Chagasove bolesti, bolesti koju uzrokuje “Guinea worm”, afričke

tripanosomoze, lepre i visceralne lišmenioze, individualnom dijagnozom i
liječenjem, (kada je potrebno i kirurškim), skrbi te rehabilitacijom
zaraženih.
54
Neglected tropical diseases

Davorka Lukas
Croatia
Neglected tropical diseases (NTDs) are widespread mainly in tropical and

subtropical world’s poorest, undeveloped countries with inadequate water supply,
sanitation, hygiene and access to health care. According to the estimates from
WHO, NTDs affect over 1.6 billion of people, including 875 million of children
causing suffering and chronic disability. It has been estimated to cause more than
half a million deaths every year. NTDs impact in life expectancy, education and
economic oportunities of affected individuals and the communities they live in.
These diseases are poverty-related, they are consequence and cause of povery.
They are called „neglected tropical diseases“ beacuse histrocially they have not
received as much attention as other diseases. NTDs are group of infectious
diseases caused by helmints, protozoa, bacteria, viruses and fungi. Most of them
are treatable with existing drugs and can be prevented, some of them just by
providing clean water, sanitary food handling and good hygiene. Many NTDs can be
diagnosed in the laboratory using simple and inexpensive microscopy, serology,
and culture techniques. In order to achieve a better control, elimination and
possible future eradication of NTDs, many interventions have been implemented
over the past decades, by different organizations, especially by the World Health
Organization’s Division of Control of Neglected Tropical Disease. These
interventions are based on providing the treatment through mass drug
administration, pharmaceutical industry partnership (drug donations) and
community involvement. WHO strategies and targets to be achived by 2020
(London Declaration 2012) are:
1. Safe and effective drug administration to all the people living in high-risk
areas, for the control of lymphatic filariasis, onchocerciasis,
schistosomiasis, soil transmitted helminths and trachoma
2. individual diagnosis and treatment, surgery where needed, care and

rehabilitation of infected individuals for the control of Chagas disease,
Guinea worm disease, human African trypanosomiasis, leprosy and visceral
leishmaniasis.
55
O-39 Infektivne bolesti među migrantima u Europi

Neven Papić
Zdravstveno stanje i problemi migranata i izbjeglica ovise o prostoru, vremenu,

dobi, spolu, zemlji iz koje dolaze i razlogu migriranja. Stoga je vrlo teško
generalizirati o općem zdravstvenom stanju ove raznolike i rastuće populacije.
Najčešći problemi novopridošlih izbjeglica i migranata uključuju ozljede,
hipotermiju, opekline, gastrointestinalne infekcije, kardiovaskularne bolesti, stanja
vezana uz trudnoću i porod, šećernu bolest i hipertenziju. Migranti u Europskoj
Uniji imaju niži rizik razvoja karcinoma, ali viši rizik obolijevanja od dijabetesa, dok
rizik kardiovaskularnih bolesti ovisi o zemlji iz koje dolaze. Usprkos
prevladavajućem mišljenju o povezanosti migracija i unošenja novih infektivnih
bolesti u zemlje EU, ne postoji značajna povezanost i migranti ne predstavljaju rizik
za domicilno stanovništvo. Međutim, iako rjeđe obolijevaju od kroničnih i malignih
bolesti, migranti su pod povećanim rizikom obolijevanja od infektivnih bolesti.
Migranti u zemljama EU čine 40% oboljelih od HIV infekcije. Kasna dijagnoza HIV
infekcije među migrantima danas predstavlja rastući problem, a migranti često
imaju lošije kliničke i imunološke indikatore kod postavljanja dijagnoze u odnosu na
domicilno stanovništvo. Prevalencija HBV infekcije među migrantima prati
prevalenciju zemlje iz koje dolaze, s posebno visokom prevalencijom (>10%) među
migrantima iz Istočne Azije i subsaharske Afrike. U ovoj populaciji viša je i
prevalencija kronične HCV infekcije. Iako prevalencija tuberkuloze od 2005. godine
opada u zemljama EU, postotak oboljelih koji čine migranti porastao je s 19% u
2005. na 27% u 2014. godini. Tijekom 2015. godine epidemije ospica, povratne
vrućice, kožne difterije, malarije, leishmanijaze, shistosomijaze, kolere, skabijesa i
tifusa javile su se u populaciji izbjeglica u zemljama EU. Rizik obolijevanja od
infektivnih bolesti za izbjeglice koje dolaze u Europu visok je zbog prenapučenosti
izbjegličkih kampova i loših higijenskih uvjeta. Omogućavanje odgovarajuće razine
dostupnosti zdravstvene zaštite, pravovremeno dijagnosticiranje i liječenje, kao i
provođenje odgovarajućeg probira ključno je u zaštiti, kako zdravlja izbjeglica i
migranata, tako i domicilnog stanovništva.
Infectious Diseases among migrants in Europe

Neven Papić
Croatia
The health of migrants and refugees varies across space, time, age, gender, across
different countries of origin and type of migration. Therefore, it is important to be
very careful when attempting to make generalizations about the general level of
health of all migrants. The most frequent health problems of newly arrived
refugees and migrants include accidental injuries, hypothermia, burns,
56
gastrointestinal illnesses, cardiovascular events, pregnancy- and delivery-related

complications, diabetes and hypertension. In terms of non-communicable disease,
migrants to Europe seem to initially have a lower risk of cancer but a higher risk of
diabetes, while the risk of cardiovascular disease varies among different groups. In
spite of the common perception of an association between migration and the
importation of infectious diseases, there is no systematic association and migrants
do not pose the risk for native population. However, although most migrants to the
EU are healthy, in population terms may bear a disproportionate burden of
infectious disease. Nowadays migrants represent 40% of reported cases of HIV in
the EU. Late diagnosis of HIV among migrants is a key issue in EU countries, since
they often have poorer clinical and immunological indicators at diagnosis than
native-born HIV cases. Prevalence rates of HBV among migrants mirror the
prevalence in the country of origin, with particularly high prevalence (>10%) among
migrants from East Asia and sub-Saharan Africa. Similarly, reported data suggest
that the prevalence of chronic HCV infection is higher in this population. Although
tuberculosis prevalence has been falling steadily in the EU since 2005, percentage
of cases in persons of foreign origin increased from 19% in 2005 to 27% in 2014.
During 2015 several outbreaks of measles, louse-borne relapsing fever, cutaneous
diphtheria, malaria, leishmaniasis, schistosomiasis, cholera, scabies and typhoid
fever were reported affecting the refugee population. The risk to refugees arriving
in Europe of contracting communicable diseases has increased due to the current
overcrowding at reception facilities, resulting in poor hygiene and sanitation
arrangements. Ensuring appropriate levels of access to medical diagnosis and
treatment services, and implementation of appropriate screening is crucial in
protecting refugees' health.
O-40 Malarija u Klinici za infektivne bolesti KBC Rijeka u periodu od 2010. do

2015. godine
Đurđica Cekinović, Biserka Trošelj Vukić
Klinika za infektivne bolesti, KBC Rijeka, Rijeka, Hrvatska
Malarija je endemska zarazna bolest tropskih područja sub-Saharske Afrike, Azije,

Oceanije i Latinske Amerike uzrokovana parazitom iz roda Plasmodium.
Interhumani prijenos malarije ostvaruje se ubodom hematofagnih komaraca iz roda
Anopheles kojim se do danas na čovjeka može prenijeti četiri soja plazmodija (P.
falciparum, P. vivax, P. ovale te P. malariae). Rastući je broj slučajeva humane
infekcije protozoom P. knowlesi, prirodnog patogena majmuna koji je odgovoran za
pojavu malarije u području jugoistočne Azije, dominantno područja Malezije.
Malarija do danas ostaje jedan od najvažnijih javnozdravstvenih problema
uzrokujući godišnji pobol preko 200 milijuna ljudi te smrt u gotovo 500 000 osoba
tijekom 2015. godine, dominantno djece sub-Saharske Afrike. Simptomi malarije su
57
nespecifični te se mora promišljati o mogućoj malariji u svakog febrilnog bolesnika

koji je boravio u endemskom području.
Do danas ne postoji efektivno cjepivo protiv ove bolesti, no visoko učinkoviti
lijekovi osiguravaju visoku stopu izlječenja u inficiranih bolesnika bez obzira na
težinu kliničke slike. Derivati artemizinina danas su prvi izbor u liječenju malarije.
Dok je peroralna terapija u većini nekompliciranih malarija dovoljna za izlječenje,
komplicirani oblici malarije zahtijevaju hospitalizaciju te kombinirano parenteralno
antimikrobno i simptomatsko liječenje. Rastuća rezistencija Plazmodija na različite
antimalarike iziskuje pomno promišljanje o izboru antimalaričnog lijeka u oboljelih
te kontinuirani nadzor bolesnika tijekom liječenja.
U ovom radu prikazani su bolesnici hospitalizirani zbog malarije u Klinici za
infektivne bolesti Kliničkog bolničkog centra u Rijeci u petogodišnjem razdoblju
(2010-2015 godina) te analiziran tijek bolesti i učinkovitost antimalaričnog liječenja
u putnika, neimunih bolesnika kao i osoba koje su rođene u endemskim područjima
malarije.
Malaria in Clinic for infectious diseases Rijeka in five year period from
2010 to 2015
Đurđica Cekinović, Biserka Trošelj Vukić
Infectious Diseases Department, University Hospital Center Rijeka, Rijeka,
Croatia
Malaria is an endemic infectious disease of tropic area of sub-Saharian area, Asia,

Oceania and Latin America caused by parasitic protozoa Plasmoidum species. Four
Plasmodium species are classified as human malaria parasites transmitted to
humans by Anopheles mosquito bite: P. falciparum, P. vivax, P. ovale and P.
malariae. Currently, fifth Plasmodium species, P. knowlesi is recognized as novel
human pathogen in Southeast Asia, primarily Malaysia.
Malaria is considered as one of major public health problems causing more than
200 million cases and approximately 500 000 deaths in 2015, mostly young children
in sub-Saharan Africa. Symptoms of malaria are generally non-specific, therefore
the diagnosis of malaria should be considered in any person with fever of unknown
origin with travel history to endemic areas.
In the absence of affective vaccine, antimalarial drugs, primarily artemisinin-based
combination therapies ensure successful treatment and control of infection,
regardless of severity of symptoms. While uncomplicated malaria is mainly treated
with peroral antimalarics, complicated malaria requires hospitalization and
combined antimalaric and symptomatic treatment. Increasing Plasmoidum
resistance to variety of antimalaric drugs implicates thoughtful selection and
appliance of antimalarics in infected patients and continuous evaluation during
treatment.
58
Here we present an overview of evaluation and treatment of patients with malaria

hospitalized in Clinic for infectious diseases in Rijeka over 5-year period (2010-
2015), both nonimmune patients and patients born and raised in endemic areas.
O-41 Zdravstveni nadzor vojnog osoblja u mirovnim misijama i operacijama -

primjer dobre prakse
Davorka Perić, Ljiljana Belošević
Ministarstvo obrane, Vojno zdravstveno središte, Zavod za zrakoplovnu
medicinu Zagreb, Zagreb, Hrvatska
Rad opisuje sustav zdravstvene zaštite vojnog osoblja - pripadnika mirovnih misija i
operacija kao i glavne zdravstvene rizike kojima je vojno osoblje izloženo u težim i
promijenjenim životno-radnim uvjetima u zemljama kao što su: Afganistan.Indija,
Pakistan, Sudan, Zapadna Sahara, Liberija, itd.
Mirovne snage sastavljene su od vojnog i civilnog osoblja: nenaoružanih časnika
promatarača prekida vatre i kontrole granica ili demilitarizirane zone; naoružanih
kontigenata vojske u funkciji tampon zone između zaraćenih strana.
U području djelovanja mirovnih snaga postoji upotreba teške mašinerije i opreme
teškog naoružanja koja donosi opasnost od mehaničkih borbenih ozljeda kao i
borbenih ozljeda
Zračni promet noću te motorna vozila iznimno su opasni ukoliko se ne provode
sigurnosne mjere. Prometne nesreće, municije, mine, profesionalna izloženost
kemijskim sredstvima, gorivima i prašinama dokazano su najvažnije profesionalne
štetnosti u pripadnika mirovnih snaga.
Pripadnici mirovnih misija i operacija izloženi su riziku obolijevanja zbog
neadaptiranosti na različite klimatološke i higijenske uvjete u ratnoj zoni.
Čini ih rizik od infekcija, higijenski neispravne vode i hrane, spolno prenosivih
bolesti, neadekvatni smještaj te opća i osobna higijena.
Infektivne bolesti su među vodećim profesionalnim ne-borbenim ozljedama
pripadnika mirovnih snaga. To su najčešće trovanje hranom, bolesti koje se prenose
vodom (hepatitis A, proljevi, tifusna groznica); vektorske bolesti: malarija, West
Nile groznica, lišmenijaza, Denga groznica, arbovirusne infekcije (žuta groznica),
murini tifus, itd. Respiratorne infekcije, meningokokni meningitis i tuberkuloza
glavni su javnozdravstveni problemi. Nadalje ih prate spolno prenosive bolesti i/ili
bolesti koje se prenose krvlju te druge endemske bolesti (Lassa groznica,
shisostomiaza, bruceloza Q groznica i bjesnoća).
Okolišni zdravstveni rizici uključuju: ekstremne toplinske uvjete, visoku vlagu,
lokalnu floru i faunu, pustinju, visoko gorje što sve utječe na uvjete života,
održavanje osobne i opće higijene, opskrbu i čuvanje hrane i vode.
Stres je važan zdravstveni rizik. Vojno osoblje usko surađuju i rade s kolegama
različitih nacionalnosti i kulturološkog nasljeđa, u nepoznatoj okolini i teškim
59
životnim uvjetima. Izolacija, neprijateljsko okruženje, nerazumjevanje, dosada,

opasnost su i glavni uzroci psihosocijalnog stresa. Važan faktor rizika je nasilje kod
međunarodnog i lokalnog osoblja.
Mi smo uspostavili vojno zdravstveni program koji se temelji na procjeni
zdravstvene sposobnosti vojnog osoblja prije upućivanja u mirovne misije i
operacije, pružanju zdravstvene skrbi tijekom rada u misiji/operaciji te procjeni
zdravstvenog stanja nakon povratka iz mirovnih misija/operacija. Temelj dobre
zdravstvene zaštite koja se provodi među našim vojnim osobljem prije upućivanja
na vojne zadaće u inozemstvo je prevencija od zaraznih bolesti, procjepljivanje,
edukacija i informiranje istih o mogućim rizicima te načinima kako ih izbjeći kao i
odgovornom spolnom ponašanju te potrebom za uspostavljanjem dobrih
međuljudskih odnosa u multinacionalnom okruženju.
Health surveillance of military personnal in the military missions and

operations - example of good practice
Davorka Perić, Ljiljana Belošević
Ministry of Defence, Military Medical Center, Institute of Aviation
Medicine, Zagreb, Croatia
The paper describes military health care surveillance of military personel who
participate in the military missions/operations and the most prominent health risks
which military personnel is exposed due to hard and changeable life-work
conditions in the countries such as Afghanistan, India, Pakistan, Sudan, West
Sahara, Liberia, etc.
Peacekeeping forces are combined of military and civilian staff; unarmed officers
monitoring ceasefires and patrolling borders or demilitarized zones, armed
contingents as a buffer between parties.
Occupational hazards include danger of mechanical injuries because of the use of
heavy machinery and equipment, especially loaded weapons. Night-time air traffic
and motor vehicles all can be extremely dangerous if safety is not emphasized.
Traffic accidents, munitions and mines, and occupational exposures (chemicals,
dust, fuels) are proved to be the most important occupational risk factors. They are
followed by the risk of infection, risk of insufficient water supllies, sexually
transmitted diseases, substandard housing and accommodations, personal
hygiene.
Currently, military operations constitute the epidemiological threat for participants
who are not familiar with diverse climatic and sanitary conditions and the combat
zone. Infectious diseases, which are among the greatest risks for the forces
deployed, are often: food or waterborne diseases, diarrhoeal diseases, hepatitis A,
typhoid/paratyphoid fevers, vector-borne diseases: malaria, West Nile fever,
Dengua fever, leishmaniasis, arboviral diseases (yellow fever), Flea-Borne (Murine)
typhus, etc. Respiratory infections, meningococcal meningitis and tuberculosis are
the major public health problems, followed by sexually transmitted and/or blood
60
borne diseases, and other endemic diseases (Lassa fever, schistosomiasis,

brucellosis, Q fever, and rabies).
Environmental health risks include: extreme heat or cold and high humidity; local
flora and fauna, desert or mountainous influencing living conditions, hygiene
maintaining, food and water management and storage, contamination of water
and food supplies.
Mental stress is a very important health risk factor in mission areas. Migrant
workers, both military and civilian, work closely with colleagues of various
nationalities and cultural backgrounds, in strange environments and difficult living
conditions. Isolation, ambiguity, powerlessness, boredom, and threat/danger, are
the major dimensions of psychological stress. Violence is important risk factors for
both international and local staff.
We have established military health program which include predeployment and
postdeployment medical assessment as well as health care system in the course of
military mission/operation. This program include : prevention of serious and
contagious diseases, vaccination, education and infoming participants of possible
risks they are facing and ways of avoiding their negative effects, responsible sexual
behavior and establishment of good interpersonal relationships between
multinational environment.
61
INFEKCIJE POVEZANE SA ZDRAVSTVENOM SKRBI

HEALTHCARE-ASSOCIATED INFECTIONS
62
O-42 Do’s and Don’ts in Infection Prevention & Control

Judith Richards
The Norfolk and Norwich University Hospital, Norwich, UK
Infection prevention and control (IP&C) has, over the years, been seen as a simple
application of “common sense”.
There has been a tendency to set aside the importance of sound scientific basis,
and to replace firm evidence by simple rules, policies and government directives,
which have become imbedded in standard practice as “must do” rituals.
This presentation and discussion will aim to address some of the myths and rituals
that have appeared to govern IP&C practices, and make a case for the
implementation of evidence base, practical and cost effective measures to help
achieve maximum benefits and introduce acceptable behaviour changes.
O-43 Medicinska dokumentacija u nadzoru i kontroli bolničkih infekcija

Vesna Mađarić1, Vlatka Janeš Poje2, Snježana Vuljak1, Anita Galinec1
1
Opća bolnica "Dr. Tomislav Bardek", Koprivnica, Hrvatska
2
Mikrobiološki laboratorij, Zavod za javno zdravstvo Koprivničko-križevačke
županije, Koprivnica, Hrvatska
Infekcije povezane sa zdravstvenom skrbi predstavljaju značajni uzrok morbiditeta i

mortaliteta u hospitaliziranih bolesnika te je njihovo sprječavanje i suzbijanje jedan
od ključnih segmenata u upravljanju kvalitetom zdravstvene usluge i sigurnosti
bolesnika od nepovoljnog događaja. Usprkos napretku u modernoj medicini, 5-10 %
bolesnika primljenih u bolnicu steknu bolničku infekciju (1). Dokazano je da
implementiranje učinkovitih programa prevencije i kontrole infekcija temeljeno na
dokazima značajno može smanjiti rizik od razvoja bolničkih infekcija. Obzirom da su
bolničke infekcije u onom segmentu kada se mogu prevenirati najčešće
uzrokovane sistemskom pogreškom, procijenjeno je da se može postići do 70%
smanjenja bolničkih infekcija za infekcije krvotoka povezane s intravenskim
kateterom i infekcije povezane s uporabom urinarnog katetera a upale pluća
povezane sa strojnom ventilacijom i postoperacijske infekcije mogu se
provođenjem standardiziranih procedura smanjiti i do 55% (2). No, s obzirom na
kompleksnost različitih čimbenika, nije moguće postići 100%-tno smanjenje
bolničkih infekcija. Kontinuirano praćenje infekcija povezanih sa zdravstvenom
skrbi i vođenje medicinske dokumentacije o istom u svim procesima upravljanja
rizikom nastanka bolničkih infekcija, od temeljne je važnosti za prevenciju nastanka
bolničkih infekcija, moguće epidemije,a u slučaju konkretnog bolesnika s bolničkom
infekcijom, medicinska dokumentacija o provedenim standardizirani postupcima,
dokaz je da je za bolesnika učinjeno sve dostupno, temeljeno na dokazima u
segmentu u kojem se bolnička infekcija mogla prevenirati.
63
1. N.N.Damani: Hospital control infection; sec.edit., Zagreb, 2004

2. Umscheid CA, Mitchell MD, Doshi JA, i dr. Estimating the proportion of
healthcare-associated infections that are reasonably preventable and the
related mortality and costs. Infection Control and Hospital Epidemiology
2011:32(2):101-14.
The medical records in HCAI control and surveillance

Vesna Mađarić1, Vlatka Janeš Poje2, Snježana Vuljak1, Anita Galinec1
1
General Hospital "Dr. Tomislav Bardek", Koprivnica, Croatia
2
Microbiological laboratory, Institute of Public Health of Koprivnica Križevci
County, Koprivnica, Croatia
Health care associated infections represent a significant cause of morbidity and

mortality in hospitalized patients so their prevention and control is one of the key
segments in health care control management and patients’ safety. Despite
advances in modern medicine, 5-10% of patients admitted to a hospital get a
hospital infection (1). It is proven that the implementation of effective prevention
programs, as well as infection controls based on evidence, may considerably reduce
the risk of hospital infections. Considering the fact that hospital infections in the
preventable segment are mostly caused by a system error, it is assessed that blood
stream infections, which are caused by intravenous catheter as well as infections
caused by the usage of a urinary catheter may be reduced by as much as 70%,
whereas pneumonias caused by machine ventilation and postoperative infections
can be reduced by up to 55%, by implementing standardized procedures (2).
However, taking into considerations the complexity of various factors, a 100%
reduction of hospital infections is not possible to achieve. Continuous monitoring
of health care associated infections and keeping medical records during all
processes of risk management connected to the occurrence of hospital infections is
of crucial important for the prevention of hospital infections and possible
epidemics. Furthermore, with particular patients suffering from hospital infections,
medical records on conducted standardized procedures need to be kept, as a proof
that all available measures have been implemented for the patient, based on
evidence in the segment where the hospital infections could have been prevented.
1. N.N.Damani: Hospital control infection; sec.edit., Zagreb, 2004
2. Umscheid CA, Mitchell MD, Doshi JA, i dr. Estimating the proportion of
healthcare-associated infections that are reasonably preventable and the
related mortality and costs. Infection Control and Hospital Epidemiology
2011:32(2):101-14.
64
O-44 Značaj medicinske dokumentacije – pravni aspekti

Josip Mađarić
Odvjetnički ured "Mađarić-Lui", Zagreb, Hrvatska
Uz primarni značaj koji medicinska dokumentacija ima i osnovni razlog zašto je

medicinska dokumentacija nastala, a to je što uspješnije liječenje pacijenta, željeli
smo ovim radom ukazati i na značaj koji medicinska dokumentacija ima kao
dokazno sredstvo u sudskom postupku. Pri tome, kada govorimo o sudskim
postupcima, prvenstveno mislimo na značaj medicinske dokumentacije kao
dokaznog sredstva u građanskim sudskim postupcima radi naknade štete zbog
pogreške u liječenju te kaznenim postupcima za kaznena djela protiv zdravlja ljudi
(kazneno djelo nesavjesnog liječenja, nepružanja medicinske pomoći i sl.).
Nakon što postavimo definicju medicinske dokumentacije i ukažemo na neke njene
specifičnosti, kratko se dotičemo pravno najznačajnijeg i praksi najspornijeg dijela
medicinske dokumentacije-informiranog pristanka. Kada već govorimo o značaju
medicinske dokumentacije u sudskom postupku, valja ukazati na zakonodavnu
podlogu koja utvrđuje dužnost vođenja i čuvanja medicisnke dokumentacije, kao i
pravo pacijenta na uvid u svoju medicinsku dokumentaciju. Već smo naveli kako uz
svrhu pravilnog liječenja pacijenta i znanstvenu svrhu, svha medicinske
dokumentacije jest i da posluži kao dokazno sredstvo u sudskom postupku, uz
ostala dokazna sredstva koja se pojavljuju u sudskim postupcima (svjedoci, uviđaj,
stranke...). Zaključno, propusti u vođenju medicinske dokumentacije mogu imati
dalekosežne posljedice u sudskim postupcima u kojima se takva medicinska
dokumentacija koristi kao dokazno sredstvo, bilo po zdravstvenu ustanovu koja
npr. mora dokazati da je liječenje nekog pacijenta provedeno prema pravilima
struke, ili pak po pacijenta koji mora dokazati da je neki propust u liječenju u
uzročnoj vezi sa štetom koja mu je nastala, što vrlo ilustrativno prikazujemo u
nekoliko primjera.
The importance of the medical records – legal aspects

Josip Mađarić
Lawyer office "Mađarić-Lui", Zagreb, Croatia
Along with its primary role and the main reason for producing medical records and
documentation, which is successful treatment of a patient, in this paper we also
want to indicate the importance which medical documentation has as evidence in
litigation. In addition, when we discuss litigation, we primarily have in mind the role
of medical records as evidence in civil lawsuits seeking compensatory damages for
medical errors and criminal lawsuits pertaining to offences against the public
health (medical malpractice, denial of medical care, etc.).
After we provide the definition of medical records and indicate some of its specific
qualities, we briefly address ''the most legal'' part of medical documentation,
65
informed consent. While discussing the role of medical record in litigation, it is

necessary to point to legislative base which determines the duty of keeping and
maintaining medical documentation, as well as the right of a patient to have an
insight into it. We have already stated that, along with the purpose of providing
proper medical treatment for a patient and the scientific purpose, medical records
also has the purpose of evidence in litigation, together with all other types of
evidence used in lawsuits (witnesses, inquest, parties, etc.). Inconclusion, errors in
keeping medical documentation can have far-reaching consequences in lawsuits
where such documentation is used as evidence, both if the party concerned is a
medical institution which has to prove that the treatment of a patient was done
according to the rules of professional conduct, or a patient who has to prove that
he/she has suffered harm due to a medical error, which is illustratively
demonstrated on several examples.
O-45 Investigating Outbreaks

Judith Richards
The Norfolk and Norwich University Hospital, Norwich, UK
Outbreaks occur frequently in healthcare settings, and represent a substantial part

of the IP&C Team’s workload.
Investigating outbreaks is like detective work, and although ten simple steps have
been recommended, there are variations in their applicability.
Not every outbreak presents in the same way, and even the recognition of an
outbreak requires some experience and judgement, as well as an understanding of
the setting and circumstances that govern its development.
Using examples from common healthcare practices, we will aim to identify some of
the difficulties and pitfalls in outbreak investigation, including the conflict between
control and investigation.
The use of Root cause analysis, to help us to learn from own and others’
experiences, coupled with information sharing in a no blame culture will be
discussed.
66
O-46 Višestruko otporni A. baumannii unutar i izvan bolničke sredine

Ivana Goić-Barišić1, Jasna Hrenović2, Marija Tonkić1
1
Klinički zavod za mikrobiologiju i parazitologiju, Klinički bolnički centar
Split, Medicinski fakultet Sveučilišta u Splitu, Split, Hrvatska
2
Biološki odsjek, Prirodoslovno-matematički fakultet Sveučilišta u Zagrebu,
Zagreb, Hrvatska
Acinetobacter baumannii jedan je od najčešćih bolničkih mikroorganizama koji

uzrokuje infekcije u svijetu. Ovaj mikroorganizam izaziva infekcije kod
imunokompromitiranih bolesnika u jedinicama intenzivnog liječenja koji u
anamnezi imaju traumu, podvrgnuti su kirurškom zahvatu ili imaju potrebu za
mehaničkom potpornom ventilacijom. Smrtnost bolesnika kod kojih je prisutna
infekcija ovim uzročnikom u jedinicama intenzivnog liječenja može biti i preko 75%,
naročito ako je respiratorni sustav mjesto ulaza mikroorganizma. Epidemije koje
imaju kao ishodište bolničke pacijente ili bolničko okruženje dobro su
dokumentirane u literature, ali ostaje dilema da li ovaj mikroorganizam posjeduje
prirodno stanište izvan bolničke sredine. Pitanja na koja se danas nastoje dobiti
odgovori su da li je bolesnik s infekcijom i bolničko okruženje jedini izvor A.
baumannii, te da li klinički izolati preživljavaju i umnažaju se u prirodnom staništu
izvan bolničke sredine.
U istraživanjima suradnika na projektu (IP-2014-09-5656 Hrvatska zaklada za
znanost) u Splitu i Zagrebu je tijekom 2014/15 otkriveno više od dvadeset
višestruko otpornih izolata A. baumannii iz bolničkih i komunalnih otpadnih voda.
Molekularna identifikacija prikupljenih izolata A. baumannii napravljena je pomoću
amplifikacije, sekvencioniranja i filogenetske analize rpoB gena. Prisutnost blaOXA
gena koji kodiraju OXA-tip karbapenemaza (OXA-51-like, OXA-23, i OXA-40-like)
potvrđena je pomoću multiplex PCR i sekvencioniranjem produkta reakcije.
Rezultati istraživanja ukazuju na postavku da su okolišni izolati kliničkog porijekla.
Višestruko otporni A. baumannii ima sposobnost preživljavanja u otpadnim vodama
i do 50 dana. Prisutnost ovakvih izolata koji posjeduju važne OXA gene za
produkciju karbapenemaza u okolišu otvara pitanje mogućnosti i prisutnosti
horizontalnog prijenosa i širenja gena rezistencije na antibiotike.
Multidrug resistant A. baumannii inside and outside hospital setting

Ivana Goić-Barišić1, Jasna Hrenović2, Marija Tonkić1
1
Department of Clinical Microbiology and Parasitology, University Hospital
Centre Split and University of Split School of Medicine, Split, Croatia
2
Department of Biology, University of Zagreb, Faculty of Science, Zagreb,
Croatia
Acinetobacter baumannii has emerged as one of the most common nosocomial
pathogens worldwide. This organism mostly targets the susceptible
immunocompromised patients in ICUs where natural barriers are breached by
trauma, surgery or mechanical support ventilation. Mortality rates of infections
67
caused by Acinetobacter can be more than 75% in the ICU patients with the
respiratory tract being the natural and major portal of entry. While it is certainly
true that A. baumannii can be isolated from patients and hospital environmental
sources during outbreaks, this species has no known natural habitat outside the
hospital setting. The answers to crucial questions regarding the epidemiology of A.
baumannii are still not known: are the infected patients and hospital environment
only sources of A. baumannii, or do clinical isolates of A. baumannii survive or even
multiply in nature and have natural habitat outside hospitals.
In several investigations of two collaborative centres from Split and Zagreb during
2014/15 (project IP-2014-09-5656, supported by the Croatian Science Foundation)
more than twenty multidrug resistant isolates of A. baumannii from hospital and
municipal wastewater were collected. Molecular identification of environmental
isolates of A. baumannii was performed by amplification, sequencing, and
phylogenetic analyses of rpoB gene. The presence of blaOXA genes encoding OXA-
type carbapenemases (OXA-51-like, OXA-23, and OXA-40-like) was confirmed by
multiplex PCR and sequencing. Obtained result suggests that isolates recovered
from municipal wastewater are most probably of clinical origin. In the water
environmental conditions MDR A. baumannii have the potential to multiply and
survive up to 50 days. Persistence of A. baumannii harbouring the clinically
important OXAs in the environmental conditions poses a potentially significant
source for horizontal gene transfer and implications for wider spread of antibiotic
resistance genes.
O-47 Infekcije povezane sa zdravstvenom skrbi i neživa okolina u bolnici

Jasenka Škrlin, Dubravka Grgurić, Valentina Koščak
Klinička bolnica Dubrava, Zagreb, Hrvatska
Infekcije povezane sa zdravstvenom skrbi (IZS) imaju ozbiljne posljedice i za

pacijente, ali i za zdravstvene ustanove. Morbiditet i mortalitet od spomenutih
infekcija je znatan, a povećava se ako su uzrokovane multirezistentnim
mikroorganizmima (MRO). Sve više postoji dokaza da onečišćenje (kontaminacija)
nežive okoline u zdravstvenim ustanovama s Clostridium difficile i MRO kao što su
meticilin-rezistentni Staphylococcus aureus (MRSA), vankomicin rezistentan
enterokok (VRE) ili Acinetobacter baumannii doprinosi težini infekcija povezanim sa
zdravstvenom skrbi.
Ručno čišćenje i dezinfekcija nežive okoline u zdravstvenim ustanovama (dnevno,
ali i pri otpustu bolesnika) bitni su elementi prevencije infekcija povezanih sa
zdravstvenom skrbi.
U zdravstvenim ustanovama, kontaminirana neživa okolina je ključni čimbenik za
prijenos bolničkih patogena. Redovito ručno čišćenje i dezinfekcija eliminira vidljivu
68
nečistoću te smanjuje biološko opterećenje okoliša i rizik od prijenosa, ali isti

postupak ne može biti efikasan i za sve kontaminirane površine.
Tehnologija automatizirane dekontaminacije prostora (ADP) može postići više
skladniju i sveobuhvatniju dezinfekciju od ručne metode, ali je za istu metodu
izazov dokazati svoju djelotvornost u randomiziranom ispitivanju multiplih
intervencija potrebnih za smanjenje stope infekcija povezanih sa zdravstvenom
skrbi. U periodu dok se ne dobiju rezultati iz multicentričnih opservacijskih studija,
ADP tehnologija bi trebala biti dodatni postupak ručnom čišćenju i dezinfekciji u
ukupnom, višeslojnom sustavu prevenciji i kontroli bolničkih patogena te
promicanju sigurnosti pacijenata. Potrebna su daljnja istraživanja djelotvornosti i
isplativosti ove nove tehnologije, uz određivanje pogodnog trenutka za najbolju
primjenu istoga.
S obzirom na sve veći interes za ADP kao alternative ili nadopune ručnim
postupcima dezinfekcije prostora, postoji jasna potreba za namjenskom
smjernicom ili standardom za automatiziranu dekontaminaciju prostora.
Referentne vrijednosti standarda mogu biti nadahnute postojećim suspenzijskim
standardima, ali se moraju prilagoditi specifičnostima i ciljevima dezinfekcije
prostora.
Healthcare associated infections and hospital environmental surfaces

Jasenka Škrlin, Dubravka Grgurić, Valentina Koščak
Clinical Hospital Dubrava, Zagreb, Croatia
Healthcare-associated infections (HCAIs) have serious implications for both patients

and hospitals. The morbidity and mortality of these HCAIs is substantial, and
increases if they are caused by an antibiotic-resistant microorganism (ARM).
Increasingly, there is evidence that contamination of the healthcare environment
with Clostridium difficile and ARMs such as meticillin-resistant Staphylococcus
aureus (MRSA), vancomycin resistant enterococci (VRE) or Acinetobacter
baumannii contributes to the burden of HCAI.
Manual cleaning and disinfection of environmental surfaces in healthcare facilities
(daily and at patient discharge) are essential elements of infection prevention
programs.
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 (AAD) 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 HCAI rates. Until data from multicenter observational studies are available,
AAD technologies should be an adjunct to manual cleaning and disinfection within
69
a total, multi-layered system and risk-based approach designed to control

environmental pathogens and promote patient safety.
Further research into the efficacy and cost-effectiveness of newer technologies,
and when to best apply them, is needed.
Considering the growing interest for AAD as an alternative or complement to
manual surface disinfection procedures, there is a clear need for dedicated AAD
benchmark guidelines or standard. These benchmarks can be inspired by existing
suspension standards but must be adapted to specificities and objectives of surface
disinfection.
O-48 Kompetencije kliničkog mikrobiologa u kontroli infekcija

Ana Budimir
Klinički zavod za kliničku i molekularnu mikrobiologiju, KBC Zagreb,
Hrvatska
Competencies of clinical microbiologist in infection control

Ana Budimir
O-49 Iskustvo s epidemijom prouzročenom M. chimaera, Coventry, Velika

Britanija
Vjeran Čajić
Klinička bolnica Coventry i Warwickshire, Coventry, Velika Britanija
Netuberkulozne mikobakterije su rijedak uzrok nozokomijalnih infekcija i bolnčkih

epidemija. Izvor infekcija su tipično vodovodni sustavi i/ili kontaminirane
medicinske otopine. Od netuberkuloznih mikobakterija, brzo rastuće vrste su
tradicionalno dominantna grupa mikobakterija povezana sa infekcijama kirurških
rana i endokarditisom. U nekoliko je europskih centara u 2015. opisano više
slučajeva infekcije s M. chimaera nakon kardiokirurških zahvata. Izvor infekcije u
svim slučajevima je bila jedinica za hlađenje i grijanje korištena tijekom
kardioplegijske operacije. Manifestacije infekcija su bile slijedeće: endokarditis,
infekcija sternuma, infekcija grafta ili diseminirana infekcija. Klinički odgovor na
kombinirano liječenje nije prelazio pedeset posto. Pregled epidemioloških,
mikrobioloških i kliničkih saznanja o ovoj epidemiji će biti prezentiran, uz prikaz
iskustva u liječenju dva bolesnika u University Hospitals Coventry and
Warwickshire.
70
M. chimaera outbreak review and clinical experience from Coventry, UK

Vjeran Čajić
University Hospitals Coventry and Warwickshire, Coventry, UK
NTMs are an occasional cause of nosocomial infections and outbreaks. On these

occasions, they are always associated with a water source, either tap water or
contaminated medical solutions. Of NTMs, RGMs have traditionally been the
predominant group associated with surgical wound infections and endocarditis. In
2015, multiple cases of M. chimaera post-cardiac surgery infection were reported
in several European centres. A common feature of the infections was their origin in
Heater-Cooler Units used during cardioplegic surgeries. The infections had similar
presentations which included endocarditis, graft infection, sternal infection, and
disseminated infection. Fifty percent of patients succumbed to uncontrolled
infection despite combined treatment. A review of epidemiological,
microbiological, and clinical evidence from the current outbreak will be presented,
together with the challenges encountered in the management of two patients in
University Hospitals Coventry and Warwickshire.
71
INFEKCIJE I UPALNE BOLESTI SREDIŠNJEG ŽIVČANOG SUSTAVA

CENTRAL NERVOUS SYSTEM INFECTIONS AND INFLAMMATIONS
72
O-50 Commonalities between infectious and autoimmune encephalitis

Maarten J. Titulaer
Erasmus Medical Center, Rotterdam, The Netherlands
O-51 Anti-NMDAR encefalitis u djece i adolescenata

Goran Tešović
Autoimuni encefalitisi (AE) klinički se manifestiraju znakovima limbičkog ili difuznog

encefalitisa, a prema etiologiji se mogu podijeliti u paraneoplastične i
neparaneoplastične.
Simptomi i znakovi AE vrlo su varijabilni i uključuju glavobolju, epileptičke napadaje
i nerijetko epileptički status, poremećaje kretanja (ataksiju, diskinezije, koreju,
distoniju i tremor), poremećaje pamćenja, ponašanja, psihoze te različite stupnjeve
poremećaja svijesti. Autonomna disfunkcija, poremećaji spavanja i hipoventilacija
mogu biti dio kliničke slike. Razvoj autoimunih encefalopatija mogu osim tumorskih
potaknuti i virusni antigeni, no najčešće okidači ostaju neidentificirani.
Prema lokalizaciji antigena na koje je autoimunosni proces usmjeren, autoimune se
encefalopatije dijele u one uzrokovane protutijelima na intracelularne antigene
(Ma2, Hu), a koje su češće u odraslih, paraneoplastičke su etiologije i slabo
reagiraju na imunoterapiju te na one uzrokovane protutijelima na površinske,
odnosno sinaptičke antigene (N-metil-diaspartatni receptor (NMDAR), kompleks
naponom reguliranih kalijevih kanala VGKC /LGI1) koje dobro reagiraju na
imunoterapiju i češće su u djece i adolescenata.
Protutijela u autoimunim encefalopatijama dokazuju se u serumu i
cerebrospinalnom likvoru. U cerebrospinalnom se likvoru nalazi blaga pleocitozai/ili
oligoklonske vrpce, a nerijetko je nalaz u likvoru normalan. EEG pokazuje difuzne
encefalopatske spore disritmičke promjene ili tzv. „ekstremne delta četke“ te
žarišne epileptogene promjene odnosno paroksizmalna izbijanja u limbičkom
encefalitisu. MR mozga u bolesnika s NMDAR protutijelima je u pravilu normalan ili
pokazuje prolazne sub/kortikalne T2 hiperintenzitete, međutim posebno je
značajan za dijagnozu limbičkog encefalitisa udruženog s kompleksom protutijela
VGKC/LGI1.
Rano prepoznavanje AE, kao i poznavanje potencijalne etiologije od izuzetnog je
značaja zbog poduzimanja cjelovitog dijagnostičkog postupka i pravovremene
primjene odgovarajuće terapije.
U radu se prikazuje 6 bolesnika pedijatrijske/adolescentne dobi s dijagnozom anti
NMDAR AE.
73
Anti-NMDAR encephalitis in children and adolescents

Goran Tešović
Pediatric Infectious Diseases Department, University Hospital for Infectious
Diseases „Dr. Fran Mihaljević“, Zagreb, Croatia
Autoimmune encephalopathies are clinically manifested as limbic or diffuse

encephalitis. According to etiology they can be classified as paraneoplastic and
non-paraneoplastic.
Signs and symptoms of AE are variable. Simptomatology commonly include
headache and epileptic attacks often progressing to epileptic status, movement
disorders (ataxia, dyskinesias, chorea, dystonia and tremor), behavior changes,
cognitive impairments, psychoses and various degrees of disorders of
consciousness. Faciobrachial dystonic seizures can precede the development of
limbic encephalitis. Autonomic dysfunction, sleep disorders and hypoventilation
are often present. The development of AE can be induced by either tumor or viral
antigens. However, in a significant number of cases disease triggers remain
unidentified. According to the localization of target antigens autoimmune
encephalopathies can be divided into those caused by antibodies against
intracellular antigens (Ma2,Hu) and those caused by antibodies against cell surface
antigens, i.e. synaptic antigens (N-methyl-D-aspartate receptor (NMDAR), voltage-
gated potassium channel complex/LGI1). The first are paraneoplastic in origin,
more often in adults and respond poorly to immunotherapy. The latter ones could
affect children as well and are usually-responsive to immunotherapy.
Antibodies can be detected in both cerebrospinal fluid and serum. Mild pleocytosis
and/or oligoclonal bands could be found in cerebrospinal fluid but in some patients
the cerebrospinal examination findings could be completely normal. EEG finding
consists of diffuse, slow dysrhythmic encephalopathic changes or so-called extreme
delta brushes and focal epileptogenic changes i.e. paroxysmal bursts in a case of
limbic encephalitis. Brain MRI is usually normal or presents transient sub/cortical
hyperintensities in T2-weighted images but is significant for diagnosis of limbic
encephalitis .
Early recognition of autoimmune encephalopathy is of utmost importance because
of the need for proper diagnostic procedure and timely implementation of
adequate therapy.
Six patients of pediatric/adolescent age with anti NMDAR AE are presented.
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O-52 Psihijatrijski aspekti encefalitisa

Vladimir Grošić1, Marija Santini2, Igor Filipčić1
1
Psihijatrijska bolnica "Sveti Ivan", Zagreb, Hrvatska
2
Psihijatrijski aspekti encefalitisa Encefalitis je nerijetko praćen psihičkim

simptomima. U svakodnevnoj kliničkoj praksi, a radi dominantnih psihičkih
simptoma, pacijenti sa encefalitisom se prvo javljaju na psihijatrijsko liječenje.
Najčešće su prisutni simptomi akutne psihoze: auto i heteroagresivno ponašanje,
sumanute misli, slušne i vidne halucinacije. Kako se često radi o skupini pacijenata
mlađe životne dobi, nerijetko su i pod utjecajem psihoaktivnih sredstava. Atipična
reakcija na terapiju antipsihotikom često je prvi znak koji nas usmjerava na
razmišljanje o drugoj dijagnozi tj. encefalitisu. Tako se događa da na male početne
doze pacijenti reagiraju izrazitom sedacijom i psihomotornom usporenošću ili se
pak događa da na velike doze antipsihotika očekivani terapijski odgovor izostaje.
Ako je uz to prisutan dizritmički promijenjen nalaz EEG-a i povećani su upalni
parametri, svakako treba obaviti dodatne dijagnostičke pretrage. Stoga je brza i
kvalitetna suradnja psihijatra i infektologa prijeko potrebna radi pravovremenog i
uspješnog liječenja.
Psychiatric aspects of encephalitis

Vladimir Grošić1, Marija Santini2, Igor Filipčić1
1
Psychiatric Hospital “Sveti Ivan” , Zagreb, Croatia
2
Croatia
Psychiatric symptoms often appear together with encephalitis. In everyday clinical

practice patients with encephalitis come first to the psychiatric treatment due to
the dominant psychiatric symptoms. Patients mostly suffer from acute psychosis:
they are autoagressive or heteroagressive, have delusions and audio or visual
hallucinations. Since they are usually young people, they often use psychoacive
substances. Atypical response to the antypsichotics is often the first sign that leads
us to consider another diagnosis, for instance encephalitis. It happens that the
patients are extremely sedated or show psychomotor retardation at a little dosage
of drugs, or on the other hand the expected response to the antypsichotics fails. If
this is accompanied by disritmic EEG, and by increased inflamatory parameters ,
additional dyagnostic procedures should be done. Therefore, fast and quality
colaboration of psychiatist and infecotologyst is necessary for timely and
succsessfull treatment of patients with encephalitis.
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O-53 Brza dijagnostika u infekcijama središnjeg živčanog sustava

Brza dijagnostika infekcija središnjeg živčanog sustava temelji se na primjeni

metoda molekularne dijagnostike tj. lančane reakcije polimerazom u stvarnom
vremenu (real-time polymerase chain reaction, PCR). U rutinskoj kliničkoj praksi
primjenjuju se real-time PCR testovi specifični za pojedine mikroorganizme.
Međutim, široki spektar mikroorganizama koji uzrokuju infekcije središnjeg
živčanog sustava ukazuju na potrebu primjene multiplex testova koji mogu
detektirati genom većeg broja mikroorganizama u istom uzorku. Stoga suvremena
dijagnostike infektivnih bolesti središnjeg živčanog sustava neizostavno uključuje i
primjenu multiplex testova koji se najčešće temelje na tehnologiji mikročipova.
Primjena ovih testova omogućuje individualni pristup dijagnostici te dobivanje
rezultata etiološkog testiranja u klinički relevantnom vremenu.
Rapid diagnostics for central nervous system infections

Croatia
Rapid diagnostics of central nervous system (CNS) infections is based on molecular

methods, mainly real-time polymerase chain reaction, PCR. Routine microbiological
diagnostics of CNS infections is often based on real-time PCR assays specific for
individual microorganisms. However, a wide range of microorganisms associated
with CNS infections is associated with the need to introduce multiplex assays able
to detect genomic nucleic acid of multiple mikroorganisms in an individual sample.
Therefore, state-of-the-art molecular diagnostics of CNS infections includes
multipex assays mainly based on microarray technology. The use of multiplex
assays enables an individualised approach to the diagnostics of CNS infectious
diseases and provides clinicians with etiological diagnosis within clinically relevant
time.
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SLOBODNE TEME
FREE COMMUNICATIONS
77
O-54 Klinički značaj Helicobacter pylori cagPAI gena virulencije u bolesnika s

gastroduodenalnim bolestima
Dijana Varda Brkić
Hrvatska
Clinical significance of Helicobacter pylori cagPAI virulence genes in

patients with gastroduodenal diseases
Dijana Varda Brkić
O-55 Fungi i respiratorni uzorci, Klinički bolnički centar Zagreb, 2011. – 2016.
Marija Jandrlić1, Violeta Rezo Vranješ1, Mirjana Anđelić1, Sanja Pleško1, Ana
Jandrlić2, Ivana Mareković1
1
Hrvatska
2
Studij medicinsko laboratorijske dijagnostike, Zdravstveno veleučilište
Zagreb
Fungi su široko rasprostranjeni u prirodi. Respiracijske fungalne kolonizacije i

infekcije česte su u imunosno ugroženih bolesnika, a uz komplikacije osnovne
bolesti i drugih infekcija često prouzročuju atributivnu smrtnost.
Klinički bolnički centar Zagreb ima oko 1800 kreveta. Retrogradno su analizirani svi
obrađeni mikološki uzorci, tj. 190.000 uzoraka tijekom 2011. - 30. 4. 2016. Izolirani
fungi identificirani su morfološkim testovima: ID32, YST Vitek 2 (BioMerieux) i
MALDI-TOF MS Bruker. In vitro testovi osjetljivosti provedeni su metodom
minimalne inhibitorne koncentracije (MIK) ATB Fungus 4 i AST Vitek 2 (BioMerieux).
Najčešće su tražene mikološke pretrage respiratornih uzoraka, 69.000 (36%).
Mikološki uzorci bili su iz nosa, ždrijela, iskašljaja i aspirata traheje (20%, 21%, 20%,
19%). Uzorci iz nosa, ždrijela i aspirata traheje bili su nadzorne i/ili dijagnostičke
kulture. Mikološkim pretragama respiracijskih uzoraka ukupno je izolirano 60.000
različitih funga. Najviše je bilo kvasaca, slijede Aspergillus, non-Aspergillus
oportunističke plijesni (Fusarium, Zygomycetes, Pseudoallescheria boydii) i
saprofitne plijesni (48%, 17%, 1%, 23%). Bakteriološkim aerobnim pretragama
izolirano je 11% kvasaca i 0,5% plijesni (bez identifikacije vrste). Bakterioloških je
pretraga bilo oko 3 puta više nego mikoloških. Mikološkom pretragom u 1
bolesnika u njegovom je uzorku izolirano 1 - 15 različitih funga. Jedan je bolesnik
imao ≥ 1 (mikoloških uzoraka, dan hospitalizacije, bolničkih odjela).
Bolesnici s različitim akutnim i kroničnim bolestima osjetljivi su na fungalne
infekcije. Moraju se analizirati skupine bolesnika prema vrstama i težini osnovne
78
bolesti. Što smo više podataka sposobni obraditi, to ćemo postati uspješniji u
liječenju respiracijskih fungalnih infekcija.
Fungi and respiratory samples, University Hospital Centre Zagreb, 2011-

2016
1
2
Professional Study in Laboratory Medical Diagnostics, University of
Applied Health Sciences, Zagreb, Croatia
Fungi are ubiquitous in nature. Respiratory fungal colonization and infections are
common in immunocompromised patients and, with the complications of
underlying disease and other infections, they often cause attributable mortality.
University Hospital Centre Zagreb has about 1,800 beds. Retrogradely, we analyzed
all mycological processed samples (190,000) from the 2011 - 30 Apr 2016 period.
The isolated fungi were identified using morphological tests, ID32, Vítek YST 2
(BioMerieux) and MALDI-TOF MS Bruker. In vitro susceptibility tests were done
using the method of the minimum inhibitory concentration (MIC) of ATB Fungus 4
and AST Vitek 2 (BioMerieux).
Most commonly requested were tests of mycological respiratory samples (69,000
samples, 36%). Mycological samples were collected from the nose, pharynx,
sputum and tracheal aspirates (20%, 21%, 20%, 19%, respectively). Samples from
the nose, pharynx and tracheal aspirates were surveillance and/or diagnostic
cultures. Mycological examinations of respiratory specimens resulted in total
isolation of 60,000 different fungi. Most were yeasts, Aspergillus, followed by the
non-Aspergillus opportunistic molds (Fusarium, Zygomycetes, Pseudoallescheria
boydii) and saprophytic moulds (48%, 17%, 1%, 23%, respectively). Bacteriological
aerobic tests were used to isolate 11% yeasts and 0.5% molds (without identifying
the species). Approximately three times more bacteriological tests were carried out
than mycological tests. Mycological examinations in the sample of one patient
resulted in isolation of 1-15 different fungi. One patient had ≥1 (mycological
sample, day hospitalization, hospital wards).
Patients with various acute and chronic diseases are susceptible to fungal
infections. Patient groups should be analyzed according to the type and severity of
the underlying disease. The more information we are able to process, the more
successful can we become in the treatment of respiratory fungal infections.
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O-56 Latrodektizam u Hrvatskoj

Boris Dželalija1, Boris Lukšić2
1
Opća bolnica Zadar, Medicinski fakultet Sveučilišta u Splitu, Hrvatska
2
Klinika za infektologiju, Klinički bolnički centar Split, Split, Hrvatska
Cilj. Prikazati klinička, epidemiološka i terapijska obilježja latrodektizma u 144

bolesnika s područja južnog dijela Hrvatske, od Zadra do Dubrovnika, u 25-
godšnjem razdoblju od 1991. do 2015. godine.
Metode. Retrospektivna analiza podataka zabilježenih u arhivi (povijest bolesti,
kompjutorski zapisi) infektoloških odjela u Općoj bolnici Zadar, Općoj bolnici
Šibenik, Općoj bolnici Dubrovnik i u Klinici za infektivne bolesti u Kliničkoj bolnici
Križine u Splitu.
Rezultati. Tijekom razodblja od 1991. do 2015. godine ukupno je zabilježeno 144
bolesnika s anamnestičkim i kliničkim podatcima latrodektizma. Najviše bolesnika
zabilježeno je u Općoj bolnici Zadar (65; 45.1%). Od ukupno 144 bolesnika većina su
muškarci (75; 52.1%), najviše ih je u dobnoj skupini od 20 do 65 godina (102;
70.8%). Ugriz pauka crna udovica zabilježen je u većine bolesnika s boravkom na
kopnu (124;86.1%) i u tijeku obavljanja poljprivrednih radova (89; 69.0%). Najviše
ugriza pauka dogodilo se u mjesecu srpnju (70; 48.6%) tijekom poslijepodneva (47;
37.3%) u polju (85; 65.9%), mjesto ugriza bilo je primjetno u većine bolesnika (82;
63.6%), a najčešće mjesto ugriza bilo je stopalo (33; 25.6%). Najviše uboda (15;
10.4%) zabilježeno je u 1995. i 1998. godini. Većina bolesnika zatražilo je prvu
pomoć u ambulanti hitne medicinske pomoći (56; 43.8%) u razdoblju do 1 sata od
incidenta (50; 39.1%), a većina njih je hospitalizirana 3 do 5 dana (70; 54.3%).
Antiviperini serum primjenjen je u 88 (68.2%) osoba, u većine unutar 2 sata (41;
41.7%), u svih po jedna doza i bez nuspojava. Najčešći klinički simptomi/znakovi bili
su generalizirana bol (119; 92.2%), spazam mišića (98;76.0%), obilno znojenje (89;
69%) i vidljiva papula s eritemom 87; 67.4% na mjestu ugriza.
Zaključak. Stanovništvo naseljeno na području južnog dijela Hrvatske (srednja i
južna Dalmacija) izloženo je, naročito tijekom ljetnih mjeseci i poljoprivrednih
radova, ugrizu otrovnog pauka crna udovica. Klinička slika latrodektizma i
rasprostranjenost otrovnog pauka zahtjevaju rano prepoznavanje simptoma bolesti
i rani početak liječenja.
Latrodectism in Croatia
Boris Dželalija1, Boris Lukšić2
1
Genaral Hospital Zadar, University of Split School of Medicine, Croatia
2
Clinic for Infectious Diseases, University Hospital Split, University of Split
School of Medicine, Croatia
Aim. To analyze clinical, epidemiological and therapeutical features of latrodectism

in 144 patients in South Croatia, from Zadar to Dubrovnik, covering a 25-years
period of time from 1991 to 2015 .
80
Methods. Retrospective analysis of data gained from the archives (patients medical
history, pc-recordings) at the departments of infectious diseases of the General
Hospital Zadar, General Hospital Šibenik, General Hospital Dubrovnik and the Clinic
for Infectious Diseases, Clinical Hospital Križine in Split.
Results. The total number of patients registered to have anamnestic and clinical
data related to latrodectism in the period 1991 -2015 was 144. Most of patients
were recorded in the General Hospital Zadar ( 65; 45.1%). The majority of 144
patients were male (75; 52.1%), mostly in the age 20 to 65 years (102; 70.8%). The
Black Widow Spider bite is recorded mostly in patients in continental parts
(124;86.1%) and during agricultural activities (89; 69.0%). The highest spider bite
incidence was in July (70; 48.6%) in the afternoon (47; 37.3%) in the field (85;
65.9%), bite spot was visible in most of patients (82; 63.6%), and the most frequent
bite spot was on foot (33; 25.6%). The largest number of bites recorded (15; 10.4%)
is in 1995 and 1998 . Majority of patients asked for help in the first-aid ambulance
(56; 43.8%) within 1 hour from the incident (50; 39.1%), most of them hospitalized
3 to 5 days (70; 54.3%). Antiviperine serum is administerd in 88 (68.2%) persons, in
most within 2 hours (41; 41.7%), one dosage in all patients, and with no side-
effects. The most frequent symptoms were general pain (119; 92.2%), muscle
spasm (98;76.0%), intensive sweating (89; 69%) and visible papule with erythema
(87; 67.4%) on the bite spot.
Conclusion: The population of southern part of Croatia (Middle and South
Dalmatia) is exposed to bites of the venomous Black Widow Spider, especially
during summer and agricultural activities. Clinical picture/feature of latrodectism
and wide-spred of the venomous spider require early identification of symptoms
and early treatment beginning.
O-57 C hepatitis u Općoj bolnici Pula 1993.-2016.

Nadia Komparić, Irena Hrstić, Katerina Klapčić, Jadranka Cetina-Žgrablić,
Ivana Babić Gvozdenović, Natali Roža Macan
Opća bolnica Pula, Pula, Hrvatska
UVOD: C hepatitis je poznati javnozdravstveni problem jer uzrokuje cirozu jetre sa

zatajenjem i HCC.
U IŽ i OBP rano se započelo s kontrolom populacije zaražene HCV-om. Premda
točan broj zaraženih nije poznat, pretpostavlja se da je/bilo zaraženo 1450–1600
osoba (stopa prevalencije 0,7-0,8%).
METODE: Deskriptivnom statistikom je obrađeno 515 bolesnika
kontroliranih/liječenih radi C hepatitisa u Odjelu gastroenterologije OBP. Grupirani
su prema općim i specifičnim karakteristikama (liječeni/neliječeni/umrli).
REZULTATI: Svi bolesnici su iz IŽ. U dobi od 26-66 godina je 91% bolesnika, 71% su
muškarci. Visoka fibroza/CJ je kod 40%; niska/umjerena kod 43%; nepoznata u 17%
81
bolesnika. Ozbiljan komorbiditet ima 33% bolesnika. Od 452 poznatih genotipova,

53% se odnosi na genotip 1 (podjednako 1a/1b); 37% genotip 3; 6% genotip 2; 4%
genotip 4. IL28B polimorfizam kod 90 bolesnika: 32% CC, 56% CT, 12% TT tip.
Liječeni: Liječeno je 350 bolesnika različitim terapijskim protokolima ( kIFN, IFN/R,
P/R, PR/T/B/S, 3/2DAA). Kod 225 bolesnika (73%) je korišten P/R režim liječenja s
postignutom eradikacijom HCV od 59%; 35% neuspješno. Višestruko je liječeno 73
bolesnika (18% dva puta; 3% tri puta ). IFN free režimom (3/2DAA) je obuhvaćeno
36 bolesnika, SVR je postignut u 14; uspješan EOT u 10; 8 je u tijeku liječenja; 4
čekaju početak liječenja.
Neupješno liječeni: Liječenih 75 bolesnika (21%) nije postignulo eradikaciju HCV.
Živih je 61, umrlih 14. G3/G2 su 22+1, G1/G4 37+1 bolesnik.
Neliječeni: Od 515 bolesnika 165 nije liječeno. Živih je 122 bolesnika, umrlih 43. U
dobi od 26-66 godina je 119 bolesnika (98%). Kompletiranu medicinsku obradu ima
68 bolesnika (58%), nekompletiranu 42%.
Umrli: 58 umrlih. Uspješno je protuvirusno liječen jedan bolesnik; neuspješno 14;
43 nisu liječena nijednim protuvirusnim protokolom.
C hepatitis in General Hospital Pula 1993-2016

Nadia Komparić, Irena Hrstić, Katerina Klapčić, Jadranka Cetina-Žgrablić,
Ivana Babić Gvozdenović, Natali Roža Macan
General Hospital Pula, Pula, Croatia
INTRODUCTION: Hepatitis C is a well-known public health problem because it

causes cirrhosis, liver failure and HCC.
In the IŽ and OBP the control of the population infected with HCV begun early.
Although the exact number of infected is not known, it is assumed that there
was/is 1450-1600 infected persons (prevalence 0.7-0.8%).
METHODS: 515 patients controlled/ treated for hepatitis C, in the Department of
Gastroenterology OBP, were processed using descriptive statistics. They were
grouped under the general and specific characteristics (treated /untreated /dead).
RESULTS: All patients are from the IŽ. Ages 26-66 years: 91% of patients. 71% are
men.
High fibrosis/CJ is in 40% of the patients; low/moderate in 43%; unknown in 17%.
33% of patients have a serious comorbidity. Of the 452 patients with known
genotypes, 53% are genotype 1 (equally 1a/1b); 37% are genotype 3; 6% are
genotype 2; 4% are genotype 4. IL28B polymorphism was found in 90 patients: 32%
CC, CT 56%, 12% TT type.
Treated: 350 patients were treated with different treatment protocols (kIFN, IFN/R,
P/R, PR/T/B/S, 3/2DAA). P/R mode of treatment was used in 225 patients (73%),
with eradication of HCV of 59%; 35% failed. 73 patients were repeatedly treated
(18% twice, 3% trice). IFN free regimen (3/2DAA) included 36 patients, SVR was
achieved in 14; successful EOT in 10; 8 patients are in the course of treatment; 4
are waiting for the start of treatment.
82
Unsuccessfully treated: 75 patients (21%) have not attained the eradication of HCV.
61 are alive, 14 died. G3/G2 22+1; G1/G4 37+1 patient.
Untreated: Of the 515 patients 165 were not treated. 122 untreated patients are
alive, 43 died. Ages 26-66 years: 119 patients (98%). 68 patients (58%) has received
a complete medical treatment; incomplete 42%.
Deceased: 58 deaths. One patient received successful antiviral treatment;
unsuccessful 14; 43 have not been treated by any antivirus protocol.
CONCLUSION: Hepatitis C leads to liver failure and death, HCC and serious
extrahepatic comorbidity. Today there are successful models of treatment of
hepatitis C. Eradication of HCV typically means life.
O-58 Kliničke značajke spondilodiscitisa u bolesnika liječenih u Klinici za

infektivne bolesti „Dr. Fran Mihaljević“ 2011.-2015. godine
Ivan Puljiz, Mia Ajduković
Cilj: analizirati kliničke značajke 114 pacijenta sa spondilodiscitisom (SD) koji su

hospitalizirani u Klinici za infektivne bolesti „Dr. Fran Mihaljević“ u Zagrebu u
razdoblju od 1. siječnja 2011. do 31. prosinca 2015. godine.
Metode: retrospektivno smo analizirali 114 bolesnika sa SD liječenih u KIB „Dr. Fran
Mihaljević“ u razdoblju od 1. siječnja 2011. do 31. prosinca 2015. godine. Dijagnoza
bolesti postavljena je temeljem kliničke slike, laboratorijskih nalaza, mikrobioloških
testova i radioloških pretraga. Korištena je arhiva Odjela za medicinsku
dokumentaciju KIB „Dr. Fran Mihaljević“ u Zagrebu.
Rezultati: većina pacijenata su bili muškarci stariji od 50 godina. Približno dvije
trećine bolesnika imala je neku od poticajnih bolesti, a komplikaciju SD-a više od
polovice. Većina bolesnika imala je subakutno-kronični tijek bolesti. Svi bolesnici su
navodili bol u leđima kao vodeći simptom koji je bio praćen uglavnom subfebrilnim
temperaturama (u prosjeku 37.7 °C), a neurološki deficit je zabilježen u jedne
trećine bolesnika. Ubrzana sedimentacija eritrocita i povišene vrijednosti C-
reaktivnog proteina bilježe se u većine, a leukocitoza u manje od polovice
bolesnika. Najčešće je bila zahvaćena lumbalna, a potom torakalna kralježnica.
Promjena na koži su bile najčešće ishodište infekcije. Najčešći uzročnik bio je
Staphylococcus aureus. Većina bolesnika liječena je kombinacijom antibiotika. Dva
bolesnika su umrla.
Zaključak: pacijenti sa SD predstavljaju sve veći problem u našoj sredini. St. aureus
je vodeći uzročnik bolesti. Pravovremeno postavljena dijagnoza i etiologija
predstavlja ključ dobre prognoze bolesti.
83
Clinical characteristics of spondylodiscitis in patients treated at the

University Hospital for Infectious Diseases in the period 2011-2015
Ivan Puljiz, Mia Ajduković
Croatia
Aim: to analyze clinical characteristics of 114 patients with spondylodiscitis (SD)

hospitalized at the University hospital for infectious diseases (UHID) „Dr. Fran
Mihaljević“ in Zagreb in the period from 01 January 2011 to 31 December 2015.
Methods: we retrospectively analysed 114 patients with SD treated at the UHID
„Dr. Fran Mihaljević“ in Zagreb in the period from 01 January 2011 to 31 December
2015. Diagnosis of disease was based on the clinical picture, laboratory findings,
microbiological tests and radiological tests. We were used archive from
Department for medical documentation UHID „Dr. Fran Mihaljević“.
Results: the majority of patients were males older than 50 years of age.
Approximately two third of patients had some type of a triggering factor, and more
than half of the patient experienced disease complications. The majority of patients
had a subacute-chronic course of disease. All patients had back-pain as the leading
symptom, sun-values of fever in average 37.7 °C and neurological deficit was
reported in one third of patients. Elevated erythrocyte sedimentation rate and
high C-reactive protein were recorded in the majority of patients, and leucocytosis
in less than half of the patients. Lumbar spine was most frequently affected,
followed by thoracic spine. Skin changes were most commonly the focus of
infection. The most common pathogen was Staphylococcus aureus. Majority of
patients were treated with combination of antimicrobial therapy. Two patients
were died.
Conclusion: patients with SD represent important problem in our setting. St. aures
is leading cause of disease. Timely detection diagnosis and etiology are key of good
prognosis of disease.
84
EMERGENTNE INFEKTIVNE BOLESTI

EMERGING INFECTIOUS DISEASES
85
O-59 Emergentne i re-emergentne bakterije

Maja Abram
Klinički bolnički centar Rijeka, Medicinski fakultet Sveučilišta u Rijeci, Rijeka,
Hrvatska
Emergentne zarazne bolesti jesu one čija je se incidencija značajno povećala, bilo
zbog pojave sasvim novog uzročnika, bilo zbog ponovne pojave već poznatog
uzročnika, nakon prividne kontrole ili eliminacije. Svi oblici mikroorganizama,
bakterije, virusi, paraziti i gljive mogu se pojaviti kao emergentni ili se ponovno
pojaviti kao re-emergentni uzročnici bolesti u ljudi, iako su virusi odgovorni za
najdramatičnije primjere.
U ovom predavanju naglasak je na emergentnim i re-emergentnim bakterijama,
isključujući sve veću učestalost višestrukorezistentnih bakterijskih sojeva. U
posljednja dva desetljeća, Centar za kontrolu i prevenciju bolesti identificirao je više
od pedeset novih bakterijskih bolesti, kao što su legionarska bolest, sindrom
toksičnog šoka, Lajmska borelioza, kampilobakterioza, shiga-toksin producirajući
sojevi Escherichia coli, helikobakter infekcije, erlihioza, bartoneloza, itd. Neke nove
bakterije, koje su odnedavno prepoznate i kao humani patogeni (Elizabethkingia,
Kocuria, Schewanella, Cronobacter, itd), vjerojatno su odavno prisutne u okolišu, ali
mi, iz nepoznatog razloga, nismo bili izloženi. Istovremeno, sve više davno poznatih
bakterijskih bolesti ponovno postaju značajni javnozdravstveni problemi. Svjetska
zdravstvena organizacija identificirala je najmanje tri re-emergentne bakterijske
infekcije na koje treba obratiti pažnju i koje treba pratiti: difteriju, koleru i kugu.
Kako bi se uspješno suprostavili izazovima novih, emergentnih zaraznih bolesti i
istovremeno kontrolirali postojeće i re-emergentne bolesti, potrebno je razumjeti
kako se i zašto mijenjaju obrasci zaraznih bolesti i koji čimbenici doprinose tim
promjenama.
Emergent and re-emergent bacteria

Maja Abram
Clinical Hospital Centre Rijeka, Faculty of Medicine University of Rijeka,
Rijeka, Croatia
Emerging infectious diseases are clinically distinct conditions whose incidence in

humans has increased. Emergence may be due to the introduction of a new agent,
while reemergence describes the reappearance of a known pathogen, after its
apparent control or elimination. All forms of infectious organisms, bacteria, viruses,
fungi, and parasites are able to emerge or re-emerge in human populations, but
viruses afford the most dramatic examples.
However, in this lecture the focus is on emergent and reemergent bacteria,
excluding the increasing occurrence of multi-resistant bacterial strains. In the last
two decades, the Center for Disease Control and Prevention identifies more than
fifty new bacterial diseases such as Legionnaire's disease, toxic shock syndrome,
86
Lyme disease, campylobacteriosis, Shiga toxin-producing Escherichia coli,

Helicobacter infections, ehrlichiosis, Bartonella infections, etc. Some new bacteria,
recently recognized as human pathogens (Elizabethkingia, Kocuria, Schewanella,
Cronobacter, etc.), seems to be present in our environment long ago, but we were
not exposed to. At the same time, a number of well known bacterial diseases have
re-emerged as important public health problems. WHO has identified at least three
worldwide re-emergent bacterial infections that should be monitored: diphtheria,
cholera, and bubonic plague.
To deal with the challenges of newly emerging infectious diseases and at the same
time to control existing diseases, it is necessary to understand how infectious
disease patterns are changing and what factors contribute to those changes.
O-60 Emergentne i re-emergentne virusne bolesti u Republici Hrvatskoj

Alemka Markotić
Emerging and re-emerging viral diseases in the Republic of Croatia

Alemka Markotić
Croatia
O-61 Novi pristupi u razumijevanju bakterije Francisella tularensis

Marina Šantić1, Mateja Ožanić1, Valentina Marečić1, Mihaela Matovina2,
Mirna Mihelčić1, Alemka Markotić3, Petra Svodoba3, Nenad Turk4, Josipa
Habuš4
1
Zavod za mikrobiologiju i parazitologiju, Medicinski fakultet, Sveučilište u
Rijeci, Rijeka, Hrvatska,
2
Zavod za organsku kemiju i biokemiju, Institut Ruđer Bošković, Zagreb,
Hrvatska
3
Klinika za infektivne bolesti "Dr. Fran Mihaljević," Zagreb, Hrvatska
4
Zavod za mikrobiologiju i zarazne bolesti, Veterinarski fakultet Sveučilišta u
Zagrebu, Zagreb, Hrvatska
F. tularensis je visoko patogena fakultativno unutarstanična bakterija koja u ljudi i

životinja uzrokuje bolest tularemiju. S obzirom na visoku infektivnost, F. tularensis
dovodi do visoke stope morbiditeta i mortaliteta, te je svrstana u kategoriju A
mikroorganizama i smatra se potencijalnim biološkim oružjem. F. tularensis se sa
inficiranih životinja na čovjeka prenosi na više načina te dovodi do različitih oblika
bolesti. Kod sisavaca, F. tularesis pokazuje sposobnost infekcije, preživljavanja i
87
razmnožavanja u različitim fagocitnim i nefagocitnim stanicama, slično kao u

stanicama artropoda. Bijeg F. tularenis iz fagosoma te daljnje razmnožavanje u
citosolu stanice domaćina smatra se ključnim za patogenezu tularemije. Posljednjih
desetljeća, incidencija tularemije na području Europe je u porastu i kod ljudi i kod
životinja. U ovom radu, opisan je unutarstanični ciklus F. tularensis s naglaskom na
život bakterije u stanicama ameba, kao i moguća uloga ameba u održavanju ove
opasne bakterije u okolišu. Nadalje, molekularnim metodama je ispitana pojavnost
tularemije kod glodavaca na području Hrvatske tijekom posljednjih nekoliko godina.
New approaches in understanding Francisella tularensis

Marina Šantić1, Mateja Ožanić1, Valentina Marečić1, Mihaela Matovina2,
Mirna Mihelčić1, Alemka Markotić3, Petra Svodoba3, Nenad Turk4, Josipa
Habuš4
1
Department of Microbiology and Parasitology, Medical Faculty University
of Rijeka, Rijeka, Croatia
2
Division of Organic Chemistry and Biochemistry, Ruđer Bošković Institute,
Zagreb, Croatia.
3
University Hospital for Infectious Diseases "Dr. Fran Mihaljević," Zagreb,
Croatia
4
Department of Microbiology and Infectious Diseases, Faculty of Veterinary
Medicine University of Zagreb, Zagreb, Croatia
Francisella tularensis is a highly virulent facultative intracellular pathogen that

causes tularemia, a zoonotic disease that infects mammals and humans. Due to its
high infectivity, morbidity, and mortality, F. tularensis has been classified as a
category A bioterrorism agent. F. tularensis is transmitted from infected animals to
humans by multiple routes and can cause disease of varying severities. In
mammals, F. tularensis invades, survives and replicates in variety of cell types
including phagocytic and non-phagocytic cells of various species, as well as
arthropod-derived cells. The key element of pathogenesis of the disease is bacterial
escape from the phagosome into cytosolic replicative niche. In the last decades, the
incidence of human and animal tularemia in Europe is increasing. Here, we review
the intracellular life cycle of Francisella and highlight the intracellular fate of F.
tularensis within amoeba cells and its possible role in sustaining this dangerous
bacterium in the environment. In addition, we report the rodent-borne tularemia in
Croatia followed by molecular screening in the last few years.
88
O-62 “Point-of-care” testovi u dijagnostici emergentnih i re-emergentnih

zaraznih bolesti
Infektivne bolesti koje se u populaciji prepoznaju kao nove, zahvaćaju sve veći broj
ljudi na određenom području ili se šire globalno, nazivaju se emergentnima. Re-
emergentne bolesti imaju poznate uzročnike koji zbog različitih razloga ponovo
postaju značajni javno-zdravstveni problem s trendom porasta incidencije i
prevalencije. Emergentne i re-emergentne bolesti često se pojavljuju u
nerazvijenim područjima. Brza i sigurna dijagnostika ključna je za rano
prepoznavanje i prevenciju širenja bolesti. Identifikacija uzročnika osnova je za
suzbijanje bolesti. Suvremena definicija testova „point-of-care“ (POCT)
podrazumijeva testiranja koja generiraju rezultate prije nego što bolesnik napusti
mjesto liječenja, bez obzira na korištenu metodu. Nalazi utječu na neposrednu skrb
o bolesniku. Nove tehnologije otvaraju brojne mogućnosti za unapređenje
dijagnostičkih testova koji se mogu koristiti u različitim uvjetima. Problem
predstavlja financiranje budući da se često radi o bolestima koje se pojavljuju u
najsiromašnijim zemljama te se smatraju zanemarivima jer nisu predmet interesa
bogatih. Težnja za profitom ograničava razvoj potrebne dijagnostike za nerazvijena
područja. Tek globalna prijetnja, kao što je npr. zika-infekcija, može potaknuti
razvoj novih testova. POCT tradicionalno se poistovjećuje s testovima koji se rade
manualno, ne zahtijevaju posebnu opremu i rezultat se očitava prema promjeni
boje. To je prva generacija POCT. Metode molekularne dijagnostike postaju također
potpuno automatizirane i primjenjive izvan laboratorija i sve češće spadaju u POCT.
Razvoj multipleks testova kao POCT, u kojima se iz jednog uzorka istovremeno
može odrediti više različitih diferencijalno dijagnostičkih patogena, omogućava
postavljanje rane etiološke dijagnoze. Osnovni preduvjet za POCT je jednostavnost,
robusnost i sigurnost u rezultate koji moraju biti komparabilni sa standardnom
dijagnostikom. Važno je poštovati i provoditi strogi sustav kontrole kvalitete, a
budući da se radi o laboratorijskoj dijagnostici koja se često provodi izvan
standardnog laboratorija, POCT treba biti integrirani dio dijagnostike unutar
zdravstvenog odnosno laboratorijskog sustava.
Point-of-care tests in diagnostics of emerging and re-emerging infectious

diseases
Croatia
Infectious diseases recognized as new in the population, affecting a growing

number of people in a particular region or spread globally, are called emergent. Re-
emergent diseases have known causes, which for various reasons again become a
89
significant public health problem with the trend of increase in incidence and
prevalence. Emergent and re-emergent diseases often appear in underdeveloped
areas. The quick and accurate diagnosis is crucial for early identification and
prevention of the spread of disease. Identification of the causative agent is the
basis for disease control. The current definition of "point-of-care" tests (POCT) is
testing that generates results before the patient leaves the place of treatment,
regardless of the method used. Findings affect immediate patient care. New
technologies provide numerous possibilities for improvement of diagnostic tests
which can be used in different conditions. The problem is funding due to the fact
that it is often case of diseases that occur in the poorest countries, and is
considered neglected because they are not the subject of the interests of the
wealthy. The profit aim restricts the development of the necessary diagnostics in
underdeveloped areas. Only a global threat, such as Zika infection, may encourage
the development of new tests. POCT is traditionally identified with tests that are
done manually, does not require special equipment, and the result is defined
according to the change of colour. This is the first generation POCT. Molecular
diagnostic methods are becoming fully automated and also applicable outside
laboratory, and more often belong to POCT. The development of multiplex assays
as POCT allows early etiologic diagnosis because simultaneously from a single
sample more different diagnostic pathogens may be determined. The basic
prerequisite of POCT is simplicity, robustness and security in the results which must
be comparable with standard diagnostics. It is important to respect and implement
strict quality control system, and since it is a laboratory diagnostic that is often
carried out outside standard laboratory, POCT should be an integrated diagnostic
part within the health or laboratory system.
O-63 Ekosustavi i emergentne i re-emergentne zoonoze

Josip Margaletić
Šumarski fakultet Sveučilišta u Zagrebu, Zagreb, Hrvatska
Ecosystems and emerging and re-emerging infectious diseases

Josip Margaletić
University of Zagreb Faculty of Forestry, Zagreb, Croatia
90
ZOONOZE
ZOONOTIC INFECTIOUS DISEASES
91
O-64 Program praćenja virusa Zapadnog Nila u Srbiji (2014.-2015. godine):

rezultati i iskustva
Tamaš Petrović1, Milanko Šekler2, Dušan Petrić3, Zoran Debeljak2, Sava
Lazić1, Dejan Vidanović2, Aleksandra Ignjatović Ćupina3, Gospava Lazić1,
Diana Lupulović1, Budimir Plavšić4
1
Naučni institut za veterinarstvo “Novi Sad”, Novi Sad, Srbija
2
Veterinarski specijalistički institut “Kraljevo”, Kraljevo, Srbija
3
Laboratorija za medicinsku I veterinarsku entomologiju, Poljoprivredni
fakultet Univerziteta u Novom Sadu, Novi Sad, Srbija
4
Uprava za veterinu, Ministarstvo poljoprivrede I zaštite životne sredine,
Beograd, Srbija
Na osnovu rezultata prethodnih istraživanja prisustva WNV i epidemiološke

situacije u Srbiji, Uprava za veterinu Ministarstva Poljoprivrede i zaštite životne
sredine je pokrenula I finansirala nacionalni Program nadzora WNV tokom 2014. i
2015. godine. Programi su sprovođeni na teritoriji cele Srbije od strane
veterinarskih instituta i terenske veterinarske službe i u saradnji sa entomolozima i
ornitolozima. Osnovni cilj programa je bila rana detekcija prisustva WNV na
području Srbije i pravovremeno informisanje humane zdravstvene službe i lokalnih
samouprava radi sprovođenja mera kontrole, suzbijanja komaraca i informisanja
stanovništva o potrebnim preventivnim merama zaštite. Programi su bili bazirani
na direktnom i indirektnom praćenju prisustva WNV u životnoj sredini i to putem
serološkog testiranja seronegativnih sentinel konja i živine, kao i putem detekcije
prisustva virusa u zbirnim uzorcima komaraca vektora virusa i uzorcima divljih ptica
kao prirodnih domaćina virusa.
Područja najintenzivnije cirkulacije WNV u Srbiji, gde je utvrđen najveći broj
pozitivnih nalaza među testiranim sentinel životinjama i prisustva WNV u uzorcima
komaraca i divljih ptica, su bila 7 okruga u Pokrajini Vojvodini (Srednjebanatski,
Severnobački, Južnobanatski, Zapadnobački, Južnobački, Sremski i Severnobanatski
okrug, odnosno kompletni severni deo Srbije) i područje Grada Beograda. U odnosu
na rezultate ostvarene u programima nadzora tokom 2014. i 2015. godine i
prijavljenih humanih slučajeva bolesti Zapadnog Nila u tom periodu, može se
zaključiti da su sprovedeni programi nadzora bili veoma uspešni i opravdani. U
većini slučajeva, humanim slučajevima bolesti su prethodili pozitivni rezultati
detekcije WNV kod životinja i/ili komaraca.
Može se zaključiti da je WNV prisutan i da cirkuliše na području Srbije najmanje 6
godina. Veterinarska služba je zajedno sa kolegama drugih profesija uspešno
implementirala i sprovela programe WNV nadzora tokom 2014. i 2015.godine. Za
uspešnost programa neophodna je zajednička koordinacija veterinarske i humane
zdravstvene službe.
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Monitoring program of West Nile virus in Serbia (2014-2015): results and

experience
Tamaš Petrović1, Milanko Šekler2, Dušan Petrić3, Zoran Debeljak2, Sava
Lazić1, Dejan Vidanović2, Aleksandra Ignjatović Ćupina3, Gospava Lazić1,
Diana Lupulović1, Budimir Plavšić4
1
Scientific Veterinary Institute „Novi Sad“, Novi Sad, Serbia
2
Veterinary Specialized Institute “Kraljevo”, Kraljevo, Serbia
3
Laboratory for Medical and Veterinary Entomology, Faculty of Agriculture,
University of Novi Sad, Novi Sad, Serbia
4
Veterinary Directorate, Ministry of Agriculture and Environmental
Protection, Belgrade, Serbia
Based on the results of the previous studies on WNV presence and epidemiological
situation in Serbia, Veterinary Directorate had launched and funded the national
WNV surveillance programs in 2014 and in 2015. The Programs encompassed the
entire territory of Serbia and were conducted by veterinary institutes and field
veterinary service in collaboration with entomologists and ornithologists. The
objective of the programs were early detection of WNV, and timely reporting to
human health service institutions and local authorities in order to inform the local
communities and for establishing the control of mosquitoes and preventive
measures for human health protection. The programs were based on direct and
indirect surveillance of WNV presence in environment, by serological testing of
seronegative sentinel horses and poultry as well as through virus detection in
pooled mosquitoes samples and samples of wild birds.
The regions of the most intensive WNV circulation in Serbia, where most of the
positive samples were detected among tested sentinel animals and WNV presence
in mosquitoes and wild birds, were found to be 7 Districts of Vojvodina Province
(Central Banat, North Backa, South Banat, West Backa, South Backa, Srem and
North Banat Districts, located on the northern part of Serbia) and the territory of
Belgrade city. Considering the results obtained during WNV surveillance programs
in 2014 and 2015 and reported human WNV cases in those years, it could be
concluded that the conducted WNV surveillance programs were successful and
meaningful. Most of the human cases were preceded by the detection of WNV in
animals and/or mosquitoes.
It can be concluded that WNV is present and circulating in Serbia for at least 6
years. Veterinary service together with colleagues of other professions successfully
managed to implement the WNV surveillance program during 2014 and 2015. For
the success of the program, synergy and coordination of veterinary and human
health services are necessary.
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O-65 Emergentne zoonoze i pristup "Jedno zdravlje"

Ljubo Barbić1, Tatjana Vilibić-Čavlek2, Vladimir Stevanović1, Vladimir Savić3,
Snježana Kovač1, Suzana Hađina1, Josip Madić1
1
2
Hrvatski zavod za javno zdravstvo; Medicinski fakultet Sveučilišta u
3
Hrvatski veterinarski institute, Centar za peradarstvo, Zagreb, Hrvatska
Prema podacima Svjetske zdravstvene organizacije preko 60% uzročnika zaraznih

bolesti ljudi su zoonotski uzročnici. Znanstvenici su 70-ih godina 20. stoljeća,
utemeljeno na razvoju medicine, a prije svega antibiotika i cjepiva kojima su u to
vrijeme iskorijenjene velike boginje, smatrali da postižemo puni nadzor nad
zaraznim bolestima. Međutim, posljednjih nekoliko desetljeća svjedočimo
pojavljivanju sve većeg broja novih, emergentnih zaraznih bolesti koje u ovom
trenutku predstavljaju izazov čovječanstvu. Od tih, emergentnih zaraznih bolesti,
čak 75% su zoonoze. Navedeno naglašava potrebu za promjenom pristupa javnom
zdravstvu te neophodnoj bliskoj suradnji liječnika i veterinara, kao i drugih
stručnjaka.
Borba protiv zoonoza interdisciplinarnom suradnjom zasigurno nije potpuno nova
ideja. Ona je sporadično provođena primjerice u suzbijanju bjesnoće koja upravo
zahvaljujući toj suradnji u ovom trenutku ide prema konačnom cilju, potpunom
iskorjenjivanju bolesti na našim prostorima. Međutim, za razliku od „starih“
zoonoza o kojima je manje više sve poznato, pojava emergentnih zoonoza donosi
niz nepoznanica uz istovremenu potrebu za što bržom reakcijom u svrhu zaštite
zdravlja ljudi. Upravo pristup „Jednog zdravlja“, koji podrazumijeva suradnju
stručnjaka iz različitih područja na lokalnoj, nacionalnoj i globalnoj razini sa
zajedničkim ciljem postizanja najboljih rezultata u očuvanju zdravlja ljudi i životinja
te očuvanju okoliša, predstavlja jedini mogući učinkovit odgovor na ove nove
izazove u javnom zdravstvu. Prepoznavanje nužnosti uvođenja ovakvog pristupa u
modernom svijetu, s intenzivnim socio-demografskim i klimatskim promjenama,
potvrđuje i uspostava bliske suradnje svih svjetskih krovnih organizacija za zaštitu
zdravlja ljudi i životinja. Međutim, ta uspostavljena suradnja nema nikakvog učinka
ukoliko se pristup „Jednog zdravlja“ u potpunosti ne prihvati i ne provodi i na
lokalnoj, odnosno nacionalnoj i regionalnoj razini.
Sustavna implementacija pristupa „Jednog zdravlja“ provodi se sve više u javnom
zdravstvu Republike Hrvatske s jasno vidljivim rezultatima u primjerice nadzoru i
suzbijanju emergentnih flavivirusnih infekcija te se zasigurno mora još intenzivnije
nastaviti kao odgovor na novonastale izazove u javnom zdravstvu.
94
Emerging zoonoses and "One Health" approach

Ljubo Barbić1, Tatjana Vilibić-Čavlek2, Vladimir Stevanović1, Vladimir Savić3,
Snježana Kovač1, Suzana Hađina1, Josip Madić1
1
2
Croatian Institute of Public Health and University of Zagreb School of
3
Croatian Veterinary Institute, Poultry Centre, Zagreb, Croatia
The WHO is reporting that over the 60% of the human infectious agents are
zoonotic pathogens. In the 1970s scientists were convinced that they were able to
control infectious diseases using antibiotics and vaccines, encouraging the
eradication of smallpox through vaccination. However, in the last few decades’
appearance of the numerous emerging infectious diseases represent the new
challenge to the humankind and more than 70% of these diseases are zoonoses.
This fact indicates the need to change approach to the public health and highlights
the importance of close collaboration between physicians, veterinarians and other
experts.
Close collaboration and interdisciplinary approach are not a new idea and they
were partially implemented with successful results in the past. One good example
is the conduct of preventive measures against rabies in our region which resulted
with disease elimination. However, for these long time present zoonoses all major
characteristics are well known. Contrary, the appearance of new emerging zoonotic
diseases at the same moment brings lots of unknown facts and the need for rapid
response in order to protect human health. “One health” approach, which
considers the collaboration between different specialists on the local, national and
global level with the aim to protect human, animal health and their environment,
would be the only successful answer for such challenge. This concept is necessary
in the modern world characterized with intensive socio-demographic and climate
changes and nowadays it is implemented in the collaboration of world leading
organizations for the protection of human and animal health. However, the real
impact of “One health” approach on public health becomes complete only with the
full implementation on the local, national and regional level.
In Croatia “One health” approach is successfully applied in the public health
system, for example in the control of emerging flavivirus infections. This concept
needs to continue even more intensive as an answer to the upcoming challenges in
public health.
95
O-66 Invazivni komarci u Hrvatskoj - novi javnozdravstveni izazov

Ana Klobučar1, Sunčica Petrinić1, Ivan Lipovac2, Sanja Mitrović-Hamzić3,
Vanja Slavić-Vrzić4, Snježana Čopor4, Biserka Hranilović5, Tatjana Vilibić-
Čavlek6, Enrih Merdić7
1
2
Zavod za javno zdravstvo Krapinsko – zagorske županije, Zlatar, Hrvatska
3
Zavod za javno zdravstvo Bjelovarsko-bilogorske županije, Bjelovar,
Hrvatska
4
Zavod za javno zdravstvo Zagrebačke županije, Zaprešić, Hrvatska
5
Zavod za javno zdravstvo Karlovačke županije, Karlovac, Hrvatska
6
7
Odjel za biologiju, Sveučilište Josip Juraj Strossmayer, Osijek, Hrvatska
Porast trgovine robama i uslugama u svijetu, povećanje broja putovanja i klimatske

promjene pogoduju širenju invazivnih i zdravstveno značajnih vrsta komaraca,
prijenosu virusa te pojavi bolesti u područjima svijeta u kojima do tada nisu
zabilježene.
Invazivni azijski tigrasti komarac, Aedes albopictus proširio se i udomaćio na
području Mediterana tijekom protekla tri desetljeća. U Hrvatskoj je pronađen prvi
put 2004. godine u Zagrebu. Sljedeće 2005. zabilježeni su brojni nalazi ove vrste u
Istri i Dalmaciji. Danas je tigrasti komarac najčešći molestant u priobalju i na
otocima te u gradu Zagrebu tijekom ljetnih mjeseci. Posljednje tri godine zabilježeni
su mjestimični nalazi ove vrste u većini županija kontinentalne Hrvatske. Komarac
Ae. albopictus vrsta je visokog vektorskog potencijala za prijenos virusa dengue,
potencijalni prijenosnik Zika virusa, a dokazan je kao prijenosnik Chikungunya
virusa u nedavnim epidemijama u Europi (Italija, Francuska). Pojava autohtone
dengue groznice u Hrvatskoj zabilježena je 2010. na poluotoku Pelješcu.
Druga invazivna vrsta komaraca Aedes japonicus pronađena je prvi put u Hrvatskoj
2013. u Krapinsko-zagorskoj županiji (Đurmanec i na području graničnog prijelaza
Hrvatska - Slovenija u Macelju). Tijekom 2014. i 2015. zabilježeno je njeno invazivno
širenje u toj županiji, a mjestimični nalazi zabilježeni su i u susjednim županijama.
Komarac Ae. japonicus kompetentan je vektor virusa Zapadnog Nila, La Crosse
virusa i virusa japanskog encefalitisa.
Širenje invazivnih komaraca u Hrvatskoj povećalo je zabrinutost i angažman
javnozdravstvenih djelatnika u istraživanju i nadzoru invazivnih vrsta komaraca te
nadzoru nad bolestima koje prenose komarci.
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Invasive mosquito species in Croatia - new public health challenge

Ana Klobučar1, Sunčica Petrinić1, Ivan Lipovac2, Sanja Mitrović-Hamzić3,
Vanja Slavić-Vrzić4, Snježana Čopor4, Biserka Hranilović5, Tatjana Vilibić-
Čavlek6, Enrih Merdić7
1
Andrija Štampar Teaching Institute of Publich Health, Zagreb, Croatia
2
Institute of Public Health Krapina-Zagorje County, Zlatar, Croatia
3
Institute of Public Health Bjelovar-Bilogora County, Bjelovar, Croatia
4
Institute of Public Health Zagreb County, Zaprešić, Croatia
5
Institute of Public Health Karlovac County, Karlovac, Croatia
6
Croatian Institute of Public Health, Zagreb, Zagreb, Croatia
7
Department of Biology, Josip Juraj Strossmayer University of Osijek, Osijek,
Croatia
The increase of trade in goods and services, number of travels globally and climate
changes favor the spread of invasive mosquito species, the virus transmission and
occurrance of desease in the world areas where were not recorded previously.
Invasive Asian tiger mosquito, Aedes albopictus has spread and established in the
Mediterranean area during the past three decades. In Croatia it was found for the
first time in 2004 in Zagreb. In 2005 there were lot of records of this species in Istra
and Dalmatia. Today the tiger mosquito is the most present molestant in coastal
areas, on the islands and in the capital Zagreb during the summer months. Some
records of this species were detected in most of counties on continental part of
Croatia in last three years. Ae. albopictus has very high vector potential for
transmitting dengue virus and potential vector of Zika virus. This mosquito is
confirmed as vector Chikungunya virus in outbreaks in Europe (Italia, France) in last
few years. The emergence of autochthone dengue fever in Croatia is recorded in
2010 on the Pelješac peninsula.
Another invasive species Aedes japonicus was found for the first time in Croatia in
2013 in Krapina – Zagorje County (Đurmanec and cross border Croatia – Slovenia in
Macelj). In last two years invasive mosquito spreading was recorded on the teritory
of this county and some findings were recorded in neighbour counties. Ae.
japonicus is competent vector of West Nile virus, La Crosse and Japaneese
encephalities virus.
The spreading of invasive mosquito species in Croatia considerably has increased
the involvement of public health professionals in surveillance and control of that
species as well as supervision over the mosquito-borne diseases.
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O-67 Virusi influence A u ptica i sisavaca: epidemiološki i zoonotski aspekti

Vladimir Savić1, Ljubo Barbić2, Andreja Jungić1, Vladimir Stevanović2, Ana
Kučak3, Tatjana Vilibić-Čavlek4
1
Hrvatski veterinarski institute, Centar za peradarstvo, Zagreb, Hrvatska
2
3
4
Hrvatski zavod za javno zdravstvo; Medicinski fakultet Sveučilišta u
Virusi influence A su izdvojeni i iz brojnih vrsta ptica i sisavaca uključujući čovjeka.

Dijelimo ih u 16 H i 9 N skupina. Prirodni domaćini virusa influence A su vodene
divlje ptice pa su iz njih izdvojeni virusi gotovo svih mogućih H i N kombinacija. Ovi
virusi u prirodnih domaćina u pravilu ne uzrokuje bolest. Ostale vrste koje bivaju
zaražene virusima influence A su najčešće perad (kokoš i puran), domaći sisavci
(svinja, konj i pas) i čovjek. Virusi influence se u prirodnim domaćinima umnožavaju
primarno u crijevima i izlučuju izmetom pa infekcija nastupa fekalno-oralnim
putem. Ovi se virusi u drugim vrstama umnožavaju najčešće u dišnom sustavu pa se
ovdje radi o tipičnoj kapljičnoj infekciji. Virusi influence A mogu prijeći s prirodnih
domaćina ili peradi na sisavce, ali i obratno. Isto tako mogu prijeći s jedne vrste
sisavca na drugu. Tada dolazi do sporadičnih infekcija, samoograničavajućih
epidemija ili nešto ustrajnijih epidemija koje se neće nužno ukorijeniti u populaciji
novog domaćina. U rijetkim slučajevima virus će se ukorijeni u novoj vrsti pa se
mogu očekivati ponavljajuće ili sezonske epidemija koje će biti uzrokovane
adaptiranim varijantama virusa. Ovakvi slučajevi ukorjenjivanja virusa se događaju
u čovjeka, svinje, konja i psa pa govorimo o humanim, svinjskim, konjskim i psećim
virusima influence A. Od spomenutih domaćina za ptičje viruse su najprijemčivije
svinje koje smatramo i univerzalnim domaćinom virusa influence A. Budući da je
čovjek prijemčiviji za svinjske viruse negoli za viruse podrijetlom iz drugih vrsta,
svinja ima značajnu ulogu u zoonotskom potencijalu virusa influence A. Za prijenos
virusa sa životinja na ljude i ukorjenjivanje takvog virusa u humanoj populaciji
postoje tri značajne barijere: barijera vrste, barijera interakcije virus-stanica
domaćina i barijera prijenosa novog virusa s čovjeka na čovjeka. Ukoliko virus
savlada sve tri barijere, nastati će novi virus humane influence A.
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Influenza A viruses in birds and mammals: epidemiological and zoonotic

aspects
Vladimir Savić1, Ljubo Barbić2, Andreja Jungić1, Vladimir Stevanović2, Ana
Kučak3, Tatjana Vilibić-Čavlek4
1
Croatian Veterinary Institute, Poultry Centre, Zagreb, Croatia
2
3
4
Croatian Institute of Public Health and University of Zagreb School of
Influenza A viruses have been isolated from a variety of birds and mammals
including humans. They are divided into 16 H and 9 N groups. Natural hosts of
influenza A viruses are aquatic wild birds so viruses of virtually all H and N
combinations have been found in these species. They generally do not cause
disease in natural hosts. Other species that are infected with influenza A viruses are
most commonly poultry (chicken and turkey), domestic mammals (swine, horse
and dog) and man. Influenza A viruses multiply in natural hosts primarily in
intestines and excrete in feces resulting in fecal-oral infection. In other species they
multiply usually in the respiratory system, so infection is airborne. Influenza A
viruses can be transmitted from birds to mammals, and vice versa. They can be also
transmitted from one mammalian species to another. Then sporadic infections,
self-limiting or somewhat persistent epidemics occur but not necessarily with
establishment in the new host. In rare cases, the virus may be established in a new
host, thus recurrent or seasonal epidemics that will be caused by the virus adapted
variants can be expected. Such events occur in humans, swine, horses and dogs,
resulting in emergence of human, swine, horse and dog influenza A virus,
respectively. Of these hosts swine are the most susceptible to infection with avian
viruses and is considered as universal influenza A host. Whereas humans are more
susceptible to swine influenza A viruses than those originating from other species,
swine has a significant role in zoonotic potential of the influenza A viruses.
Transmission from animals to humans and the virus establishment in human
population is hampered by three barriers: species barrier; virus–cell interaction
barrier; and human-to-human transmission barrier. Crossing of all three barriers
results in emergence of a new human influenza A virus.
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O-68 Bruceloza - emergentna zoonoza u Bosni i Hercegovini

Jadranka Nikolić
Klinika za infektivne bolesti, Sveučilišna klinička bolnica Mostar, Mostar,
Bosna i Hercegovina
Bruceloza je najvjerojatnije najčešća antropozoonoza poznata još od davnih

vremena, ali je još uvijek često zanemarena i neprepoznata infekcija te stoga i
enigma 21. stoljeća. Globalne granice bruceloze su enormne, a interes za ovu
bolest je povećan jer je postala emergentna u mnogim dijelovima svijeta.
Analizirajući kretanja pojedinih zoonotskih bolesti u Bosni i Hercegovini u razdoblju
od 1996. do 2007. godine, kao i definiciju emergentnih bolesti, može se zaključiti da
je bruceloza emergentna bolest i u našoj zemlji.
Prije rata u BiH zabilježena je samo jedna manja epidemija bruceloze 1985. godine s
40 oboljelih vojnika i stočara. Tijekom rata uništen je znatan dio stočnog fonda, a
nakon ratnih zbivanja uvezen je iz različitih dijelova Europe veliki broj stoke, prije
svega koza i ovaca, a bez stroge veterinarske i granične kontrole uvoza. Zbog svega
navedenog, bruceloza postaje rastući veterinarski i javnozdravstveni problem,
posebno u regijama gdje je izbjeglicama i raseljenim osobama donirana uvezena
stoka.
Danas se bruceloza u BiH smatra endemskom bolešću. Prve oboljele osobe u BiH se
registriraju 1999. i 2000. godine. U razdoblju od 2001. do 2010. godine bilježi se
2174 bolesnika, a za istaknuti je da su tijekom epidemijske 2008. godine prijavljena
994 bolesnika (778 u FBiH i 216 u RS).
Strategija kontrole i suzbijanja bruceloze u BiH ima svoje posebnosti, što je
uvjetovano epidemiološkom situacijom, društvenopolitičkim miljeom te
materijalnim okolnostima. Stoga su u našoj zemlji uspostavljeni institucionalni i
legislativni okviri u svrhu zaštite zdravlja te kontrole i prevencije bolesti u životinja,
a s ciljem unaprjeđenja zdravlja ljudi. Od 2001. primjenjivao se program „testiraj i
ukloni“ koji je 2009. godine zamijenjen implementacijom masovnog cijepljenja
malih preživača Rev 1 cjepivom. Navedena strategija je dala značajne rezultate u
smanjenju epizootije i morbiditeta ljudi.
Humano, animalno i zdravlje ekosustava je neraskidivo povezano pa je koncept
„jednog zdravlja“ ("One Health") kamen temeljac u kontroli bruceloze.
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Brucellosis - emerging zoonosis in Bosnia and Herzegovina

Jadranka Nikolić
Clinic for Infectious Diseases, University Clinical Hospital Mostar, Mostar,
Bosnia and Herzegovina
Brucellosis is probably the most common anthropozoonosis, it has been present

since the old times but it is still very much neglected and unrecognised infection
which makes it the enigma of 21st century. Global boundaries of brucellosis are
enormous and the interest for this disease has become larger because it became
emerging disease in many parts of the world.
Analysing the dynamics of certain zoonotic diseases in Bosnia and Herzegovina in
the period between 1996 and 2007 and considering the definition of emerging
diseases, it can be concluded that brucellosis is the emerging disease in our
country.
Before the war in B&H, there has been registered only one outbreak of brucellosis
in 1985 with 40 sick soldiers and farmers. During the war, much of livestock has
been destroyed and after the war events, large amount of stock has been imported
from different parts of Europe, especially goats and sheep, but without strict
veterinarian and border control. Because of everything mentioned, brucellosis has
become growing veterinarian and public health problem, especially in regions
where imported stock has been donated to refugees and internally displaced
people.
Today, brucellosis is considered an endemic disease in B&H. First infected people in
B&H were registered in 1999 and 2000. In the period between 2001 and 2010,
there have been recorded 2174 people suffering from brucellosis but it is important
to say that in epidemic year of 2008, there have been registered 994 patients (778
in FB&H and 216 in RS).
The strategy of fighting brucellosis in B&H has its particularities which are defined
by epidemiologic situation, socio-political milieu and financial circumstances.
Therefore, in our country institutional and legislative framework has been
established with the aim of protecting animal health in the purpose of improving
human health. Since 2001, the program “test and eliminate” has been practised but
since 2009, it has been replaced with the implementation of massive vaccination of
small ruminants with Rev 1 vaccine. This strategy gave important results in
decreasing epizooty and morbidity in humans.
Human, animal and the health of ecosystem is inseparably connected, therefore,
the concept known as "One Health Initiative" is a cornerstone in controlling
brucellosis.
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O-69 Zika virus: jučer, danas, sutra

Tatjana Vilibić-Čavlek1, Ljiljana Betica-Radić2, Irena Tabain1, Ljubo Barbić3,
Vladimir Stevanović3, Vladimir Savić4, Ana Klobučar5, Andrea Babić- Erceg1
1
2
3
4
Hrvatski veterinarski institut, Zagreb, Hrvatska
5
Zika virus (ZIKV) izoliran je 1947. godine iz majmuna na području šume Zika u
Ugandi. Epidemiološki značaj ZIKV uočen je tek nakon izbijanja epidemije na
mikronezijskom otoku Yap 2007. godine, nakon čega je nastavljeno širenje
pacifičkim otocima, a 2015. godine virus je unesen u Brazil uz daljnje širenje po
američkom kontinentu. Na području Europe se importirane ZIKV infekcije
kontinuirano bilježe. U endemskom ciklusu virus se održava u prijenosu između
majmuna i komaraca, dok su u urbanom ciklusu rezervoar ljudi, a glavni vektori
komarci Ae. aegypti i Ae. albopictus. Osim ubodom zaraženog komarca, virus se
može prenijeti i transfuzijom krvi/krvnih pripravaka, spolnim putem te
transplacentalno/perinatalno sa zaražene majke na dijete. Iako većina ZIKV
infekcija prolazi asimptomatski ili se očituje kao blaga bolest praćena povišenom
temperaturom, osipom i konjunktivitisom, u slučaju infekcije u trudnoći mogu
nastati teške kongenitalne malformacije (mikrocefalija). Nadalje, opisana je i viša
učestalost Guillian-Barre-ovog sindroma nakon ZIKV infekcije. Na području
Hrvatske, do sada je testirano ukupno 17 osoba koje su boravile u endemskim
područjima od kojih je u jedne i potvrđena importirana klinički manifestna ZIKV
infekcija.
Potvrda importirane infekcije, uz činjenicu da je na području Hrvatske prisutan i
široko rasprostranjen jedan od glavnih vektora (Ae. albopictus) naglašava rizik od
unošenja ZIKV i širenja bolesti i u našoj zemlji. U skladu s navedenim, potrebno je
uspostaviti i sustavno provoditi kontrolu ove emergentne virusne zoonoze.
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Zika virus: past, present and future

Tatjana Vilibić-Čavlek1, Ljiljana Betica-Radić2, Irena Tabain1, Ljubo Barbić3,
Vladimir Stevanović3, Vladimir Savić4, Ana Klobučar5, Andrea Babić- Erceg1
1
Croatian National Institute of Public Health, Zagreb, Croatia
2
General Hospital Dubrovnik, Dubrivnik, Croatia
3
Faculty of Veterinary Medicine University of Zagreb, Croatia
4
Croatian Veterinary Institute, Zagreb, Croatia
5
Teaching Institute of Public Health "Dr Andrija Štampar", Zagreb, Croatia
Zika virus (ZIKV) was isolated in 1947 from monkey in Zika forest (Uganda).
Epidemiological importance of ZIKV was observed after the outbreak in Yap Island,
Federated States of Micronesia in 2007. The virus spreads through Pacific Islands
and was imported in Brazil in 2015 with further spreading across the Americas. In
Europe, imported ZIKV infections are continuously reported. In endemic
transmission cycle, virus is transmitted between monkeys and mosquitoes. In
urban cycle, humans represent virus reservoir and the main vector are mosquitoes
Ae. aegypti and Ae. albopictus. ZIKV can be transmitted through the bite of infected
mosquitoes, blood transfusion, sexual contact and transplacentally/perinatally
from infected mother to newborn. Majority of ZIKV infections are asymptomatic or
presented as a mild disease with fever, rash and conjunctivitis. However, infection
in pregnant women can cause severe congenital malformations (microcephaly). In
addition, a higher incidence of Guillian-Barre syndrome was observed after ZIKV
infection. In Croatia, a total of 17 travelers returning from endemic areas were
tested to ZIKV so far. Imported clinically manifest ZIKV infection was confirmed in
one person.
Since Ae. albopictus, one of the main vector of ZIKV is widely distributed in Croatia,
confirmation of imported infection highlights the risk of importation and spreading
of ZIKV in our country. Accordingly, it is necessary to establish and implement
surveillance program for this emerging viral zoonosis.
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IMPORTIRANE ARBOVIRUSNE INFEKCIJE U HRVATSKOJ

IMPORTED ARBOVIRAL INFECTIONS IN CROATIA
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O-70 Importirane denge infekcije u Hrvatskoj

Nenad Pandak1, Ivan-Christian Kurolt2, Ivica Čabraja1, Božana Miklaušić1,
Marijan Šiško1, Oktavija Đaković Rode2, Alemka Markotić2
1
Opća bolnica „Dr. Josip Benčević“, Slavonski Brod, Hrvatska
2
Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Denga je danas u svijetu jedna od najrasprostranjenijih bolesti koju prenose

komarci. U posljednjih pet desetljeća je incidencija denge uvećana trideset puta.
Trenutno je denga endemska bolest u 128 uglavnom slabije razvijenih zemalja, a
oko 4 milijarde ljudi je godišnje u opasnosti da bude inficirano. Radi se o infekciji
koju izaziva jedan od četri serotipa virusa, označenih kao DENV1-4. To je bolest koju
na ljude prenose ženke komaraca roda Aedes. Najvažniji vektor u tropskom i
subtropskom dijelu svijeta je Ae. aegypti dok Ae. albopictus postaje sve značajniji
vektor je se radi o vrsti koja se lako adaptira na nova okruženja uključujući i
područja s umjerenom klimom. Bolest se najčešće javlja u tropskim i suptropskim
područjima što znači da je od ove infekcije ugrožena gotovo trećina čovječanstva.
Bolest koju uzrokuje DENV se manifestira različito teškim stanjima, od blažih i
asimptomatskih denga groznica (DG) do teških denga hemoragijskih groznica (DHG)
i denga sindroma šoka (DSŠ) koji je nerijetko smrtonosni oblik bolesti. Brzo globalno
širenje denga groznice je rezultat brze urbanizacije, porasta broja međunarodnih
putovanja, izostanka učinkovitih mjera borbe protiv komaraca i globalizacije.
Radom se prikazuje dva nepovezana bolesnika s importiranom denga groznicom u
Slavonski Brod. Jedan se bolesnik vratio s turističkog putovanja na Maldive dok
drugi bolesnik, inače hrvatski državljanin, živi i radi u Tanzaniji, a u Hrvatsku je
došao na godišnji odmor. Obojica su se razboljela naglo, a imali su visoku
temperaturu, glavobolju, mijalgije i artralgije. Jedan je bolesnik imao i osip.
Svake se godine određeni broj putnika vraća s dengom, a taj broj se neprestano
povećava. Kako je kompetentni vektor denge Ae. albopictus prisutan na cijelom
području Južne Europe, epidemije denge se mogu očekivati onog trenutka kad se
infektivni bolesnik i vektor nađu u određenom vremenu na određenom mjestu.
Imported dengue infections in Croatia

Nenad Pandak1, Ivan-Christian Kurolt2, Ivica Čabraja1, Božana Miklaušić1,
Marijan Šiško1, Oktavija Đaković Rode2, Alemka Markotić2
1
General Hospital „Dr. Josip Benčević“, Slavonski Brod, Croatia
2
Croatia
Dengue has become one of the most widespread reemerging mosquito-borne

diseases globally. Incidence of dengue has increased 30-fold in the last five
decades. Currently, dengue is endemic to 128 countries, mostly developing nations,
posing a risk to approximately 4 billion people annually. Dengue is an infectious
disease caused by any of the four dengue virus serotypes: DENVs 1–4. It is a
105
mosquito-borne disease and is primarily transmitted to humans by the female

Aedes mosquito. Ae. aegypti has been the most important epidemic vector in the
tropical and subtropical regions. Ae. albopictus has become an increasingly
important vector as it can easily adapt to new environments, including temperate
regions. The disease is mainly concentrated in tropical and subtropical regions,
putting nearly a third of the human population, worldwide, at risk of infection.
Infection with DENV results in varying degrees of pathological conditions, ranging
from mild asymptomatic dengue fever (DF) to severe dengue hemorrhagic fever
(DHF) and dengue shock syndrome (DSS) which may turn fatal. A dramatic
worldwide expansion of the DENV has occurred due to rapid urbanization, increase
in international travel, lack of effective mosquito control measures, and
globalization.
We report two unrelated cases of dengue fever imported to Slavonski Brod. One of
the patients was a tourist returnig from Maldives and the other one, a native Croat,
resides in Tanzania but came for a vacation to Croatia. Both of them had an abrupt
oncet of the disease with high fever, headache, myalgias and arthralgias. One
patient had rash.
Each year, certain travelers return home with dengue and the number increases
over time. As a competent vector Ae. albopictus is present in the whole Southern
Europe, dengue outbreaks could occur anytime in the future when the infectious
person/vector is in the suitable place at a suitable time.
O-71 Prvi slučaj importirane klinički manifestne Chikungunya infekcije u

Hrvatskoj
Boris Lukšić1, Nenad Pandak2, Tatjana Vilibić-Čavlek3, Edita Dražić-Maras1,
Svjetlana Karabuva1, Mislav Radić4, Vladimir Stevanović5, Ljubo Barbić5
1
2
Opća bolnica “Dr. Josip Benčević”, Slavonski Brod, Hrvatska
3
4
Klinika za unutarnje bolesti, KBC Split, Split, Hrvatska
5
Chikungunya groznica je emergentna virusna bolest koju prenose komarci, a izaziva

ju Chikungunya virus (CHIKV) koji pripada rodu Alfavirus iz porodice Togaviridae.
Bolest je endemska u mnogim područjima Afrike i Azije gdje se seroprevalencija
penje do 75%. U Africi se virus održava u silvatičkom ciklusu između divljih primata i
šumskih komaraca za razliku od Azije gdje se prijenos CHIKV-e odvija u urbanom
ciklusu koji uključuje ljude i komarce vrste Aedes (Ae. aegypti, Ae. albopictus).
Tipični klinički znaci Chikungunya groznice su visoka tjelesna temperatura,
glavobolja, bolovi u mišićima, osip i bolovi u zglobovima. U mnogih bolesnika
simptomi bolesti, poglavito artralgije, mogu biti vrlo jaki i dugotrajni.
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U mnogim europskim državama se redovito prijavljuju importirani slučajevi

Chikungunya groznice. Prva autohtona epidemija chikungunye u Europi, s 200
oboljelih, zbila se 2007. godine u pokrajini Ravenna u Italiji, a 2014. godine se u
Montpelieru, u Francuskoj, odvila epidemija s 12 bolesnika. U Hrvatskoj su
sporadično detektirana protutijela na CHIKV u turista koji su boravili u endemskim
područjima. Seroepidemiološka studija koja je provođena tijekom 2011. i 2012.
godine je pokazala da 0,9% stanovništa priobalnog područja Hrvatske posjeduje
specifična protutijela na CHIKV.
Ovim se radom opisuje klinički manifestna Chikungunya groznica koja je po prvi put
importirana u Hrvatsku. 27-godišnja žena se zbog vrućice, bolova u zglobovima i
osipa javila u specijalističku ambulantu Klinike za infektologiju u Splitu. Radilo se o
stjuardesi koja radi na kruzeru, a u vrijeme početka bolesti je bila stacionirana u
Kostariki. Pet dana nakon uboda komarca se počela žaliti na artralgije. Dva dana
kasnije je dobila vrućicu, a istovremeno se pojavio i osip koji je svrbio. Tegobe su
spontano nestale, ali su artralgije zaostale i nakon prestanka bolesti.
Od iznimne je važnosti biti svjestan da tropske bolesti mogu biti importirane u
Hrvatsku. Moramo biti vični prepoznati ih kako bi se pravovremeno mogle uvesti
mjere za sprječavanje širenja ovakvih infekcija.
The first case of imported clinically manifested Chikungunya infection in

Croatia
Boris Lukšić1, Nenad Pandak2, Tatjana Vilibić-Čavlek3, Edita Dražić-Maras1,
Svjetlana Karabuva1, Mislav Radić4, Vladimir Stevanović5, Ljubo Barbić5
1
University Hospital for Infectology, UHC Split, Split, Croatia
2
General Hospital“Dr. Josip Benčević”, Slavonski Brod, Croatia
3
Croatian National Institute of Public Health, Zagreb, Croatia
4
University Hospital for Infectology, UHC Split, Split, Croatia
5
Faculty of Veterinary Medicine University of Zagreb, Croatia
Chikungunya fever is a mosquito-borne emerging viral disease caused by

Chikungunya virus (CHIKV) that belongs to the genus Alphavirus of the family
Togaviridae. It is endemic in many parts of Africa and Asia where seroprevalence
rates reaches 75%. In Africa, the virus is maintainted in a sylvatic cycle between
non-human primates and forest-dwelling mosquitoes, while in Asia transmission of
CHIKV occurs in an urban cycle involving humans and Aedes spp. mosquitoes (Ae.
aegypti, Ae. albopictus).Typical clinical symptoms of Chikungunya include fever,
headache, myalgia, rash and arthralgia. The symptoms, particularly joint pain, can
be severe and long lasting in many patients.
In many European countries, imported cases of Chikungunya were continuously
reported. The first autochthonous CHIKV cases were reported during the 2007
outbreak involving more than 200 cases in the Ravenna Province, Italy. In 2014, an
outbreak including 12 CHIKV cases occurred in Montpelier, France. In Croatia,
CHIKV antibodies were sporadically detected in travellers from endemic areas. A
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seroepidemiological study conducted during 2011-2012 showed that 0.9%

inhabitants of the Croatian littoral are seropositive to CHIKV.
We report the first imported clinically manifest Chikungunya fever in Croatia. A 27
year old woman visited The Infectious Diseases University Hospital outpatient
departement because of the fever, arthralgias and rash. She works as a stewardess
on a cruise ship and was stationed in Costa Rica at the time she became ill. Five
days after a mosquito bite she felt symetrical artralgias in her joints. Two days later
she had chills and high fever and at the same time she had an itchy rash. Eventually
her symptoms subsided yet arthralgias remained for some time.
It is of extreme importance to be aware that tropical diseases can be imported to
Croatia. We have to be able to recognise them and implement measures to
prevent spreading of those infections.
O-72 Prvi dokaz importirane Zika infekcije u Hrvatskoj

Ljiljana Betica-Radić1, Tatjana Vilibić-Čavlek2, Giulietta Venturi3, Claudia
Fortuna3, Stjepan Đuričić1, Antonella Salvia-Miloš1, Irena Tabain2, Ljubo
Barbić4, Vladimir Stevanović4, Eddy Listeš5, Mihaela Bender1, Giovanni
Savini5
1
2
3
Istituto Superiore di Sanità, Rim, Italija
4
5
Hrvatski veterinarski institut, Regionalni zavod Split, Hrvatska
6
OIE Referentni centar za West Nile virus, Istituto Zooprofillatico
Sperimentale "G. Caporale", Teramo, Italija
Prikazan je prvi slučaj importirane ZIKV infekcije kod putnice iz Hrvatske, koja je
boravila u Brazilu. Prvi importirani slučaj Zika virusne infekcije u Europi, zabilježen
je 2013. godine u njemačkog putnika koji se vratio iz Tajlanda.
Prethodno zdrava, mlađa žena iz Hrvatske, u dobi od 29. godina, vratila se iz Brazila
početkom ožujka 2016. godine. Nakon četiri tjedna boravka u Brazilu (siječanj-
veljača 2016. godine), pacijentica je došla u Portugal, gdje je ostala naredna dva
tjedna. Dana 14. veljače, bolesnica je dobila povišenu temperaturu (37,5 ° C), osip
po licu i trupu, opću slabost, mijalgije, artralgije i edem nogu. Preporučeno joj je
simptomatsko liječenje paracetamolom. Pacijentica se oporavila u roku od tjedan
dana. Navela je brojne ujede komaraca, unatoč korištenju repelenata. Nije bila
prethodno cijepljena protiv flavivirusa (krpeljni meningoencefalitis, žuta groznica).
Po povratku u Hrvatsku, pacijentica je bila bez simptoma bolesti. Fizikalni pregled je
bio uredan kao i laboratorijski parametri: eritrociti 5.05x1012/L , hemoglobin 134
g/L, leukociti 6.46x109/L, C-reaktivni protein 7,56 mg/L, bilirubin 4,3 µmol/L,
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aspartat aminotransferaza 23 U/L, alanin aminotransferaza 13 U/L, gama glutamil

transferaza 11 U/L, urea 3.88 mmol/L, kreatinin 70 µmol/L.
Uzeta su tri uzorka seruma 32., 64. i 98. dana nakon početka bolesti i testirana na
ZIKV, dengue (DENV) i Chikungunya (CHIKV) protutijela. ZIKV infekcija je serološki
potvrđena dokazom IgM i IgG protutijela ELISA, IFA te PRNT testom. Serološko
ispitivanje provedeno je u Nacionalnom referentnom laboratoriju za arboviruse,
Hrvatskog zavoda za javno zdravstvo i u Istituto Superiore di Sanità, u Rimu, Italija.
Zbog sličnih kliničkih simptoma i geografske distribucije, kao i mogućih koinfekcija s
dengom i Chikungunya infekcijom, DENV i CHIKV bi trebali biti uključeni u
diferencijalnoj dijagnozi kod febrilnih putnika.
First detection of imported Zika infection in Croatia

Ljiljana Betica-Radić1, Tatjana Vilibić-Čavlek2, Giulietta Venturi3, Claudia
Fortuna3, Stjepan Đuričić1, Antonella Salvia-Miloš1, Irena Tabain2, Ljubo
Barbić4, Vladimir Stevanović4, Eddy Listeš5, Mihaela Bender1, Giovanni
Savini5
1
General Hospital Dubrovnik, , Dubrovnik, Croatia
2
3
Istituto Superiore di Sanità, Roma, Italy
4
5
Croatian Veterinary Institute, Regional Institute Split, Croatia
6
OIE Reference Center for West Nile Disease, Istituto Zooprofillatico
Sperimentale "G. Caporale", Teramo, Italy
We report first Zika virus (ZIKV) infection in a Croatian traveler, imported from
Brazil. In Europe, the first imported case of Zika fever was reported in 2013 in a
German traveler returning from Thailand.
The case involves previously healthy, 29 year old Croatian woman who returned
from Brazil at the beginning of March. After a four-week trip in Brazil (January-
February 2016), the patient came to Portugal where stayed the next two weeks. On
14 February, she developed low-grade fever (37.5°C), rash on face and trunk,
weakness, myalgia, arthralgia and edema of the legs. Symptomatic treatment with
paracetamol was recommended. The patient fully recovered within a week. She
had noted numerous mosquito bites despite using repellents. She reported no
previous flavivirus vaccination (tick-borne encephalitis, yellow fever). Upon return
to Croatia, the patient was asymptomatic. Physical examination was normal as well
as laboratory parameters: erythrocytes 5.05x1012/L, hemoglobin 134 g/L, leukocyte
6.46x109/L, C-reactive protein 7.56 mg/L, bilirubin 4.3 µmol/L, aspartate
aminotranspherase 23 U/L, alanine aminotranspherase 13 U/L, gamma glutamil
transferase 11 U/L, urea 3.88 mmol/L, creatinine 70 µmol/L.
Three serum samples were collected on days 32, 64 and 98 after disease onset and
tested for ZIKV, dengue virus (DENV) and Chikungunya virus (CHIKV) antibodies.
ZIKV infection was confirmed serologically by detection of IgM and IgG antibodies
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using ELISA, IFA and PRNT. Serologic testing was performed at the National
Reference Laboratory for Arboviruses, Croatian National Institute of Public Health,
and at the Istituto Superiore di Sanità, Roma, Italy.
Due to similar clinical symptoms and geographical distribution as well as possible
coinfections with dengue and Chikungunya, DENV and CHIKV should be included in
the differential diagnosis in febrile travelers.
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INFEKCIJE MOKRAĆNOG I SPOLNOG SUSTAVA

UROGENITAL TRACT INFECTIONS
111
O-73 HDKM smjernice za bakteriološku dijagnostiku infekcija mokraćnog i

spolnog sustava
Edita Sušić
Služba za kliničku mikrobiologiju, Zavod za javno zdravstvo Šibensko-
kninske županije, Šibenik, Hrvatska
Kako bismo tijekom svakodnevnog rada i donošenja odluka postigli što viši stupanj
standardizacije među mikrobiološkim laboratorijima, Hrvatsko društvo za kliničku
mikrobiologiju (HDKM) pristupilo je izradi smjernica koje se temelje na podacima
zasnovanim na dokazima iz stručno-znanstvene literature i načelima dobre
laboratorijske prakse opisane u međunarodnim udžbenicima i postupnicima. HDKM
smjernice sadrže upute i preporuke o načinu prikupljanja, pohranjivanju, transportu
i laboratorijskoj obradi uzoraka važnih za bakteriološku dijagnostiku infekcija
mokraćnog i spolnog sustava žena i muškaraca. Za svaki od kliničkih sindroma
navedeni su uzročnici infekcija, preporučeni su odgovarajući uzorci, dijagnostičke
metode i pretrage. Distalni dijelovi mokraćno-spolnog sustava naseljeni su
normalnom mikrobiotom koja kontaminira uzorke iz mokraćnog i spolnog sustava,
otežava obradu i interpretaciju bakterioloških pretraga. Bakteriološka obrada i
pouzdan mikrobiološki nalaz uvelike ovise o predanalitičkoj fazi koja se najčešće
odvija izvan mikrobiološkog laboratorija, a započinje uzimanjem odgovarajućeg
uzorka za pretragu. Stoga je neophodna suradnja i upućenost zdravstvenih
djelatnika različitih profila o načinu uzimanja uzorka, pohrani i transportu do
zaprimanja u mikrobiološkom laboratoriju. Nepotpuni ili netočni podaci o uzorku i
pacijentu mogu krivo usmjeriti pretragu. Obrada i interpretacija urinokulture ovise
o tome je li uzorak srednji mlaz urina, je li uzet iz trajnog katetara, jednokratnom
kateterizacijom, vrećicom, suprapubičnom aspiracijom ili nekim drugim
postupkom, što treba biti jasno naznačeno na uputnici. U smjernicama se
upozorava i na neodgovarajuće uzorke (ejakulat za dijagnostiku kroničnog
bakterijskog prostatitisa), nepotrebne pretrage (tri uzastopne urinokulture ili
obrisak cerviksa na anaerobe) i nepotrebnu antimikrobnu terapiju zbog pozitivnih
mikrobioloških nalaza (pozitivan nalaz urinokulture iz trajnog katetera) budući da je
to u našoj sredini još uvijek uvriježena praksa. Iako su prvenstveno namijenjenje
kliničkim mikrobiolozima, ove smjernice su namijenjene i kliničarima koji se bave
infekcijama mokraćnog i spolnog sustava, dopuna su ISKRA smjernicama za
antimikrobno liječenje i profilaksu infekcija mokraćnog sustava i ISKRA smjernicama
za dijagnostiku i liječenje prostatitisa, a trebale bi doprinijeti širenju dobre kliničke i
laboratorijske prakse u Hrvatskoj.
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HDKM guidelines for bacteriological diagnosis of urogenital tract

infections
Edita Sušić
Department of Clinical Microbiology, Public Health Institute of Šibenik-Knin
County, Šibenik, Croatia
In order to achieve the highest possible degree of standardization among the

microbiological laboratories in daily work and decision making, Croatian Society of
Clinical Microbiology (HDKM) has been developing evidence-based guidelines
obtained from the professional and scientific literature and principles of good
laboratory practice described in international textbooks and checklists. HDKM
guidelines contain instructions and recommendations for sample collection,
storage, transport and laboratory processing important for the bacteriological
diagnosis of female and male urogenital tract infections. For each of the clinical
syndromes infection-causing pathogens are listed with appropriate samples,
diagnostic procedures and recommended tests. Distal parts of the urogenital
system are inhabited by the normal microbiome that contaminates samples,
hinders bacteriological processing and interpretation, which largely depend on
preanalytical phase taking place outside the microbiological laboratory. This
requires cooperation and familiarity of medical professionals of different profiles
with the method of sampling, storage and transport to the microbiological
laboratory. Incomplete or discordant sample and patient information may
misdirect the focus of the search. Urine processing and culture interpretation
depend on whether the urine is a midstream sample or taken from an indwelling
catheter, by single, intermittent catheterization („in and out“), from a bag, by
suprapubic aspiration etc., which should be clearly indicated on the referral. The
guidelines draw attention to inadequate samples (ejaculate for chronic bacterial
prostatitis diagnosis), unnecessary procedures (three consecutive urine cultures or
cervical swab for the anaerobes) and unnecessary antimicrobial therapy due to
positive microbiological findings (positive urine culture resulting from indwelling
catheter), since it is still a common practice in this country. Although these
guidelines have been primarily intended for clinical microbiologists, they are also
intended for clinical practitioners who deal with urogenital tract infections. They
are addition to ISKRA guidelines for antimicrobial treatment and prophylaxis of
urinary tract infections and to ISKRA guidelines for diagnosis and treatment of
prostatitis, and should also contribute to spread good clinical and laboratory
practice in Croatia.
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O-74 Infekcije urogenitalnog trakta u starijih muškaraca

Dalibor Vukelić
Infekcije urinarnog trakta muškaraca smatramo kompiliciranom formom infekcija

urotrakta i one kao takve zahtjevaju obradu urotrakta da bi isključili strukturne ili
funkcionalne abnormalnosti.
Incidencija Infekcija urinarnog trakta postepeno raste sa dobi a osnovni problem je
hipertrofija prostate. Cilje obrade urotrakta tijekom ili nakon infekcije je otkriti one
kojima je potrebno dalje liječenje (kirurški zahvat, antimikrobna profilaksa itd ).
Urinary tract infections in elderly males

Dalibor Vukelić
Croatia
UTI is one of the most common bacterial infections encountered. Most UTIs are
uncomplicated, i.e. they occur in otherwise healthy individuals with normal urinary
tracts, and predominantly afllict women, except in the first year of life.
The general view is that a symptomatic UTI in a man of any age should be
considered as a complicated infection that demands a thorough evaluation of the
urinary tract, to exclude structural or functional abnormalities of clinical
importance ].
Urinay tract infection in men without indwelling catheters is uncommon among
men younger than 60 years of age, but the incidence increases substantially among
men 60 years ofage or older. The prostate gland may harbour microorganisms,
which have been suggested to be the main cause of recurrent UTI. It si important to
evaluate the anatomy and function of the urinary tract in men with febrile UTI, and
to attempt to identify those patients most likely to have abnormalities amenable
to surgical correction.
O-75 Liječenje prostatitisa

Alemka Markotić
Treatment of prostatitis
Alemka Markotić
Croatia
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O-76 Važnost otkrivanja klamidijske infekcije u mladoj populaciji

Vanja Kaliterna
Nastavni zavod za javno zdravstvo Splitsko-dalmatinske županije, Split,
Hrvatska
Genitalne infekcije uzrokovane klamidijama ubrajaju se među najčešće spolno

prenosive bolesti, naročito među mlađom populacijom (u dobi mlađih od 25
godina). Chlamydia trachomatis može uzrokovati akutne komplikacije, kao i
dugotrajne posljedice na gornje dijelove spolnoga sustava, utječući tako na
reproduktivno zdravlje u oba spola. C.trachomatis se može jednostavno
dijagnosticirati i liječiti. U današnje vrijeme testovi izbora su molekularni testovi
amplifikacije nukleinske kiseline, zbog njihove visoke osjetljivosti kao i mogućnosti
izvedbe testa u neinvazivnim uzorcima poput samouzetog uzorka obriska rodnice i
prvoga mlaza urina. Mogućnost pretrage na DNK klamidije iz neinvazivnih uzoraka
dodatno olakšava provođenje testiranja adolescentne populacije. Prema
smjernicama CDC-a, klamidija se vrlo uspješno liječi jednokratnim uzimanjem 1 g
azitromicina ili dva puta dnevno po 100 mg doksiciklina 7 dana (terapija se provodi
kod svih pozitivnih spolnih partnera). Najveći problem klamidijskih infekcija je to
što su one u najvećem broju slučajeva asimptomatske (do 70%), pa su
neprepoznate i neliječene. Neliječena infekcija može dovesti do komplikacija s
razvojem neželjenih posljedica (zdjelična upalna bolest, vanmaternična trudnoća,
problemi u trudnoći i sterilitet). Stoga se, prema novijim smjernicama, preporuča
godišnji „screening“ na C.trachomatis najugroženije populacije (mlađih od 25
godina). Neke zemlje već provode testiranje na klamidiju u sklopu standardne
preventivne obrade. Cilj probira je pronaći ljude zaražene klamidijom među
asimptomatskom, a rizičnom populacijom, te primjeniti terapiju za oboljele i
zaražene partnere prije nastanka komplikacija. Klamidijska infekcija je glavni
preventabilni čimbenik razvoja steriliteta u žena. Zbog toga je probir žena mlađih
od 25 godina na C.trachomatis svrstan u 10 najkorisnijih i najisplatljivijih
preventivnih strategija. Takav pristup ulaganja u prevenciju i pravovremeno
liječenje je u konačnici jeftiniji za zdravstveni sustav od liječenja posljedica
neliječene klamidijske infekcije.
The importance of detection of chlamydial infection in youth population

Vanja Kaliterna
Chlamydial genital infections are among the most common sexually transmitted
diseases, and prevalence is the highest in young heterosexual adults under 25 years
of age. Chlamydia trachomatis (CT) can cause acute complications and long-term
sequelae in upper genital tract, thus affecting the reproductive health in both
sexes. It can be easily diagnosed and treated. Nucleic acid amplification tests are
the test of choice because of their high sensitivity, and they can be performed on
115
easily collected noninvasive specimens, such as self-collected vaginal swab or urine,

that increase patient acceptability for testing. According to CDC recommendations,
highly effective treatment options include single-dose oral azithromycin or 1-week
course of doxycycline (with treating all positive sex partners). The most important
problem of chlamydial infections is that they are generally asymptomatic (up to
70%), and they are often unrecognized and untreated. Left untreated, infection can
lead to complications with serious consequences for female reproductive health
(pelvic inflammatory disease, ectopic pregnancy, adverse pregnancy outcome, and
infertility). The recent studies suggest a need to introduce annual screening for
C.trachomatis for the most vulnerable populations (younger than 25 years). Some
countries had already implemented the screening for Chlamydia as a standard
preventive procedure. The aim of screening for CT infection is to find and treat
asymptomatic cases and sexual partners before progressing to complications.
Clamydial infection is the most preventable cause of female infertility and adverse
pregnancy outcome. Consequently, screening females aged < 25 years is ranked as
one of the 10 most beneficial and cost-effective prevention strategies.
O-77 Molekularni pristup etiopatogenezi i dijagnostici bakterijske vaginoze

Tatjana Marijan, Sunčanica Ljubin-Sternak, Jasmina Vraneš
Služba za kliničku mikrobiologiju, Nastavni zavod za javno zdravstvo „Dr.
Andrija Štampar“, Zagreb, Hrvatska
Bakterijska vaginoza (BV) je najčešći uzrok vaginalnog iscjetka u žena reproduktivne

dobi. Prevalencija se, ovisno o primijenjenim dijagnostičkim kriterijima te
promatranoj populaciji, kreće u rasponu od 20 do 60%. Iako je gotovo 40% žena s
bakterijskom vaginozom asimptomatsko, ova infekcija može dovesti do ozbiljnih
komplikacija osobito u trudnoći. Stope rekurencije su, i nakon uspješno provedene
terapije, vrlo visoke.
Primjena novih molekularnih metoda (sekvencioniranje amplikona 16S rRNA gena,
prisutnog u svih prokariota, te metagenomsko sekvencioniranje, kojim se
sekvencioniraju DNA fragmenti dobiveni iz cjelokupnog genskog materijala neke
mikrobne populacije) te istraživanja koja se provode u okviru projekta „Human
microbiome project“ u posljednjih su deset godina pridonijeli novim spoznajama o
etiopatogenezi ovog sindroma. Utvrđeno je da je vaginalna mikrobiota (skup svih
molekularno detektiranih mikroorganizama koji nastanjuju vaginu) mnogo
raznovrsnija i promjenjivija nego se ranije vjerovalo. Otkrivene su brojne nove
bakterijske vrste, kako unutar roda Lactobacillus, tako i vrste povezane s
bakterijskom vaginozom, a koje tradicionalnim metodama poput kultivacije nije
bilo moguće detektirati. Osim već ranije poznatih vrsta: Gardnerella vaginalis,
Mobiluncus spp., Prevotella spp., Mycoplasma hominis, sada se zna i za nove, za BV
visoko specifične vrste: Atopobium vaginae, Megasphaera spp., Sneathia spp. i
BVAB (BV-associated bacteria) 1, 2 i 3. Jedan od ključnih elemenata u nastanku BV
116
te u njenom neuspješnom liječenju je i stvaranje kompaktnog vaginalnog biofilma

kojeg dominantno čine G. vaginalis i A. vaginae.
U smjernicama za dijagnostiku BV još uvijek se preporučuje primjena kliničkih
Amsel-ovih kriterija te Gram preparata (Nugent-ovi kriteriji). Iako je na tržištu već
dostupno nekoliko kvantitativnih molekularnih testova kojima se utvrđuje sastav
vaginalne mikrobiote te prisutnost vrsta specifičnih za bakterijsku vaginozu,
potrebna je njihova daljnja evaluacija i validacija prije uvođenja u rutinsku
dijagnostičku upotrebu.
Molecular approach to etiopathogenesis and diagnostics of bacterial

vaginosis
Tatjana Marijan, Sunčanica Ljubin-Sternak, Jasmina Vraneš
Department of Clinical Microbiology, Teaching Institute of Publich Health
Dr. Andrija Štampar, Zagreb, Croatia
Bacterial vaginosis (BV) is the most common cause of vaginal discharge in

reproductive age women. The prevalence is, depending on diagnostic criteria used
and population under consideration, in the range between 20 and 60%. Although
as high as 40% of women with bacterial vaginosis may be asymptomatic, this
condition can lead to serious complications especially in pregnancy. The recurrence
rates are, even after successfully completed therapy, pretty high.
During the last ten years new molecular methods (amplicon sequencing of the 16S
rRNA gene, which is inherent to all prokaryotes, and metagenome sequencing, by
which DNA fragments gained from the whole genomic material of particular
microbial community are sequenced) as well as studies from “Human microbiome
project” have significantly contributed to understanding of etiopathogenesis of
bacterial vaginosis. It has been determined that vaginal microbiota (all molecularly
detected microorganisms inhabiting vagina) is much more complex and prone to
alterations than previously thought. Numerous new bacterial species have been
discovered, not only among the Lactobacillus spp. but also species specifically
connected to bacterial vaginosis, all of them which could not have been previously
detected by traditional methods like cultivation. Besides already known species
like: Gardnerella vaginalis, Mobiluncus spp., Prevotella spp., Mycoplasma hominis,
new, for BV highly specific species have been discovered: Atopobium vaginae,
Megasphaera spp., Sneathia spp. and BVAB (BV-associated bacteria) 1, 2 and 3.
One of the key factors in the development of BV, as well as in its inefficient
treatment, is dense vaginal biofilm which is primarily constituted by G. vaginalis
and A. vaginae.
Guidelines for diagnostics of BV still recommend use of clinical Amsel's criteria as
well as Gram stain (Nugent's score). Although several quantitative molecular tests
which determine the composition of vaginal microbiota and the presence of BV-
associated species, are already commercially available, their further evaluation and
validation is needed before implementation in routine diagnostic practice.
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SEPSA I ENDOKARDITIS
SEPSIS AND ENDOCARDITIS
118
O-78 Mikrobiološka dijagnostika infektivnog endokarditisa

Jasenka Škrlin¹, Andrea Janeš¹, Sandra Šestan-Crnek¹, Karolina Dobrović¹,
Katarina Dujmović¹, Igor Rudež2, Željko Sutlić2
1
Centar za kliničku mikrobiologiju i bolničke infekcije, KB Dubrava, Zagreb,
Hrvatska
2
Zavod za kardijalnu i transplantacijsku kirurgiju, KB Dubrava, Zagreb,
Hrvatska
Pozitivne hemokulture i dalje su temelj dijagnostike infektivnog endokarditisa (IE)

jer su tako uzgojeni mikroorganizmi dostupni za identifikaciju i ispitivanje
antimikrobne osjetljivosti. Uzimaju se najmanje tri seta u intervalima od 30 minuta,
po mogućnosti iz periferne vene, a ne centralnog venskog katetera, te se inkubiraju
aerobno i anaerobno. Ukoliko je prije uzimanja hemokulture započeta terapija,
ponekad je za uspješnu identifikaciju uzročnika potrebno više setova. Kod IE
bakterijemija je gotovo stalna, te uzimanje hemokultura ne treba biti ograničeno na
epizode febriliteta. Preliminarna identifikacija vrši se na temelju mikroskopskog
preparata po Gramu. Potom se odmah informacija prenosi kliničaru kako bi se
prilagodila antimikrobna terapija. Proces identifikacije patogena obično traje 2
dana, no u slučaju teško uzgojivih ili atipičnih mikroorganizama može potrajati i
dulje. Jedna od novih i brzih dijagnostičkih metoda koja se temelji na peptidnom
spektru jest i matrix-assisted laser desorption ionization time-of-flight mass
spectrometry (MALDI-TOF). Bakterijske kolonije tako se mogu identificirati direktno
iz supernatanta bočice za hemokulturu. IE s negativnom hemokulturom (blood
culture–negative IE, BCNIE) odnosi se na IE u kojem se uzročnik ne može detektirati
uobičajenim metodama kultivacije, što predstavlja dijagnostički i terapijski
problem. Ukoliko pacijent prethodno nije liječen antibioticima, takvih slučajeva
trebalo bi biti manje od 5%. U slučajevima BCIE za identifikaciju uzročnika mogu se
koristiti serologija i PCR. U KB Dubrava je kroz period 2000.-2015. g. zbog IE liječeno
196 pacijenata te će naši rezultati biti prikazani u ovom predavanju.
Microbiological diagnosis of infective endocarditis

Jasenka Škrlin¹, Andrea Janeš¹, Sandra Šestan-Crnek¹, Karolina Dobrović¹,
Katarina Dujmović¹, Igor Rudež2, Željko Sutlić2
1
Center for clinical microbiology and hospital infection, Clinical Hospital
Dubrava, Zagreb, Croatia
2
Department for cardiology and transplantation medicine, Clinical Hospital
Positive blood cultures (BC) remain the mainstay of diagnosis of infective

endocarditis (IE) because they provide live microorganisms for both identification
and susceptibility testing. At least three sets are taken at 30-min intervals from
peripheral vein rather than central venous catheters, each containing 10 mL of
blood, and are incubated both aerobically and anaerobically. More samples may be
119
necessary if a patient has previously received antibiotics. In IE, bacteraemia is

almost constant, therefore blood sampling should not be limited to fever peaks.
From a positive blood culture bottle presumptive identification is based on Gram
staining. This information is immediately reported to clinicians in order to modify
presumptive antibiotic therapy. Complete identification is routinely achieved within
2 days, but may require longer for fastidious or atypical organisms. One of the
novel procedures for rapid bacterial identification is based on peptide spectra
obtained by matrix-assisted laser desorption ionization time-of-flight mass
spectrometry (MALDI-TOF). With MALDI-TOF bacterial colonies are directly
identified in the blood culture bottle supernatant. Blood culture–negative IE
(BCNIE) refers to IE in which no causative microorganism can be grown using the
usual blood culture methods, which often poses diagnostic and therapeutic
dillema. If the patient has not previously received antibiotic therapy and the blood
cultures are obtained as specified above, these cases should represent fewer than
5%. Serology and PCR can be used in cases of BCNIE. In University Hospital
Dubrava 196 patients were diagnosed and treated for IE in the period 2000-2015
and those results are going to be discussed in this lecture.
O-79 Popravak ili zamjena zaliska: što je bolje kod IE?

Igor Rudež
Zavod za kardijalnu i transplantacijsku kirurgiju, KB Dubrava, Zagreb,
Hrvatska
Repair VS Replacement: Which is better in IE?

Igor Rudež
Department for cardiology and transplantation medicine, Clinical Hospital
O-80 Infektivni endokarditis povezan s primjenom elektrostimulatora

Josip Vincelj
Zavod za bolesti srca i krvnih žila, KB Dubrava, Zagreb, Hrvatska
Infectious endocarditis associated with pacemaker implantation

Josip Vincelj
Department of Heart Disease and Blood Vessels, Clinical Hospital Dubrava,
Zagreb, Croatia
120
O-81 Liječenje infektivnog endokarditisa u jedinici intenzivnog liječenja

Vladimir Krajinović
Usprkos napretku u dijagnostici i liječenju infektivnog endokarditisa (IE), ukupna

smrtnost i dalje je visoka i iznosi 11-26%, a nakon jedne godine od hospitalizacije
doseže čak 30%. Glavni razlozi lošeg ishoda su kardijalne i ekstrakardijalne
komplikacije koje se pojavljuju kod većine bolesnika. Iako se svi bolesnici s IE liječe
antibioticima, većina nedavnih istraživanja ističe kako se skoro 50% bolesnika liječi I
kirurškom zamjenom ili popravkom zahvaćenog zaliska. Teško je procijeniti udio
bolesnika s IE koji se liječe u jedinici intenzivnog liječenja (JIL). Mnogi bolesnici kod
kojih je nužno primijeniti kardiokirurško liječenje provedu određeno vrijeme u JIL
tijekom boravka u bolnici. Naravno, prateće komplikacije IE često zahtijevaju
liječenje u JIL. Na žalost, rijetka su se istraživanja fokusirala na bolesnike s teškim IE
koji zahtijevaju prijem i liječenje u JIL. Liječnici intenzivisti često teško donose
odluke glede liječenja ove skupine bolesnika.
Teška sepsa i septički šok (TSSŠ) česte su manifestacije IE i ovi bolesnici obično
trebaju liječenje u JIL. Iako neke studije pokazuju da septički šok tijekom IE treba
odgoditi kardiokirurški zahvat, još uvijek nije poznato kada operirati bolesnika s
ovom komplikacijom.
Glavni ciljevi ovog istraživanja bili su: a) opisati glavne komplikacije u bolesnika s
infektivnim endokarditisom i njihov utjecaj na ishod i b) procijeniti učinkovitost
kardiokirurškog liječenja u bolesnika s TSSŠ tijekom IE i njegovog utjecaja na ishod
bolesnika
U razdoblju od siječnja 2000. do prosinca 2011. liječeno je 294 bolesnika u Klinici za
infektivne bolesti u Zagrebu. U JIL je primljeno ukupno 141 (48%) bolesnik.
Indikacije za prijem u JIL bile su najčešće neurološke komplikacije (94 bolesnika,
32%), teška sepsa ili septički šok (91 bolesnik, 31%), kongestivno zatajenje srca (74
bolesnika, 25,2%) ili kardiogeni šok (30 bolesnika, 10,2%). Mehanička ventilacija
bila je neophodna u 68 (23,1%) bolesnika. Kardiokirurško liječenje tijekom akutne
faze bolesti (tijekom hospitalizacije) bilo je povezano s boljim preživljenjem
bolesnika.
Pri odluci o indikaciji i vremenu izvođenja kardiokirurškog zahvata treba uzeti u
obzir prisustvo srčanog zatajenja, neuroloških komplikacija, zatajenja bubrega i
septičkog šoka sa sindromom multiorganske disfunkcije. Prisustvo TSSŠ kao
neovisne varijable nema utjecaj na ishod bolesnika s IE osim ako je prisutna
multiorganska disfunkcija s visokim SOFA skorom.
121
Treatment of Patients with Infective Endocarditis in Intensive Care Unit

Vladimir Krajinović
Croatia
Despite advances in diagnosis and treatment of infective endocarditis (IE) the

overall in-hospital mortality remains high (11-26%), approaching 30% at one year.
Main reasons for unfavourable outcome are cardiac and extracardiac
complications, one or more of which occur in the majority of patients. Although all
patients with IE are treated with antibiotics, most recent data underline that
approximately 50% of patients underwent early valve replacement or repair. It is
difficult to estimate the proportion of patients with IE requiring admission to the
intensive care unit (ICU). Many of those requiring surgery go through the ICU at
some stage of their hospital admission. In addition, the associated complications of
IE may necessitate management in the ICU setting. Unfortunately, very few studies
focused on patients with severe IE leading to ICU admission. Intensivists often have
difficult decisions regarding treatment of this group of patients.
Severe sepsis and septic shock (SSSS) are common presentations of IE and these
patients usually require treatment in intensive care units. Although some studies
showed that septic shock should defer cardiac surgery it is still unknown when to
operate the patients with this complication. The main objectives of the study were:
(a) to describe the main complications in patients with IE of treated in ICU (b) to
estimate the efficacy of cardiac surgery in patients with SSSS during IE and its
impact on patient’s outcome.
In a period between January 2000 and December 2011, 294 pts were treated in
Hospital for infectious diseases in Zagreb, Croatia. Admission to the ICU was
necessary in 141 (48.0%) patients. The causes indicating ICU admission were
predominantly neurological complications (94 pts, 32%), severe sepsis or septic
shock (91 pts, 31%), congestive heart failure (74 pts, 25.2%) or cardiogenic shock
(30 pts, 10.2%). Sixty eight (23.1%) of the patients required mechanical ventilation.
Cardiac surgery during the acute phase of IE (during hospitalization) was
associated with better survival.
The decision to operate and the timing of cardiac surgery should take into
account the presence of congestive heart failure, neurological complications,
renal failure and septic shock with multiorgan dysfunction syndrome. The
presence of SSSS as an independent variable has no influence on outcome in
patients with IE, unless it is associated with severe multiorgan failure with high
SOFA score.
122
INFEKCIJE KOJE UZROKUJE CLOSTRIDIUM DIFFICILE

CLOSTRIDIUM DIFFICILE INFECTIONS
123
O-82 Clostridium difficile - učestali uzročnik infekcija povezanih sa

zdravstvenom skrbi
Sanja Zember1, Blanša Bilić2, Gordana Kolaric Sviben3, Slađana Dukarić1,
Patricija Dulibić2, Snježana Vuljak3
1
Opća bolnica Varaždin, Varaždin, Hrvatska
2
Opća bolnica Šibenik, Šibenik, Hrvatska
3
Opća bolnica "Dr. Tomislav Bardek", Koprivnica, Hrvatska
Cilj retrospektivnog opservacijskog istraživanja provedenog u OB Varaždin, OB

Šibenik i OB "Dr.Tomislav Bardek" Koprivnica bio je usporediti incidenciju
Clostridium difﬁcile infekcije(CDI) u ovisnosti o potrošnji antibiotika u navedenim
ustanovama kao i definirati rizične čimbenike za nastanak CDI. U studiju su
uključeni svi hospitalizirani pacijenti s dijarealnim sindromom u periodu od
1.1.2016-30.6.2016.godine. U svrhu detekcije CD antigena u stolici primijenjen je
GDH test u sve tri ustanove, a pozitivni uzorci su testirani NAAT testom u OB
Varaždin i OB Šibenik, dok je u OB Koprivnica korištena ELFA za dokaz toksina A i B.
U opserviranom periodu, od ukupno 26067 hospitaliziranih pacijenata, njih 128 je
imalo dokazanu CDI, a 81(63%) je bilo ženskog spola. Prosjek bolesničko-opskrbnih
dana (BOD) prije pojave CDI bio je 16 dana.(Varaždin 19,69; Šibenik 16,9;
Koprivnica 13,32). Stopa incidencije CDI/1000 BOD u OB Varaždin je bila 3,2, u OB
Šibenik 7,7, a u OB Koprivnica 5,5. Osim starije životne dobi, s medijanom od 73
godine, čimbenik rizika za razvoj CDI definirana je prethodna politerapija
antibioticima (Varaždin 31(72%), Šibenik 37(86%), Koprivnica 18(42%) te upotreba
inhibitora protonske pumpe (Varaždin 23(54%); Šibenik 28(65%); Koprivnica
17(39%). Potrošnja najčešće propisivanih antibiotika, izražena u stopama
DDD/1000 BOD, u OB Varaždin iznosi 344, u OB Šibenik 761, a u OB Koprivnica 500.
Monoterapija metronidazolom je prvi terapijski izbor u sve tri ustanove, no
kombinacija metronidazola i vankomicina kao i monoterapija vankomicinom se
učestalije primjenjuje u OB Varaždin. Recidiv CDI zabilježen je kod 16% slučaja u OB
Varaždin, 18% u OB Šibenik, a 4% u OB Koprivnica. Smrtnost koja se povezuje s CDI
u OB Varaždin iznosi 7,1%, u OB Šibenik 6,9%, u OB Koprivnica 6,9%.
Zaključak: Najviša stopa incidencije CDI je u OB Šibenik gdje je i najviša stopa
potrošnje najčešće propisivanih antibiotika, a razlike u odabiru terapije koreliraju s
težinom CDI definiranom McCabe skorom.
C. difficile - a frequent causative agent of HCAI

Sanja Zember1, Blanša Bilić2, Gordana Kolaric Sviben3, Slađana Dukarić1,
Patricija Dulibić2, Snježana Vuljak3
1
General Hospital Varaždin, Varaždin, Croatia
2
General Hospital Šibenik, Šibenik, Croatia
3
General Hospital "Dr.Tomislav Bardek", Koprivnica, Croatia
124
O-83 Što znamo o našim hospitaliziranim bolesnicima s Clostridium difficile

dijarejom?
Mirjana Balen Topić1, Nikolina Bogdanić3, Tomislav Brblić3, Ninoslava
Vicković2, Boško Desnica2
1
Klinika za infektivne bolesti „Dr. Fran Mihaljević“, Medicinski fakultet
Sveučilišta u Zagrebu, Zagreb, Hrvatska
2
3
Rastuća upotreba antibiotika i širenje hipervirulentnih sojeva rezultiraju porastom

pobola i stope smrtnosti od dijarejalnih bolesti uzrokovanih toksikogenim sojevima
Clostridium difficile (CD).
Cilj ovog rada je utvrđivanje epidemioloških i kliničkih osobina bolesnika
hospitaliziranih zbog CD proljeva.
U ovo retrospektivno istraživanje su uključeni bolesnici svih dobi i oba spola liječeni
u Klinici za infektivne bolesti „Dr. Fran Mihaljević“ zbog dijareje s dokazanom CD
infekcijom (metodama EIA/PCR) iz uzoraka stolice od 2013.-2015. godine. Podaci su
dobiveni iz povijesti bolesti.
Od 671 hospitalizacije s promatranom otpusnom dijagnozom CD je dokazan u
556/671 (82,9%) slučajeva, s rastućim brojem hospitalizacija u promatranim
godinama (141-177-238). Među hospitaliziranima su prednjačile žene (313/556;
57,4%). Raspon dobi je bio 6 mj.-93 g, prosjek 69,6 g, a medijan 75 g. Bolesnika ≥65
g. je bilo 72,5%, a ≥ 80 g. je bilo 30,9%; nepokretno je bilo 48,6% bolesnika. Prosjek
trajanja hospitalizacije je bio 16,5 (medijan 12) dana. Zbog recidiva bolesti
navedenih 556 hospitalizacija se odnosi na 451 bolesnika; 369/451 (81,8%) je bilo
hospitalizirano jednom, 66/451 (14,6%) dva, a 16/451 (3,6%) 3-5 puta. S
vanbolničkim liječenjem je povezano 18,9% bolesti, s ustanovama za smještaj 6,5%,
a s bolničkim liječenjem 74,6% bolesti; 16.4% je nastalo tijekom hospitalizacije.
Klinički znaci teže bolesti su zabilježeni u 89/556 (16%), a od laboratorijskih je
najčešća bila kombinacija leukocitoze (>15000) i hipoalbuminemije (<30 g/l) u
102/556; 18,3% slučajeva. Zabilježeno je 14 crijevnih kirurških komplikacija (7
subileusa, dva ileusa, 5 toksičnih megakolona); 5 bolesnika je upućeno na kirurško
liječenje. U jedinici intenzivne medicine su liječena 32 bolesnika, od toga 11 zbog
komplikacija CD dijareje. Smrtni ishod je zabilježen u 57/556; 10,3% hospitalizacija,
odnosno 57/451; 12,6% bolesnika.
Zaključujemo da u usporedbi s podacima iz drugih studija, naši promatrani bolesnici
su CD dijareju dobijali češće vezano uz bolničko liječenje te je u njih stopa smrtnosti
razmjerno visoka. S obzirom na porast broja hospitalizacija bolesnika s CD dijarejom
po godinama u promatranom razdoblju, navedena bolest u našoj sredini
predstavlja rastući zdravstveni problem.
125
What do we know about our hospitalized patients suffering from

Clostridium difficile associated diarrhea?
Mirjana Balen Topić1, Nikolina Bogdanić3, Tomislav Brblić3, Ninoslava
Vicković2, Boško Desnica2
1
University Hospital for Infectius Diseases „Dr. Fran Mihaljević“, University
of Zagreb School of Medicine, Zagreb, Croatia
2
University Hospital for Infectius Diseases „Dr. Fran Mihaljević“, Zagreb,
Croatia
3
Greater use of antibiotics and spread of hypervirulent strains caused an increase of

morbidity and mortality associated with diarrheal diseases caused by Clostridium
difficile (CD) toxigenic strains.
This study aims to determine the epidemiological and clinical characteristics of
patients hospitalized with CD diarrhea.
This retrospective study includes patients of all ages and both sexes, hospitalized at
the University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, due to
diarrhea with a confirmed CD infection (EIA/PCR methods) in stool samples, during
2013-2015. Data was collected from patients’ medical records.
Among 671 hospitalizations with an observed discharge diagnosis, CD was proven
in 556/671 (82.9%) cases, the number of hospitalizations rising during that period
(141-177- 238). Female patients were prevalent (313/556;57.4%). Age range varied
from 6 months to 93 years, the average being 69.6, the median 75 years. Patients
aged ≥65 yrs. represent 72.5%, ≥ 80 yrs. 30.9% of cases; 48.6% of patients were
immobile. Average hospitalization lasted 16.5 (median 12) days. The 556 recorded
hospitalizations refer to 451 patients (disease recidivism); 369/451 (81.8%) were
hospitalized once, 66/451 (14.6%) twice, and 16/451 (3.6%) 3-5 times. 18.9% of
cases involved previous non-hospital treatment, 6.5% chronic-care institutions,
while 74.6% were associated with hospital care; 16.4% developed during
hospitalization. Clinical signs of a more severe disease were recorded in 89/556
(16%) cases; among laboratory markers the most common was a combination of
leucocytosis (>15000) and hypoalbuminaemia (<30 g/l), recorded in 102/556;
18.3% of cases. There were 14 abdominal surgical complications (7 subileus, 2 ileus,
5 toxic megacolon); 5 patients were surgically treated. Intensive medical care unit
treated 32 patients, 11 of them due to complications from CD diarrhea. 57/556;
10.3% of hospitalizations ended lethally, i.e., 57/451; 12.6% of patients died.
To conclude, in comparison with other studies, our observed patients developed
CD diarrhea more often as a result of hospital-based treatment, with a relatively
high mortality rate. This disease is an expanding health problem featuring
increasing yearly hospitalizations due to CD diarrhea in the observed period.
126
O-84 Clostridium difficile infekcije u Kliničkom bolničkom centru Split

Marija Tonkić, Anita Novak
Klinički bolnički centar Split, Medicinski fakultet Sveučilišta u Splitu, Split,
Hrvatska
Clostridium difficile, Gram-pozitivni, sporogeni, anaerobni bacil, je danas najčešći

uzročnik bolničkog proljeva u industrijski razvijenim zemljama. Clostridium difficile
infekciju (CDI) karakterizira stalni porast incidencije, smrtnosti, težine kliničke slike
te pojava rekurentnih infekcija. U KBC-u Split se za dijagnostiku CDI koristi
dvostupanjski protokol koji preporučuje European Society of Clinical Microbiology
and Infectious Diseases (ESCMID). U razdoblju od 2010.-2015. god. analizirano je
ukupno 3310 uzoraka stolice na prisustvo toksina A i B C. difficile. Od toga je 614
(18,5%) bilo pozitivno. Broj testiranih uzoraka je tijekom ispitivanog razdoblja
porastao 6 puta, a broj pozitivnih uzoraka 14 puta. Sve češće se detektiraju
rekurentne CDI tako da su 2010. god. zabilježene 3, a 2015. god. 71 rekurentna
infekcija. Bolesnici koji su imali CDI su najčešće bolovali od kroničnih bolesti srca,
pluća i bubrega. Genotipizacijom sojeva C. difficile detektirano je šesnaest različitih
PCR-ribotipova. Najučestaliji PCR-ribotipovi su bili 001 i 014/020. Teške CDI su
mahom uzrokovali izolati otporni na kinolone. Učestalost takvih izolata je bila
značajno veća u bolesnika koji su prije nastanka CDI primali kinolone. Čimbenici koji
se također povezuju sa nastankom teške CDI su terapija trećom generacijom
cefalosporina prije nastanka CDI, zloćudne bolesti i prethodni kirurški zahvati.
Testiranjem osjetljivosti na antibiotike metodom E-testa tijekom 2015. god.
ustanovljeno je da 37% sojeva C. difficile rezistentno na eritromicin, 35% na
klindamicin te 28% na ciprofloksacin dok su svi testirani sojevi bili osjetljivi na
vankomicin i metronidazol. Zabilježena je i pojava multiplo rezistentnih izolata
(MDR) (12%). Povećana kontrola propisivanja antimikrobnih sredstava, posebno
cefalosporinske skupine, svakako će doprinijeti sprečavanju nastanka teške kliničke
slike CDI, osobito u slučaju kada se radi o kirurškim i onkološkim bolesnicima.
Clostridium difficile infections in the University Hospital Center Split

Marija Tonkić, Anita Novak
University Hospital Center Split, University of Split School of Medicine,
Split, Croatia
Clostridium difficile, gram-positive, spore-forming, anaerobic bacillus, today is the

most common cause of hospital diarrhea in industrialized countries. Clostridium
difficile infections (CDI) are characterized by a steady increase in the incidence,
mortality, severity and occurrence of recurrent infections. In University Hospital
Centre Split, the two-stage diagnostic protocol for CDI is used, according to
European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
recommendation. In the period 2010 – 2015, a total of 3310 stool samples for the
presence of toxin A and B of C. difficile were tested. Of these, 614 (18.5%) were
127
positive. Number of samples tested during the study period increased 6 times, and
the number of positive samples increased 14 times. Recurrent CDIs were also
increasingly detected. In 2010, 3 recurrent infections were detected, and 71 in
2015. Patients who have had CDI usually suffered from chronic heart, lung and
kidney disease. Genotyping of C. difficile strains showed 16 different PCR ribotypes.
The most common PCR-ribotypes were 001 and 014/020. Severe CDI were mainly
caused by isolates resistant to quinolones. The frequency of these isolates was
significantly higher in patients who were receiving quinolones prior to the onset of
CDI. Factors that are also associated with the occurrence of severe CDI are third-
generation cephalosporins given before the emergence of CDI, malignancies and
previous surgical treatment. During 2015, antibiotic susceptibility testing of C.
difficile isolates was performed by using E-tests. Resistance rates to erythromycin,
clindamycin, and ciprofloxacin were 37%, 35%, and 28%, respectively. All the
strains tested were sensitive to vancomycin and metronidazole. The occurrence of
multi-resistant isolates (MDR) was also detected (12%). Increased control of
antimicrobials use, especially cephalosporins, will, for sure, contribute to the
prevention of severe CDI, particularly when it occurs in surgical and oncology
patients.
O-85 Rekurentne Clostridium difficile infekcije

Anita Novak
Klinički bolnički centar Split, Medicinski fakultet Sveučilišta u Splitu, Split,
Hrvatska
Clostridium difficile je vodeći uzročnik bolničkih proljeva u razvijenim zemljama

svijeta. Europsko društvo za kliničku mikrobiologiju i infektivne bolesti (ESCMID) je
istaknulo rekurenciju kao najvažniji problem u liječenju CDI. Rekurentne CDI imaju
značajan utjecaj na život i zdravlje pacijenata, a zbog produženog trajanja bolničkog
liječenja dodatno ekonomski opterećuju zdravstveni sustav.
Prema ESCMID-ovim smjernicama, rekurentna CDI je definirana ponovnom
pojavom simptoma CDI nakon početnog poboljšanja i dobrog odgovora na terapiju
uz mikrobiološki nalaz toksin-producirajućeg soja C. difficile u stolici pacijenta.
Rekurencija je česta, nastaje u 30% pacijenata nakon provedene inicijalne terapije.
Svaka iduća epizoda bolesti povezana je s povećanim rizikom dodatnih ponavljanja
(45% nakon prvog i 65% nakon drugog recidiva).
Ponavljajuće infekcije nastaju zbog nemogućnosti oporavka crijevne mikroflore i
izostanka optimalnog imunološkog odgovor na C. difficile. Rizični čimbenici za
nastanak ponavljajućih infekcija su brojni (životna dob iznad 65 godina, primjena
antibiotika, neučinkovit imunološki odgovor na toksine, ranije ponavljajuće epizode
itd.).
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Liječenje rekurentnih CDI predstavlja osobiti izazov kliničarima. Idealan lijek bi bio
onaj koji ciljano djeluje na C. difficile i spriječava produkciju njegovih spora i
toksina, a istovremeno ima minimalni učinak na crijevnu mikrobiotu. Prema
najnovijim ESCMID-ovim smjernicama, za liječenje rekurentne CDI može se koristiti
vankomicin ili fidaksomicin. Fidaksomicin, za razliku od vankomicina, ima uski
spektar djelovanja, minimalni utjecaj na crijevnu mikrofloru i nisku stopu recidiva.
Fekalna transplantacija (FMT) je alternativni način liječenja višestruko rekurentnih
CDI i obično se koristi u najtežim kliničkim slučajevima. FMT obnavlja crijevnu
mikrofloru te na taj način spriječava germinaciju spora C. difficile i kolonizaciju
crijeva.
Zbog visoke učestalosti rekurentnih CDI, njihovog utjecaja na zdravlje pacijenata i
na cjelokupni zdravstveni sustav, novi terapeutski postupci i nove klase antibiotika
su u različitim fazama kliničkih ispitivanja. Smanjenje incidencije rekurentnih
infekcija značajno bi ublažilo posljedice CDI, smanjilo stopu prijenosa infekcije te
troškove nastale dodatnom hospitalizacijom.
Recurrent Clostridium difficile infections

Anita Novak
Split, Croatia
Clostridium difficile is the leading cause of nosocomial diarrhoea in industrialised

countries. The European Society of Clinical Microbiology and Infectious Diseases
(ESCMID) has highlighted recurrence as the most important problem in the
treatment of C. difficile infection (CDI). Recurrent CDI has the significant personal
burden, as well as important economic impact due to an increased length of
hospitalisation.
ESCMID defines recurrent CDI as being an increase in stool frequency for two
concecutive days or the development of new signs of colitis following an initial
response to treatment (with microbiological evidence of toxin-producing C. difficile
in stools).
Recurrence is related to a combination of the presence in the intestines of spores
of C. difficile, failure to re-establish the colonic microflora and a sub-optimal
immune response. Some of risk factors for recurrent CDI are: impaired immune
system, concomitant antibiotics, renal impairment, aged over 65 years and
previous episode of CDI. There is growing awareness of the importance to identify
and treat those at high risk of recurrence. Each episode of disease is associated
with an increased risk of additional recurrent episodes (30% following primary CDI,
45% after the first and 65% after the second recurrence).
Treatment of primary and recurrent CDI is challenging. An ideal treatment would
be effective against C. difficile, inhibit the production of spores and toxins, while
having minimal impact on the normal bowel microflora. The ESCMID guidelines
recommends the use of either vancomycin or fidaxomicin for the first recurrent
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episode. For multiple recurrences, either vancomycin with a tapered and/or pulsed
dosing regimen or fidaxomicin is preferred. Faecal microbiota transplantation
(FMT) has emerged as an alternative salvage therapy for multiple recurrent CDI and
the most severe cases.
Reduction of recurrence could potentially reduce the costs of treating CDI and also
reduce the rate of person-to-person transmission.
O-86 Prevencija i kontrola Clostridium difficile infekcija

Nataša Boban
Klinički bolnički centar Split, Split, Hrvatska
Prevention and control of Clostridium difficile infections

Nataša Boban
130
INFEKCIJE U IMUNOKOMPROMITIRANIH (UKLJUČUJUĆI I HIV)

INFECTIONS IN IMMUNOCOMPROMISED & HIV
131
O-87 Infekcije poliomavirusima kod transplantiranih bolesnika

Ivana Mareković, Zrinka Bošnjak, Ana Budimir
Klinički bolnički centar Zagreb, Zagreb, Hrvatska
Poliomavirusi pripadaju u obitelj Polyomaviridae koja obuhvaća ukupno četiri roda i

73 vrste virusa. Pojedine vrste poliomavirusa razlikuju se s obzirom na vrstu
domaćina koju mogu inficirati a do sada je otkriveno ukupno 13 vrsta specifičnih za
čovjeka. Najznačajniji poliomavirusi koje susrećemo kao uzročnike infekcija kod
čovjeka su BK poliomavirus (BKV) i JC virus (JCV). BKV uzročnik je poliomavirusne
nefropatije (PVN) kod bolesnika s transplantiranim bubregom te poliomavirusnog
hemoragičnog cistitisa (PVHC) kod bolesnika nakon alogene transplantacije
krvotvornih matičnih stanica. JCV uzročnik je progresivne multifokalne
leukoencefalopatije te također PVN. Nakon primarne infekcije u djetinjstvu, BK
virus ostaje u latentnom stanju u epitelnim stanicama tubula bubrega te se
reaktivira u stanju imunosupresije. Kod bolesnika s transplantiranim bubregom
provodi se probir u svrhu otkrivanja intenziteta virusne replikacije kako bi se na
vrijeme započelo postepeno smanjivanje imunosupresije te omogućilo djelovanje
BKV specifičnog staničnog imunološkog odgovora. Dijagnostika PVHC temelji se na
prisutnosti simptoma i znakova cistitisa, hematurije stupnja II – IV te virurije. Za
otkrivanje virurije i viremije koristi se kvantitativni PCR kojim se određuje broj
prisutnih virusnih kopija. Osnovu liječenja PVN čini redukcija imunosupresije a PHC
suportivne mjere i mjere u svrhu kontrole krvarenja. Postoje i druge mogućnosti
liječenja koje se mogu primijeniti u slučaju neadekvatnog odgovora ali još nisu
ispitane u dovoljnom broju randomiziranih kliničkih studija.
Zahvaljujući modernoj tehnologiji i povećanom zanimanju zbog nedavno otkrivenog
onkogenog potencijala nekih poliomavirusa, njihov broj neprestano raste. Kada se u
obzir uzme i to da za njih trenutno ne postoji učinkovit i siguran antivirusni lijek, te
vulnerabilna grupa bolesnika kod kojih uzrokuju infekcije, za pretpostaviti je da će
interes za njihovo istraživanje u budućnosti i dalje rasti.
Polyomavirus infection in transplanted patients

Ivana Mareković, Zrinka Bošnjak, Ana Budimir
University Hospital Centre Zagreb, Zagreb, Croatia
Polyomaviruses are by taxonomy placed in the family Polyomaviridae which

includes four genera and 73 species. Polyomavirus species are different according
to the host they infect and 13 species are specific for humans. The most clinically
relevant species are BK polyomavirus (BKV) and JC virus (JCV). BKV is a causative
agent of polyomavirus-associated nephropathy (PVAN) in transplanted kidney
patients and polyomavirus-associated hemorrhagic cystitis (PVAHC) in patients with
allogeneic hematopoietic stem cell transplant (HSCT). JCV is a causative agent of
progressive multifocal leukoencephalopathy and also PVAN. After primary infection
early in the childhood, BKV remains latent in renal tubular epithelial cells and
132
reactivates in the state of immunosuppression. In the patients with transplanted

kidney, screening is recommended in order to detect intensity of viral replication
and start reduction of immunosuppression on time. This enables acting of BKV
specific cellular immunological response. Diagnostic of PAHC is based on the
presence of symptoms and signs of cystitis, hematuria nad viruria. Quantitative PCR
for determining number of viral copies present is recommended for the detection
of viruria and viremia. Treatment of PVAN is based on the reduction of
immunosuppression and PVAHC supportive measures and bleeding control. There
are other options available in case of inadequate response but they are still not
validated in relevant number of randomized clinical studies. The number of newly
discovered polyomaviruses is constantly increasing because of modern technology
and recently demonstrated oncogenic potential of certain polyomaviruses. Taking
that in consideration as well as the fact that there still is no effective and safe
antiviral drug available and that the target population is very vulnerable, it can be
assumed that the interest for their research will increase in the future.
O-88 Nove metode u dijagnosticiranju gljivičnih infekcija

Sanja Pleško, Ivana Mareković, Marija Jandrlić, Violeta Rezo Vranješ
Klinički bolnički centar Zagreb, Zagreb, Hrvatska
New methods in the diagnosis of fungal infections

Sanja Pleško, Ivana Mareković, Marija Jandrlić, Violeta Rezo Vranješ
University Hospital Centre Zagreb, Zagreb, Croatia
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O-89 Infekcije kod bolesnika liječenih transplantacijom autolognih perifernih

hematopoetskih matičnih stanica
Njetočka Gredelj Šimec1, Viktor Zatezalo1, Martina Lukić2, Silvana Jurenec3,
Iva Butić4, Tihana Frišćić1, Delfa Radić Krišto1, Arjana Tambić Andrašević4,
Slobodanka Ostojić Kolonić1,5
1
Zavod za hematologiju, Klinika za unutarnje bolesti, Klinička bolnica
Merkur, Zagreb, Hrvatska
2
Odsjek za kliničku transfuziju i telemedicinu, Hrvatski zavod za
transfuzijsku medicinu, Zagreb, Hrvatska
3
Odjel za anesteziju, reanimatologiju i intenzivno liječenje, Klinička bolnica
Merkur, Zagreb, Hrvatska
4
Odjel za bakteriologiju i bolničke infekcije, Klinika za infektivne bolesti “Dr.
Fran Mihaljević“, Zagreb, Hrvatska
5
Postupak transplantacije autolognih perifernih matičnih hematopoetskih stanica

(autotransplantacija) predstavlja metodu liječenje u kojoj se nakon visokodozne,
mijelotoksične kemoterapije reinfundiraju ranije prikupljene hematopoetske
matične stanice bolesnika. Svrha reinfuzije matičnih stanica je osiguranje
adekvatnog oporavka hematopoeze, skraćivanje perioda duboke neutropenije i
smanjenje visokog rizika od teških infekcija. Postupak autotransplantacije nosi
umjereni rizik za infekcije, no dio bolesnika je u visokom riziku zbog prirode
osnovne bolesti, ranijih oblika liječenja i visoke učestalosti teškog mukozitisa u
transplantiranih. Zbog navedenog, svi bolesnici borave u izolaciji i primaju
antinfektivnu profilaksu ciprofloksacinom, flukonazolom i aciklovirom. U periodu
od 3 i pol godine na Zavodu za hematogiju učinjeno je 177 autotransplantacija.
Bolesnici su bili u dobi od 20 do 72 godine, s medijanom od 55,18 godina. Multipli
mijelom je imalo 59,88% bolesnika, 37,3% bolesnika limfom (ne Hodgkinov limfom i
Hodgkinov limfom), a 2,82% bolesnika akutnu mijeloičnu leukemiju. Vrijeme do
oporavka neutrofila trajalo je od 7 do 20 dana, uz medijan od 10 dana te prosjek od
10,25 dana. U 42,93% bolesnika razvila se febrilna neutropenija koja je empirijski
liječena priperacilinom s tazobaktamom u dozi od 4,5g 4 puta dnevno, uz dodatak
vankomicina u slučaju izraženog mukozitisa ili verificiranog plućnog infiltrata. Kod
svih su bolesnika učinjene hemokulture i urinokultura te bris na gripu u vrijeme
sezonske gripe. Uzročnik je izoliran iz 51,31% hemokultura, od kojih su 54.29% bili
G-uzročnici. Do smrtnog ishoda u periodu od mjesec dana nakon
autotransplantacije došlo je kod ukupno 2 bolesnika (1,12%). Naši podaci o
učestalosti infekcija sukladni su literaturnim podacima, no velik je broj radova koji
govore u prilog zadovoljavajuće sigurnosti bolesnika otpuštenih iz bolnice
neposredno nakon autotransplantacije i liječenih kod kuće u fazi duboke
neutropenije. Ostaje otvoreno pitanje da li je i u našim uvjetima u zdravstvu
moguće na taj način provoditi postupak autotransplantacije.
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Infections in patients treated with autologous peripheral hematopoietic

stem-cell transplantation
Njetočka Gredelj Šimec1, Viktor Zatezalo1, Martina Lukić2, Silvana Jurenec3,
Iva Butić4, Tihana Frišćić1, Delfa Radić-Krišto1, Arjana Tambić Andrašević4,
Slobodanka Ostojić Kolonić1,5
1
Department of Hematology, Department of Internal Medicine, University
hospital Merkur, Zagreb, Croatia
2
Section of Clinical Transfusion and Telemedicine, Croatian Institute of
Transfusion Medicine, Zagreb, Croatia
3
Department of Anesthesiology, Reanimatology and Intensive Care,
University hospital Merkur, Zagreb, Croatia
4
Department of Bacteriology and Hospital Infections, University Clinic for
Infectious Diseases “Dr. Fran Mihaljević“, Zagreb, Croatia
5
Autologous peripheral hematopoietic stem-cell transplantation is a procedure of a

stem cell rescue with patients own, previously collected, hematopoietic stem cells,
after myelotoxic therapy. The purpose of stem cell reinfusion is to ensure adequate
recovery of hematopoiesis, shorten the period of profound neutropenia and to
reduce the risk of infections. The transplantation itself carries a moderate risk for
infection but some patients have higher risk due to the nature of underlying
disease, earlier treatment and in case of severe mucositis. For these reasons, all
treated patients are in isolated cleanrooms and receive ciprofloxacin, fluconazole
and acyclovir prophylaxis. In the 3,5 year period, 177 autologous transplantations
were performed. The patients were 20 to 72 years old, with median of 55.18 years.
Of all transplanted patients 59.88% had multiple myeloma, 37.3% lymphoma and
2.82% acute myeloid leukemia. Time to neutrophil recovery was 7-20 days, with a
median of 10 days, and average of 10.25 days. Febrile neutropenia was reported in
42.93% of patients, all of whom were treated with empirical therapy with
piperacillin/tazobactam 4.5 grams four times a day with the addition of vancomycin
in the case of severe mucositis or pulmonary infiltrates. In all cases blood and urine
cultures were performed as well as testing for seasonal flu. In 51.31% pathogen
was isolated. G-bacteria caused sepsis in 54,29% of patients. In one month follow
up period, there were two (1,12%) infection related deaths. Our data on incidence
of infections is consistent with literature data but large number of papers show
satisfactory results of safety of patients discharged from hospital immediately after
the autologous stem cell transplantation and who were treated at home during the
phase of profound neutropenia. There is still an ongoing debate whether it is
possible to conduct this procedure in such manner in our health system.
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O-90 HIV i rezistencija na antivirusne lijekove

Rezistencija HIV-a na antiretrovirusne lijekove uzrokovana je mutacijama u pol

regiji genoma virusa koje dovode do promjene slijeda aminokiselina u aktivnim
mjestima virusnih enzima koji su ciljne strukture lijekova. Inhibitori integraze ili
INSTI (integrase strand transfer inhibitors) sprječavaju integraciju provirusne DNA u
genom CD4+ T-limfocita. Inhibitori integraze tj. raltegravir, elvitegravir i
dolutegravir dio su preporučenih terapijskih algoritama.
Rezistencija HIV-a na raltegravir najčešće je posredovana mutacijama Y143, Q148 i
N155 dok se u bolesnika s rezistencijom na elvitegravir najčešće pojavljuju mutacije
E92Q, N155H i Q148R. Dolutegravir ima veću genetsku barijeru za rezistenciju u
usporedbi s raltegravirom i elvitegravirom. Nastanak klinički značajne rezistencije
na dolutegravir najčešće se povezuje s pojavom mutacije Q148 uz najmanje još
dvije klinički značajne mutacije. Određivanje rezistencije HIV-a na inhibitore
integraze u osoba s virusološkim neuspjehom liječenja provodi se u Referentnom
centru za dijagnostiku i liječenje HIV/AIDS-a od početka 2016.g. a za sada su
otkrivena dva bolesnika s rezistencijom na raltegravir i elvitegravir.
HIV resistance to antiretroviral drugs

University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, University
HIV resistance to antiretroviral drugs is associated with mutations in the pol region
of the virus that lead to the changes in the composition of aminoacids within the
active sites of viral enzymes that are targeted by the drugs. Integrase strand
transfer inhibitors are a class of antiretroviral drugs that prevents the integration of
proviral DNA into the genome of CD4+ T-cells. Integrase inhibitors raltegravir,
dolutegravir and elvitegravir are currently widely used as first-line regimens. HIV
resistance to raltegravir is most frequently mediated by mutations Y143, Q148 and
N155 whereas the most frequent resistance-associated mutations in patients
exhibiting virological failure to elvitegravir are E92Q, N155H i Q148R. Dolutegravir
has a higher genetic barier for resistance compared to raltegravir and elvitegravir.
Clinically significant resistance to dolutegravir is mofst frequently associated with
the occurence of Q148 mutation in combination with two additional mutations.
Analysis of HIV resistance to integrase inhibitors is available at the Croatian
Reference center for HIV/AIDS since 2016 and clinically relevant resistance to
raltegravir and elvitegravir was detected in two patients.
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O-91 Liječenje i skrb za oboljele od zaraze HIV-om u Hrvatskoj

Josip Begovac
Klinika za infektivne bolesti „Dr Fran Mihaljević“, Medicinski fakultet
Hrvatska ima centralizirani sustav za osobe koje žive s HIV-om, u kojem su svi
bolesnici s HIV-om liječe u Klinici za infektivne bolesti u Zagrebu. Pacijenti ne
moraju dobiti uputnicu od liječnika primarne zdravstvene zaštite kako bi se uključili
u skrb. Od 2015.g. svaka osoba koja je zaražena HIV-om koja toželi dobiva
antiretrovirusnu terapiju. Antiretrovirusni lijekovi se izdaju iz bolničke ljekarne
Klinike za infektivne bolesti u Zagrebu. Pacijenti koji su se uključili u skrb između
2008. i 2015. godine su u početku bili testirani u različitim ustanovama: u
bolnicama (33%), u ambulantma (14,6%), na poticaj liječnika primarne zdravstvene
zaštite (2,5%), u centrima za dobrovoljno savjetovanje i testiranje (26%), u centrima
za testiranje u zajednici (6%), transfuzijskim centrima (4,8%) i zatvoru (1,3%).
Ostatak slučajevima bio neklasificiran. Od 731 bolesnika koji su uključeni u skrb u
razdoblju 2007. do 2015. godine, 43 je već bio u skrbi drugdje. Većina ih je bila u
skrbi u drugim europskim zemljama. Tijekom vremena, došlo je do porsta broja
osoba koje se uključuju u skrb. Novi slučajevi su uglavnom u populaciji muškaraca
koji imaju spolne odnose s drugim muškarcina, a oko 40% je iz Zagreba. Najveći broj
novouključenih u skrb je u mlađoj dobi (u dobi od 18-39.g.), a medijan broja
limfocita CD4 kod uključenja u skrb je u porastu. U 2015. godini, 50% onih koji
dijagnosticira imao broj limfocita CD4 manji od 350 stanica/mm3 u vrijeme
postavljanja dijagnoze, što je manje od visokih 70% u 2011. godini. Oko 20% onih
koji se uključuju u skrb su recentne infekcije (prema ranijem testiranju, akutnom
sindromu ili evoluciji seroloških testova). Kada su osobe uključenu u skrb,
zadržavanje u skrbi je vrlo dobro, u rasponu između 94 i 96% u 2011.-2015.
HIV treatment and care in Croatia

Josip Begovac
University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, University
Croatia has a centralized system of HIV care, in which all patients diagnosed with
HIV are treated at the University Hospital for Infectious Diseases in Zagreb. Patients
are not required to obtain a referral from primary care in order to receive HIV
treatment. “Test and treat” was implemented in Croatia in 2015. ART is provided
via the clinic pharmacy. Patients entering care between 2008 and 2015 were
initially tested at a variety of sources including at hospitals (33%), outpatient
settings (14.6%), primary care physicians (2.5%), voluntary counselling and testing
centres (26%), community based settings (6%), transfusion centers (4.8%), and
prison (1.3%). The remainder of cases were difficult to classify. Of 731 patients
entering care during the period 2007 to 2015, 43 had already been in care
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elsewhere. The majority of these were transfer of care cases, mostly from other
European countries. Over time, the number of patients entering care is increasing.
New cases are mostly MSM and about 40% are residents in Zagreb. These new
cases were likely to be younger (aged 18-39) and that the median CD4 count of
newly diagnosed individuals is increasing over time. In 2015, 50% of those
diagnosed had a CD4 cell count of less than 350 cells/mm3 at diagnosis, this had
declined from a high of 70% in 2011. About 20% of those entering care are recent
infections (as measured by previous negative tests, symptoms of acute infection or
Western Blot results). Once people have begun receiving HIV care, retention in
care, defined as the proportion of individuals in care also seen during the next year
is high, ranging between 94 and 96% in 2011-2015.
138
POSTERI
POSTERS
139
PO-1 Procjena čimbenika rizika za kolonizaciju višestrukootpornim

organizmima na Jedinici intenzivnog liječenja Klinike za unutarnje bolesti i
Zavoda za urologiju, Kliničke bolnice “Sveti Duh”
Nataša Andrijašević¹, Sanja Maraković¹, Nikolina Marić², Slaven Ovčariček³,
Bojana Miličević³
1
Zavod za kliničku mikrobiologiju i bolničke infekcije, Klinička bolnica “Sveti
Duh”, Zagreb, Hrvatska
2
Jedinica intenzivnog liječenja, Klinika za unutarnje bolesti, Klinička bolnica
“Sveti Duh”, Zagreb, Hrvatska
3
Jedinica intenzivnog liječenja, Zavod za urologiju, Klinička bolnica “Sveti
Duh”, Zagreb, Hrvatska
Jedinice intenzivnog liječenja (JIL) prostori su visokog rizika za kolonizaciju i

infekciju s višestrukootpornim organizmima (MDRO). Širenje MDRO u JIL-ovima
rezultat je nekritične primjene antibiotika, nedosljednog provođenja mjera kontrole
infekcija i težine osnovne bolesti bolesnika. Nazalna i rektalna kolonizacija često
prethode infekciji.
U razdoblju od ožujka do lipnja 2016. godine proveli smo prospektivno praćenje
142 bolesnika, 77 muškaraca i 65 žena, prosječne dobi 67.10±13.93. Svim
hospitaliziranim bolesnicima JIL-ova Klinike za unutrašnje bolesti i Zavoda za
urologiju oduzeti su nadzorni brisevi nosa i rektuma pri prijemu i otpustu.
Demografski podaci preuzeti su iz medicinske dokumentacije, te su evaluirani
čimbenici rizika za kolonizaciju s MDRO.
U nadzornim kulturama nosa pri prijemu 8 (5.63%) bolesnika bilo je kolonizirano je
s MDRO, a prilikom otpusta 23 (16.2%).
Kolonizacija rektuma prilikom prijema utvrđena je u 16 bolesnika (11.27%), a
prilikom otpusta u 60 bolesnika (42.25 %).
Tijekom boravka u JIL-u prosječno je primjenjeno 1.7±1.3 skupina antibiotika,
3.71±1.66 invazivnih pomagala, uz prosječan broj dana boravka u JIL-u 12.5 (raspon
1-244 dana).
Među bolesnicima koloniziranim i nekoloniziranim s MDRO utvrđena je statistički
značajna razlika prema broju primijenjenih antimikrobnih skupina, broju invazivnih
pomagala i duljini hospitalizacije (Mann–Whitney U test all p’s<0.05). Kolonizacija s
MDRO se ne razlikuje u odnosu na prethodnu hospitalizaciju, dijalizu, ili
imunosupresiju (chi2 test all p’s>0.05).
Multivarijantnom logističkom regresijom utvrđeno je, da su broj antimikrobnih
skupina (p=0.014), trajanje hospitalizacije (p=0.018), ali ne broj invazivnih pomagala
(p=0.620), niti dob (p=0.255), statistički značajni rizični čimbenici za kolonizaciju.
Možemo zaključiti da su rutinsko uzimanje nadzornih kultura te podatak o statusu
kliconoštva pritom dobiven, koristan dodatak kontroli bolničkih infekcija zbog
mogućnosti izolacije bolesnika i ograničavanja širenja MDRO.
Isti je i pomoć pri odabiru empirijske antimikrobne terapije.
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Evaluation of risk factors for colonisation with multidrug resistant

microorganisms in intensive care unit and urology Department in Sveti
Duh University Hospital
Nataša Andrijašević¹, Sanja Maraković¹, Nikolina Marić², Slaven Ovčariček³,
Bojana Miličević³
1
Department of Clinical microbiology and hospital infection, University
Hospital Sveti Duh, Zagreb, Croatia
2
Medical Intensive care unit, University Hospital Sveti Duh, Zagreb, Croatia
3
Urology Intensive care unit, University Hospital Sveti Duh, Zagreb, Croatia
ICUs (Intensive Care Unit) are high risk areas for increasing occurrence of
colonisation and infection caused by multidrug resistant pathogens (MDRO).
Spreading of MDRO in ICU is result of overuse of antibiotics, suboptimal infection
control and vulnerable population. Nasal and rectal colonisation often precede
infection.
From March until July 2016 we did a prospective study which submitted 142
patients, 77 males and 65 females aged 67.10±13.93 years. All patients admitted to
the Medical and Urology ICU were screened upon admission and after discharge for
nasal and rectal carriage. We evaluated risk factors for colonisation with MDRO.
At admission, MDRO colonisation of NF was present in 8 cases (5.63%) and at
discharge in 23 (16.2%). Rectal colonisation with MDRO at admission was present
in 16 cases (11.27%) and at discharge in 60 cases (42.25 %).
During the hospitalisation in ICU patients were prescribed with 1.7±1.3 antibiotics
classes, treated with 3.71±1.66 invasive devices and on average spent 12.5 days in
ICU (range 1-244 days). The differences in number of antibiotics, invasive devices
and duration of hospitalisations between groups of patients that were colonised
and those that were not, were statistically significant (Mann–Whitney U test all
p’s<0.05) while groups did not significantly varied according to status of previous
hospitalisation, dialysis or current immunosuppression (chi2 test all p’s>0.05).
Multivariate logistic regression revealed that number of antibiotics (p=0.014) and
duration of hospitalisation (p=0.018), but not number of invasive devices (p=0.620)
nor the age (p=0.255) were significant predictors of colonisation.
In conclusion, use of surveillance cultures is crucial for infection control purposes as
limited spread of MDRO by early detection of carriers, as well as guide for empirical
antimicrobial therapy.
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PO-2 Osjetljivost uropatogena na antibiotike u Splitsko-dalmatinskoj županiji

Zvonimir Barišić1, Sanda Sardelić2, Jakica Karanović2, Ena Sardelić3, Vanja
Kaliterna1
1
Nastavni zavod za javno Zdravstvo Splitsko-dalmatinske županije, Split,
Hrvatska
2
KBC Split, Split, Hrvatska
3
Medicinski fakultet Sveučilišta u Splitu, Split, Hrvatska
Infekcije mokraćnog sustava (IMS) spadaju među najčešće bakterijske infekcije u

izvanbolničkih i bolničkih pacijenata. Za liječenje IMS je ključno poznavanje
najčešćih uzročnika i njihove osjetljivosti na antibiotike.
Cilj rada je prikazati najčešće uzročnike IMS i njihovu osjetljivost na antibiotike u
bolesnika s podučja Splitsko-dalmatinske županije te analizirati rezultate u svjetlu
važećih hrvatskih nacionalnih smjernica za antimikrobno liječenje IMS (ISKRA-
smjernice).
Za 2015. god. analizirana je osjetljivost najčešćih izolata iz urina odraslih bolničkih
(KBC Split) i izvanbolničkih (NZJZ-SDŽ) pacijenata oba spola uz bakterijuriju ≥ 10.000
CFU/ml. Interpretacija antibiograma rađena je prema EUCAST standardu.
Najčešći izolat u KBC Split je bila Escherichia coli, potom Klebsiella pneumoniae,
Enterococcus faecalis, Proteus mirabilis i Pseudomonas aeruginosa. U NZJZ-SDŽ
poredak je bio: Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae,
Proteus mirabilis te Streptococcus agalactiae.
Uz očekivano visoki postotak rezistentnih sojeva bolničkih i izvanbolničkih izolata E.
coli i P. mirabilis na ampicilin i kotrimoksazol, uočen je visok postotak rezistencije
na fluorokinolone. Na ciprofloksacin je bilo otporno 20% bolničkih izolata E. coli,
47% K. pneumoniae i 34% E. faecalis. U izvanbolničkih izolata je na ciprofloksacin
bilo otporno 13% E. coli, 24% K. pneumoniae te 13% E. faecalis. Postotak
rezistentnih sojeva enterobakterija na cefuroksim kretao se od 8% kod
izvanbolničke E. coli do 41% kod bolničke K. pneumoniae.
Rezistencija enterobakterija na ceftriakson bila je u rasponu od 4% kod
izvanbolničke E. coli do 40% kod bolničkih izolata K. pneumoniae.
Uočava se razlika u osjetljivosti bolničkih i izvanbolničkih enterobakterija na
cefalosporine II i III generacije te izolata K. pneumoniae, P. mirabilis i enterokoka na
fluorokinolone. Podaci za E. coli se gotovo ne razlikuju u bolničkoj i izvanbolničkoj
populaciji.
Temeljem iznesenih podataka možemo zaključiti da su ISKRA-smjernice potpuno
primjenjive u liječenju IMS izvanbolničkih pacijenata. U bolničkih pacijenata se ne
može preporučiti emipirijska terapija fluorokinolonima, a upitan je i terapijski
uspjeh pri propisivanju cefalosporina II i III generacije, vjerojatno zbog visoke
učestalosti ESBL izolata.
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Antibiotic susceptibility among uropathogens in Split and Dalmatia

County
Zvonimir Barišić1, Sanda Sardelić2, Jakica Karanović2, Ena Sardelić3, Vanja
Kaliterna1
1
2
3
University of Split School of Medicine, Split, Croatia
Urinary tract infections (UTI) are among the most common bacterial infections in
hospital inpatient and outpatient settings. For effective treatment of these
infections it is essential to have knowledge of main bacterial causes and their
susceptibilty to antibiotics.
The aim of this study was to get insight into the susceptibilty profiles of main
bacterial species causing UTI in patients from Split-Dalmatia County and to analyze
these results regarding the current national guidelines on antimicrobial treatment
of UTI (ISKRA guidelines).
In 2015 susceptibilty to antibiotics was investigated in five most common bacterial
isolates of adult inpatients at University Hospital Centre Split (UHCS) and
outpatients at Educational Institute of Public Health of Split-Dalmatia County (EIPH)
of both sexes having bacteriuria of at least 10000/CFU/ml and interpreted
according to EUCAST standard.
The five most common urinary isolates in inpatients were E. coli, followed by
Klebsiella pneumoniae, Enterococcus faecalis, Proteus mirabilis and Pseudomonas
aeruginosa, while in EIPH E. coli was followed by Enterococcus faecalis, Klebsiella
pneumoniae, Proteus mirabilis and Streptococcus agalactiae.
High percentage of resistance of inpatients and outpatients E. coli and P. mirabilis
to ampicillin and cotrimoxazole was expected, but it was also observed with
fluoroquinolones. Twenty percent of inpatients E. coli isolates, 47% of K.
pneumoniae and 34% of Enterococcus faecalis, respectively, were resistant to
ciprofloxacin. In outpatients, 13% of E. coli, 24% of K. pneumoniae and 13% of E.
faecalis isolates were resistant to this antibiotic. The percentage of resistant
enterobacterial isolates to cefuroxime ranged from 8% in outpatient E. coli to 41%
in inpatients K. pneumoniae isolates. Four percent of outpatients E. coli isolates
were also resistant to ceftriaxone while the highest percentage of resistance was
observed in inpatients K. pneumoniae (40%).
The difference between susceptibility of inpatients and outpatients urinary isolates
of enterobacteria was mainly evident with second and third generation of
cephalosporins, while K. pnemoniae, P. mirabilis and E. faecalis were significantly
less susceptible to ciprofloxacin in inpatients' isolates. No significant difference was
observed in susceptibility of E. coli isolates from both settings.
Therefore, we could conclude that, regarding the UTI treatment, ISKRA guidelines
are thoroughly applicable in outpatient setting. However, in hospital inpatient
setting empirical treatment with fluoroquinolones could not be recommended.
143
Treatment failure with 2. and 3. generation of cephalosporins is also possible

because of high frequency of ESBL isolates.
PO-3 Utjecaj rizičnih faktora domaćina na pojavu albicans i non-albicans

kandidemije kod pacijenata hospitaliziranih u Općoj Bolnici Šibenik
Ivana Bego1, Edita Sušić1, Jasminka Brkičić2
1
Služba za medicinsku mikrobiologiju i parazitologiju, Zavod za Javno
zdravstvo Šibensko-kninske županije, Šibenik, Hrvatska
2
Odjel za zarazne bolesti, Opća bolnica Šibenik, Šibenik, Hrvatska
Uvod: Kandidemija predstavlja važan uzrok morbiditeta i mortaliteta kod teško

bolesnih pacijenata obično duže hospitaliziranih na jedinicama intenzivnog
liječenja. Takvi pacijenti izloženi su brojnim faktorima rizika koji različito utječu na
pojavu kandidemije.
Cilj rada bio je utvrditi faktore rizika i njihov utjecaj na pojavu albicans i non-
albicans kandidemije, njihovu zastupljenost te razliku u zastupljenosti među
pojedinim faktorima rizika koja bi mogla imati utjecaja na pojavu albicans i non
albicans kandidemije.
Materijal i metode: Određeni su faktori rizika za pojavu albicans i non-albicans
kandidemije na temelju pregledane medicinske dokumentacije za 40
hospitaliziranih pacijenata u razdoblju od početka 2008. do sredine 2016.godine.
Izolacija i identifikacija uzročnika Candida spp. iz pozitivnih hemokultura pacijenata
sa kandidemijom i testiranje osjetljivosti provedeno je u mikološkom laboratoriju
Službe za mikrobiologiju konvencionalnim metodama i automatiziranim
komercijalnim sistemom.
Rezultati: Candida albicans vodeći je uzročnik kandidemije (55%), a kod non-
albicans kandidemije na prvom mjestu je zastupljena Candida glabrata (23%),
potom Candida parapsilosis (18%), te Candida tropicalis (4%). Utvrđeni su faktori
rizika koji bi mogli imati utjecaja na pojavu CA i NCA kandidemije, među kojima su:
starija životna dob, prethodna upotreba antibiotika, prisutnost komorbiditeta-
kardiovaskularne bolesti i ostale, kolonizacija Candidom, CVK, prethodna
bakteremija i druge. Razlika u zastupljenosti među faktorima rizika bila je za
kardiovaskularne bolesti (zastupljenije kod NCA kandidemije), te za kolonizaciju
Candidom i prethodnu bakteremiju (zastupljenije kod CA kandidemije). Redovno su
prisutni multipli rizični faktori.
Zaključak: Na temelju utvrđenih faktora rizika, njihove zastupljenosti i razlika među
njihovom zastupljenošću ne možemo ustanoviti kliničku značajnost njihovog
utjecaja na pojavu CA i NCA kandidemije, tim više što se radi o malom uzorku
populacije. Moguću kliničku značajnost opaženih faktora rizika potrebno je
statistički analizirati. Kliničari bi trebali biti svjesni prisutnosti faktora rizika u svrhu
što ranijeg prepoznavanja i pravovremenog liječenja moguće kandidemije.
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Impact of host-related risk factors on incidence of albicans and non-

albicans candidemia in hospitalized patients in General Hospital of
Šibenik and Knin County
Ivana Bego1, Edita Sušić1, Jasminka Brkičić2
1
Department of Clinical Microbiology, Public Health Institute of Šibenik-
Knin County, Šibenik, Croatia
2
Department for Infectious Diseases, General Hospital Šibenik, Šibenik,
Croatia
Impact of host-related risk factors on incidence of albicans and non-albicans

candidemia in hospitalized patients in General Hospital of Šibenik and Knin County
Introduction: Candidemia represents important cause of morbidity and mortality
among critically ill patients hospitalized in ICUs. Those patients are exposed to
many risk factors which has different influence on incidence of albicans and non-
albicans candidemia.
The objective: The objective was to determine risk factors and their impact on
incidence of CA and NCA candidemia, their representations and differences among
their representations, which could have impact on incidence of CA and NCA
candidemia.
Material and methods: Risk factors were determined based on reviewed medical
documentation of 40 hospitalized patients in period from the January 2008. till the
June 2016.
Isolation and identification of Candida spp. from positive blood cultures of patients
with candidemia were performed in Laboratory of mycology, using both
conventional methods and automated comercial system.
Results: Candida albicans is leading cause of candidal BSIs (55%), the leading cause
of non albicans BSIs is Candida glabrata (23%), Candida parapsilosis (18%), Candida
tropicalis (4%). The determined risk factors which might have impact on incidence
of albicans and non albicans candidemia were: older age, previous use of
antibiotics, underlying conditions (such as cardiovascular diseases and others),
Candida colonisation, CVC, previous bacteremia and others. Differences in
representations among risk factors was for cardiovascular diseases with greater
representation in NCA candidemia. Candida colonisation and previous bacteremia
were more represented in CA candidemia. There is presence of multiple risk
factors, regularly.
Conclusion: According to determined risk factors (including their representations
and differences in their representations), we can't establish clinical significance of
their impact on incidence of CA and NCA candidemia, furthermore small part of
population was observed. Presumably clinical significance of risk factors should be
statistically analyzed. Clinicians should be aware of presence of risk factors, in
purpose to early recognise and treat potential candidemia.
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PO-4 Usporedba tipizacijskih metoda pulsed-field gel electroforesis (PFGE-a) i

DiversiLab-a u tipizaciji izolata Klebsielle pneumoniae
Tamara Bošnjak1, Ivana Mareković2, Ana Budimir2, Zrinka Bošnjak2
1
Neonatologija, Klinika za ženske bolesti i porode, KBC Split, Split, Hrvatska
2
Klinički zavod za kliničku i molekularnu mikrobiologiju, KBC Zagreb, Zagreb,
Hrvatska
Kada se uspoređuju rezultati rep-PCR i PFGE, važno je istaknuti osnovne principe

metoda.
Rep-PCR mjeri udaljenosti između ponavljajućih elemenata dobivenih PCR
(vizualizira između ~ 150 i 5.000 parova baza), dok PFGE restrikcijskim enzimom
obuhvaća genom (ali vizualizira 50.000 do 500.000 parova baza). Za usporedbu i
interpretaciju rezultata važno je uzeti u obzir osnovne principe dviju istarživanih
metoda. Izolati koji se testiraju pomoću navedenih metoda najčešće su dio
epidemija koje se prate unutar aktivnosti praćenja infekcija u zdravstvenim
ustanovama. Izolati koji, PFGE metodom, pokazuju moguću povezanost
međusobno, a na rep-PCR su isti, zahtjevaju daljnu analizu unutar kontrole infekcija
u cilju pronalaska dokaza o povezanosti izolata. Izolati koji PFGE-om i rep-PCR-om
ne pokazuju povezanost ne smatraju se dijelom epidemije. Naši podaci pokazaju da
DiversiLab grupira izolate koji nisu geografski povezani što bi mogao biti nedostatak
ove metode te je potrebna daljna analiza.
Trošak i jednostavnost izvedbe rep-PCR čine ga razumnim izborom za one
mikrobiološke laboratorije gdje se izvodi veliki broj tipizacija. Rep-PCR tehnologija,
kao i PFGE, zahtjeavaju početne izdatke za kupnju specijalizirane opreme, ali i
edukaciju djelatnika. Prema našem mišljenju, pozitivni aspekti DiversiLab sustava
uključuju brzo vrijeme pretrage za koju je potreban jedan dan (u usporedbi s 2 do 3
dana za PFGE), standardizirani reagensi komercijalno dostupni u obliku kita i web-
softver. To osigurava intra- i inter-laboratorijsku usporedbu. Osim toga, DiversiLab
sustav je znatno manje tehnički zahtjevan od PFGE-a.
Comparison of typing methods - pulsed-field gel electroforesis (PFGE) and

DiversiLab s in typing of Klebsiella pneumoniae isolates
Tamara Bošnjak1, Ivana Mareković2, Ana Budimir2, Zrinka Bošnjak2
1
Neonatal Intensive Care Unit, Clinical Hospital Center Split, Split, Croatia
2
Department of Clinical and Molecular Microbiology, Clinical Hospital
When comparing rep-PCR and PFGE results, it is important to highlight the basic
principles of both methods. Rep-PCR surveys distances between repetitive
elements obtained by PCR (but only visualize between ~ 150 and 5.000 base pairs),
while PFGE digests the entire genome by restriction enzyme (but only visualizes
about 50.000 to 500.000 base pairs). Therefore, it is important to compare the
outcome or interpretation of the two methods. For example, by PFGE samples that
146
are generally assumed to be part of the outbreak by infection control. Samples that
is probably and possibly related by PFGE, and similar by rep-PCR, need additional
investigation by infection control to determine if there is other evidence to relate
the samples to the outbreak and finally samples different by PFGE are generally
different by rep-PCR and are not considered part of the outbreak. Our dana
showed that commercial rep-PCR (DiversiLab) grouped in clusters even
geographically unrelated isolates strains. This could be the disadvantage of this
method, but need further investigations.
The cost and ease of performance of rep-PCR also make it a reasonable option for
those microbiology laboratories where typing volume is sufficient. The rep-PCR
technology, as well as PFGE, has initial expenditures for the purchase of specialized
equipment, but extensive training does not seem to be required in order to
perform the former assay accurately. In our opinion, positive aspects of the
commercial rep-PCR (DiversiLab) system include a 1-day turnaround time
(compared with 2 to 3 days for PFGE), standardized reagents commercially
available in kit form, and the Web-based software. This guarantees intra- and inter-
laboratoriy reproducibility. In addition, the DiversiLab system is considerably less
technically demanding than PFGE.
PO-5 Osjetljivost kliničkih izolata kvasca Candida na anidulafungin

Marina Bubonja Šonje1,2, Goran Pinjuh1, Maja Abram1,2
1
Klinički zavod za kliničku mikrobiologiju, KBC Rijeka, Rijeka, Hrvatska
2
Zavod za mikrobiologiju, Medicinski fakultet Sveučilišta u Rijeci, Rijeka,
Hrvatska
Anidulafungin pripada novoj jedinstvenoj skupini antimikotika – ehinokandinima.

Rezistencija na anidulafungin je u porastu, osobito u non-albicans izolata.
Osjetljivost 80 kliničkih izolata roda Candida na anidulafungin i flukonazol je
određena E-testovima na RPMI agaru s 2% glukoze korištenjem EUCAST standarda.
Izolati iz različitih kliničkih uzoraka sakupljeni su u prvom tromjesečju 2016. god., a
uključivali su 31 C. albicans soj, dok je većina non-albicans Candida pripadala
vrstama C. glabrata, C. parapsilosis, C. tropicalis i C. krusei.
Izuzev jednog soja, svi C. albicans sojevi su osjetljivi na flukonazol i anidulafungin
(30/31). Većina non-albicans sojeva je rezistentna na flukonazol (30/49).
Rezistencija ili smanjena otpornost na anidulafungin je detektirana u 7 non-albicans
sojeva, većinom u C. parapsilosis. MIC50 i MIC90 vrijednosti za anidulafungin non-
albicans izolata iznose 0.012 mg/l, odnosno 0.906 mg/l.
147
The activity of anidulafungin against clinical isolates of Candida spp.

Marina Bubonja Šonje1,2, Goran Pinjuh1, Maja Abram1,2
1
Department od Clinical Microbiology, University Hospital Center
Rijeka, Rijeka, Croatia
2
Department of Microbiology, University of Rijeka School of Medicine,
Rijeka, Croatia
Anidulafungin belongs to a unique class of new antifungals known as

echinocandins. Resistance to anidulafungin is emerging, especially in non-albicans
Candida isolates. The susceptibility of 80 clinical Candida isolates to anidulafungin
and fluconazole was determined by E-test on RPMI agar with 2% glucose using
EUCAST breakpoints. Clinical isolates from different clinical specimens were
collected in first quarter of 2016. Colection included 31 C. albicans, while most non-
albicans isolates belonged to C. glabrata, C. parapsilosis, C. tropicalis and C. krusei
species. Almost all C. albicans strains were susceptible to fluconazole and
anidulafungin (30/31), while majority of non-albicans isolates were resistant to
fluconazole (30/49). Resistance or decreased sensitivity to anidulafungin was
detected in 7 non-albicans strains, particulary in C. parapsilosis. The MIC50 and the
MIC90 values for anidulafungin for non-albicans isolates were 0.012 mg/l or 0.906
mg/l, respectively.
PO-6 Usporedba različitih imunoeseja u dijagnostici Epstein-Barr virusne

infekcije
Marina Bubonja Šonje1,2, Mirza Musić1, Maja Abram1,2
1
2
Zavod za mikrobiologiju, Medicinski fakultet Sveučilišta u Rijeci, Rijeka,
Hrvatska
Serološko je testiranje metoda izbora u dijagnostici primarne Epstein-Barr virusne

(EBV) infekcije, a komercijalno je dostupan veći broj različitih imunoeseja. U ovom
su radu uspoređena dva komercijalna enzimatska imunoeseja za automatizirano
određivanje EBV serološkog statusa: Vircell® i Enzygnost®. Serumi čije su vrijednosti
odstupale testirani su trećom metodom: CMIA (engl. chemiluminescent
microparticle immunoassay) na analizatoru Architect i1000SR, Abbott). Ukupno 90
seruma uzorkovanih od bolesnika s postavljenom kliničkom sumnjom na infektivnu
mononukleozu je analizirano određivanjem VCA IgM i IgG i EBNA-1 IgG protutijela.
Testiranja provedena Vircell i Enzygnost testovima su dala slične rezultate. Iako je
bilo odstupanja u pojedinim markerima rezultati oba imunoeseja su zadovoljavajući
u dijagnostici EBV infekcije.
148
Comparison of different immunoassays in diagnosis of Epstein-Barr virus

infection
Marina Bubonja Šonje1,2, Mirza Musić1, Maja Abram1,2
1
Department od Clinical Microbiology, University Hospital Center
Rijeka, Rijeka, Croatia
2
Department of Microbiology, School of Medicine University of Rijeka,
Rijeka, Croatia
Serological testing is the method of choice for the diagnosis of primary Epstein-Barr
virus (EBV) infection. Large number of serological tests are in use today. We
compared two commercially available enzyme immunoassays for automated EBV
serology: Vircell® and Enzygnost®, with final classification of discrepancies by CMIA
(chemiluminescent microparticle immunoassay) method (i1000SR Architect
Analyzer, Abbott). Collection of 90 sera from clinically suspected infectious
mononucleosis cases were analyzed measuring VCA IgM and IgG, and EBNA-1 IgG.
The Vircell and Enzygnost approaches gave similar results. Although there were
limitations in some individual markers, the assays evaluated are satisfactory for
diagnosis of EBV infection.
PO-7 Molekularna epidemiologija bolničkih karbapenem rezistentnih sojeva

Pseudomonas aeruginosa
Marina Bubonja-Šonje1,2, Mihaela Matovina4, Ivana Škrobonja2, Branka
Bedenić4, Davorka Repac-Antić1,2, Damir Ambrožić2, Maja Abram1,2
1
2
Zavod za mikrobiologiju i parazitologiju, Medicinski fakultet Sveučilišta u
Rijeci, Rijeka, Hrvatska
3
Klinički zavod za kliničku i molekularnu dijagnostiku, KBC Zagreb, Zagreb,
Hrvatska
4
Zavod za organsku kemiju i biokemiju, Institut Ruđer Bošković, Zagreb,
Hrvatska
Pseudomonas aeruginosa je značajan oportunistički patogen, ubikvitaran u okolišu i

sposoban uzrokovati široki raspon infekcija u osjetljivih pojedinaca. Zabrinjava sve
veća učestalost višestrukorezistentnih sojeva P. aeruginosa (MDRPA) u bolničkom
okruženju zbog ograničenih mogućnosti liječenja. Ciljevi istraživanja bili su ispitati
temeljne mehanizme odgovorne za karbapenemsku rezistenciju u prikupljenih
izolata te ispitati njihovu klonsku povezanost. Istraživanjem je obuhvaćeno 38
sojeva P. aeruginosa, sa smanjenom osjetljivošću na barem jedan od karbapenema,
izoliranih iz različitih kliničkih uzoraka bolesnika hospitaliziranih u KBC Rijeka u
razdoblju od šest mjeseci (srpanj do prosinac 2009. godine). Radi utvrđivanja
mehanizama koji dovode do rezistencije, svih 38 izolata je analizirano na ekspresiju
149
kromosomske beta-laktamaze (AmpC), porin važan za unos karbapenema (OprD) i

efluksnog sustava koji sudjeluje u izbacivanju nekih beta-laktama. Svi su izolati
genotipizirani pomoću gel-elektroforeze u pulsirajućem polju (PFGE). 82% izolata
rezistentnih prema karbapenemima bilo je i višestrukorezistentno (MDRPA).
Reakcijom lančane polimeraze nisu identificirani geni za metalobetalaktamaze ili
druge karbapenemaze. Otpornost na karbapeneme bila je uglavnom rezultat
mutacije i posljedične inaktivacije OprD (82% sojeva), sa ili bez hiperekspresije
MexAB-OprM (44% sojeva) ili MexAB-OprJ (11% sojeva). PFGE postupkom
detektirano je 35 različitih profila raspoređenih u pet klastera. Najveća skupina
označena C, obuhvaća 22 od 38 izolata (58%). Molekularna epidemiologija pokazala
je da su dva klona, A i C, odgovorna za epidmiju u bolničkim Jedinicama intenzivnog
liječenja. Naše je istraživanje pokazalo oligoklonsku epidemiju karbapenem
rezistentnim P. aeruginosa. Za rezistenciju prema karbapenemima odgovorno je
više mehanizama, prvenstveno smanjenu propustljivot stanične stijenke u
kombinaciji s povećanom ekspresijom efluksnog sustava.
Molecular epidemiology of hospital carbapenem resistant Pseudomonas

aeruginosa
Marina Bubonja-Šonje1,2, Mihaela Matovina4, Ivana Škrobonja2, Branka
Bedenić4, Davorka Repac-Antić1,2, Damir Ambrožić2, Maja Abram1,2
1
Department of Clinical Microbiology, University Hospital Center Rijeka,
Rijeka, Croatia
2
Department of Microbiology and Parasitology, Medical Faculty University
of Rijeka, Rijeka, Croatia
3
4
Division of Organic Chemistry and Biochemistry, Ruđer Bošković Institute,
Zagreb, Croatia
Pseudomonas aeruginosa is an important opportunistic pathogen, characterized by

environmental versatility and ability to cause a wide range of human infections in
susceptible individuals. The increasing frequency of multi-drug-resistant P.
aeruginosa (MDRPA) strains in hospital environment is of major concern due to
limited treatment options. The aims of the study were to investigate the underlying
mechanisms that conferred the carbapenem resistance phenotype, and to examine
the clonal relationships of isolates. The study included 38 P. aeruginosa strains,
with reduced susceptibility to at least one of the carbapenems, recovered
consecutively from various clinical specimens of separate patients at the Clinical
Hospital Centre Rijeka over a period of six months (July to December 2009). To
assess the mechanisms leading to resistance, all 38 isolates were analysed for
expression of the chromosomal beta-lactamase (AmpC), the porin important for
entry of carbapenems (OprD) and an efflux system known to extrude some beta-
lactams. All isolates were genotyped by pulsed-field electrophoresis (PFGE). Up to
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82% of the carbapenem-resistant isolates were multidrug-resistant. PCR analysis

did not detect any MBLs or KPC genes. Carbapenem resistance was driven mainly
by mutational inactivation of OprD (82% of strains), accompanied or not by
hyperexpression of MexAB-OprM (44% of strains) or MexAB-OprJ (11% of strains).
Pulsed-field gel electrophoresis (PFGE) revealed 35 distinct profiles distributed in 5
clusters. The largest pulsogroup designated C comprised 22 out of 38 isolates
(58%). Molecular epidemiological studies have revealed that two clones, A and C,
caused outbreaks in hospital ICUs. Our study showed oligoclonal outbreak of P.
aeruginosa with several mechanisms involved in carbapenem resistance - the low
outer membrane permeability combined with efflux system overexpression.
PO-8 Reaktivacije inaktivne i okultne infekcije virusom hepatitisa B

Marija Bukša, Miro Morović
Opća bolnica Zadar, Zadar, Hrvatska
Okultna i inaktivna HBV infekcija su vjerojatno najčešći oblici kronične HBV infekcije
i od posebnog su značaja zbog moguće reaktivacije bolesti u uvjetima
imunosupresije, čime se značajno povećava morbiditet i mortalitet tih bolesnika.
Reactivation of inactive and occult HBV infection

Marija Bukša, Miro Morović
General hospital Zadar, Zadar, Croatia
OBI and inactive carriers represent the most common forms of HBV infection and
have epidemiological and clinical significance due to the possibility of disease
reactivation in the setting of immunosuppression; this reactivation increases both
morbidity and mortality in these patients.
PO-9 Uloga seroloških testova u dijagnostici hepatitisa C

Nataša Cetinić Balent, Radojka Mikulić, Oktavija Đaković Rode
Klinika za infektivne bolesti „Dr.Fran Mihaljević“, Zagreb, Hrvatska
UVOD: Dijagnostika hepatitisa C započinje serološkim testiranjem pri čemu se za

probir preporuča imunoenzimski test (EIA) četvrte generacije koji istovremeno
određuje antigen i protutijela anti-HCV (HCV Ag-Ab). Komercijalno je dostupan mali
broj kombiniranih testova HCV Ag-Ab i veliki broj anti-HCV treće generacije. U radu
smo analizirali rezultate testa HCV Ab Version 4.0 (Dia.Pro, Italija) i rezultate
rutinskih testova koji se koriste u laboratoriju.
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MATERIJALI I METODE: Usporedili smo rezultate HCV Ab Version 4.0 (Dia.Pro,

Italija) s testovima Monolisa HCV Ag-Ab ULTRA V2 i Monolisa Anti-HCV PLUS
Version 3 (Bio-Rad, Francuska) za 170 seruma pacijenata podijeljenih u četiri grupe:
20 s pozitivnim anti-HCV (grupa 1), 20 s akutnom EBV-infekcijom (grupa 2), 100
HIV-bolesnika (grupa 3) i 30 s pozitivnim HBsAg (grupa 4). Sve EIA-reaktivne nalaze
potvrdili smo imunoblotom.
REZULTATI: Osim HCV-bolesnika iz prve grupe, anti-HCV bio je pozitivan u 4/100
HIV-bolesnika i 4/30 s pozitivnim HBsAg. Sva tri testa dala su jednake rezultate osim
za jedan uzorak s pozitivnim HBsAg koji je bio reaktivan u testu HCV Ab (Dia.Pro), a
negativan u ostalim testovima. Statističkom obradom osjetljivost HCV Ab (Dia.Pro)
bila je 100%, a specifičnost 99,3%.
ZAKLJUČAK: Test HCV Ab (Dia.Pro) pokazao je u ovom testiranju dobru korelaciju s
testovima Monolisa HCV Ag-Ab ULTRA i Monolisa Anti-HCV PLUS. Inicijalna
dijagnostika HCV mogla bi započeti testovima treće generacije za anti-HCV uz
obavezno savjetovanje o značenju dijagnostičkog prozora. Za rizične bolesnike
prednost bi trebalo dati kombiniranim testovima HCV Ag-Ab. Svaki reaktivni nalaz
anti-HCV potrebno je potvrditi određivanjem HCV RNK.
Role of serologic assays in diagnostic of hepatitis C

Nataša Cetinić Balent, Radojka Mikulić, Oktavija Đaković Rode
University Hospital for Infectious Diseases „Dr.Fran Mihaljevic“, Zagreb,
Croatia
INTRODUCTION: Diagnostics of hepatitis C begins with serological testing where the

fourth generation enzyme immunoassays (EIA) based on the simultaneous
detection of HCV core antigen and antibodies (HCV Ag-Ab) are generally
recommended for screening. There are only a few of commercially available HCV
Ag-Ab combination assays and large number of the third generation anti-HCV EIA.
In this study we evaluated the results of HCV Ab Version 4.0 (Dia.Pro, Italy) and EIA
which are routinely used in clinical laboratory.
OBJECTIVES AND METHODS: We compared the results of HCV Ab Version 4.0
(Dia.Pro, Italy) with Monolisa HCV Ag-Ab ULTRA V2 and Monolisa Anti-HCV PLUS
Version 3 (Bio-Rad, France) for 170 serum samples from patients divided into four
groups: 20 anti-HCV-positive patients (group 1), 20 patients with acute EBV
infection (group 2), 100 HIV-positive patients (group 3) and 30 HBsAg-positive
patients (group 4). Each reactive results are confirmed by immunoblot.
RESULTS: Including the HCV-positive patients from the group 1, anti-HCV were
positive in 4/100 HIV-positive patients and 4/30 HBsAg-positive patients. All three
assays gave the same results except for one HBsAg-positive sample which was
reactive by HCV Ab (Dia.Pro) and negative by other used assays. Statistical analysis
revealed 100% sensitivity and 99,3% specifity of HCV Ab (Dia.Pro).
CONCLUSION: HCV Ab (Dia.Pro) assay used in this study showed a good correlation
with Monolisa HCV Ag-Ab ULTRA and Monolisa Anti-HCV PLUS. The initial testing
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for HCV could begin with the third generation anti-HCV EIA with further counselling
for significance of the window period. For high-risk patients the use of HCV Ag-Ab
combination assays is recommended for screening. Each reactive screening test
result requires further determination of HCV RNA.
PO-10 Prevalencija i antimikrobna osjetljivost Ureaplasme urealyticum i

Mycoplasme hominis u Požeško-slavonskoj županiji
Sabina Cviljavić1, Božica Lovrić1, Tihomir Jovanović1, Toni Vlainić2
1
Opća županijska bolnica Požega, Požega, Hrvatska
2
Ecolab d.o.o., Zagreb, Hrvatska
CILJ istraživanja je bio utvrditi prevalenciju i antimikrobnu osjetljivost U.

urealyticum i M. hominis u vremenu od 1.1.2011. do 31.12.2015. godine na
području Požeško-slavonske županije.
MATERIJALI I METODE: U istraživanom vremenu obrađeno je 3559 ginekoloških
uzoraka u Mikrobiološkom laboratoriju OŽB Požega. Brisevi su odmah dostavljani u
laboratorij gdje su se obrađivali prema standardnom laboratorijskom protokolu,
koristeći se Mycoplasma IST 2 kitovima. U. urealyticum i M. hominis su se
identificirale promjenom boje medija (od žutog u crveno) budući da metaboliziraju
ureu i arginin koji su dodani u medij zajedno s indikatorom promjene boje.
Antimikrobna osjetljivost je testirana za sedam antibiotika: doxycycline,
tetracycline, azithromycin, erythromycin, clarythromycin, ciprofloxacin, ofloxacin.
Rezultati su očitavani nakon 48 sati inkubacije na temperaturi od 37°C kao
„osjetljivo“, „intermedijarno“, i „rezistentno“ prema Clinical and Laboratory
Standards Institute protokolima.
REZULTATI: Ukupno pozitivnih briseva je bilo 974 (27,3%). Od toga pozitivnih
Ureaplasmi je bilo 876 (24,6%), a pozitivnih Mycoplasmi 98 (2,8%). Distribucija
M.hominis i U.urealyticum po dobnim skupinama je najveća u skupini od 20-29
godina. Antimikrobna osjetljivost U. urealyticum je najveća na tetracycline
(doxycyclin i tetracyclin), a najmanja na kinolonske antibiotike (ciprofloksacin i
ofloksacin), dok je osjetljivost na makrolide (eritromicin, azitromicin, klaritromicin)
umjerena. Antimikrobna osjetljivost M. hominis je najveća na tetracycline
(doxycyclin i tetracyclin), a najmanja na makrolide (eritromicin, azitromicin,
klaritromicin), dok je osjetljivost na kinolonske antibiotike (ciprofloksacin i
ofloksacin) umjerena.
ZAKLJUČAK: Ukupna prevalencija infekcija uzrokovanih s U.urealyticum i M.hominis
iznosi 27,3% što je nešto manje u udnosu na druge države (Grčka 47,4%; Italija
44,5%; Kina 33,9%; Poljska 33,5%). To se može objasniti konzervativnom sredinom i
običajima koji iz toga proizlaze. Infekcije uzrokovane s U.urealyticum su znatno
češće (24,6%) u odnosu na infekcije uzrokovane s M.hominis (2,8%). U empirijskom
liječenju infekcija uzrokovanih U.urealyticum i M.hominis kao prvi lijek izbora
preporučuju se tetracyclini, što je u skladu s istraživanjima drugih autora.
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Prevalence and antimicrobial susceptibility of Ureaplasma urealyticum

and Mycoplasma hominis in Požega-Slavonia County
Sabina Cviljavić1, Božica Lovrić1, Tihomir Jovanović1, Toni Vlainić2
1
General County Hospital Požega, Požega, Croatia
2
Ecolab d.o.o., Zagreb, Croatia
OBJECTIVE: The objective of this study was to determine the prevalence and
antimicrobial susceptibility of U. urealyticum and M. hominis in the period from
1.1.2011. to 31.12.2015. in the field of Pozega-Slavonia County.
MATERIALS AND METHODS: In the study period were processed 3559 gynecological
samples in microbiological laboratory of General Hospital Pozega. The swabs were
immediately delivered to the laboratory where they are processed according to
standard laboratory protocol using Mycoplasma IST 2 strips. U. urealyticum and M.
hominis were identified by changing the color of the media (from yellow to red) as
they metabolize urea and arginine which were added to the medium together with
the indicator changes color. Antimicrobial susceptibility was tested in seven
antibiotics: doxycycline, tetracycline, azithromycin, erythromycin, clarythromycin,
ciprofloxacin, ofloxacin. The results were read after 48 hours incubation at 37 ° C as
"sensitive", "intermediate", and "resistant" to the Clinical and Laboratory Standards
Institute protocols. RESULTS: Total positive swabs were 974 (27.3%). Of this
positive Ureaplasma was 876 (24.6%), and Mycoplasma positive 98 (2.8%).
Distribution M. hominis and U. urealyticum by age group is the largest in the group
of 20-29 ages. Antimicrobial sensitivity of U. urealyticum is the largest in the
tetracycline group (doxycycline and tetracycline), and the lowest in the quinolone
antibiotics (ciprofloxacin and ofloxacin), while the sensitivity of macrolides
antibiotics (erythromycin, azithromycin, clarithromycin) is moderate. Antimicrobial
susceptibility of M. hominis is the largest in tetracycline group (doxycycline and
tetracycline), and the lowest in macrolide group (erythromycin, azithromycin,
clarithromycin), while the sensitivity to quinolone antibiotics (ciprofloxacin and
ofloxacin) is moderate. CONCLUSION: The overall prevalence of infection caused by
U. urealyticum and M. hominis is 27.3% which is slightly less higher in relation to
other countries (Greece 47.4%, Italy 44.5%, China 33.9%, Poland 33, 5%). This can
be explained by the conservative enviroment and practices arising from it.
Infections caused by U. urealyticum are more frequently (24.6%) compared to
infection with M. hominis (2.8%). In the empirical treatment of infections caused by
U. urealyticum and M. hominis as the first drug of choice recommended
tetracycline, which is in line with research by other authors.
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PO-11 Epidemiologija invazivnih bakterijskih bolesti u djece prije i nakon

uvođenja cijepljenja protiv Haemophilus influenzae tipa b
Diana Didović1, Neven Papić2, Maja Vrdoljak2, Iva Butić2, Elvira Čeljuska
Tošev2, Ivica Knezović2, Goran Tešović2
1
Sveučilište u Zagrebu, Medicinski Fakultet, Zagreb, Hrvatska
2
Klinika za infektivne bolesti “Dr. Fran Mihaljević”, Zagreb, Hrvatska
Uvod: H. influenzae tip b, S. pneumoniae i N. meningitidis su prije uvođenja

konjugiranog Hib cjepiva bili vodeći uzročnici invazivnih bakterijskih bolesti (IBB) u
djece mlađe od 5 godina. U zemljama koje su uvele rutinsko cijepljenje
konjugiranim Hib cjepivom došlo je do značajnog pada incidencije, a gotovo i
nestanka invazivne H. influenzae bolesti (IHB).
Cilj: Prikazati učestalost i karakteristike IBB u djece i adolescenata mlađih od 18
godina prije i nakon uvođenja konjugiranog Hib cjepiva u hrvatski nacionalni
imunizacijski program (NIP) 2002. godine.
Ispitanici i metode: Retrospektivna analiza elektronskih i arhivskih podataka Klinike
za infektivne bolesti „Dr. Fran Mihaljević“ (KIB FM).
Rezultati: Obuhvaćeno je 1112 bolesnika u dobi od 0 do 18 godina s etiološki
dokazanom IBB. Bolesnici su podijeljeni u tri razdoblja: prvo (referentno) razdoblje
prije uvođenja Hib cjepiva te u dva postvakcinalna razdoblja. Do statistički značajne
promjene udjela u drugom razdoblju došlo je za meningokok (p<0,05), BHSB
(p<0,05) i H. influenzae (p<0,0001), a taj se trend održao i u trećem razdoblju za H.
influenzae (p<0,0001). Također, bilježi se pad u broju slučajeva Hib meningitisa
(p<0,0001).
Zaključak: Uvođenje Hib cjepiva u hrvatski NIP dovelo je do značajnog smanjenja
incidencije IHB. S. pneumoniae i N. meningitidis i dalje su vodeći uzročnici IBB stoga
valja razmatrati uvođenje adekvatnog pneumokoknog i meningokoknog cjepiva u
hrvatski NIP.
Epidemiology of invasive bacterial disease in children before and after the

introduction of vaccination against Haemophilus influenzae type b
Diana Didović1, Neven Papić2, Maja Vrdoljak2, Iva Butić2, Elvira Čeljuska
Tošev2, Ivica Knezović2, Goran Tešović2
1
2
Pediatric Infectious Diseases Department, University Hospital for
Infectious Diseases „Dr. Fran Mihaljević“, Zagreb, Croatia
Introduction: H. influenzae type b, S. pneumoniae and N. meningitidis were the

leading causative agents of invasive bacterial diseases (IBD) among children of less
than 5 years of age prior to the introduction of the H. influenzae type b conjugate
vaccine. A significant decrease of invasive H. influenzae diseases (IHD) occured in
nations that implemented routine Hib vaccination in their national immunization
program (NIP).
155
Aim: The goal of this study was to describe the frequency and characteristics of
pediatric patients with IBD before and after implementation of routine Hib
vaccination was implemented into the Croatian NIP.
Subjects and methods: A retrospective analysis of administrative databases at
University Hospital for Infectious Diseases “Dr. Fran Mihaljević”.
Results: A total of 1112 pediatric patients’ (from 0 to 18 years of age) records with
etiologically-proven IBD were analyzed. The patients were divided into three
periods: first (reference) period prior to Hib vaccine introduction and two
postvaccinal periods. During the second period, a statistically significant change in
proportion occured for N. meningitidis (p<0,05), S. agalactiae (p<0,05) and H.
influenzae (p<0,0001). H. influenzae (p<0,0001) maintained this trend during the
third period as well. Additionally, a decrease in Hib meningitis cases was noted
(p<0,0001).
Conclusion: The implementation of Hib vaccine in the Croatian NIP led to a
significant decrease of IHD. S. pneumoniae and N. meningitidis are still the leading
causative agents of IBD and thus the introduction of adequate pneumococcal and
meningococal vaccine in Croatian NIP should be considered.
Key words: children, Haemophilus influenzae type b, invasive bacterial diseases,
Neisseria meningitidis, Streptococcus pneumoniae, vaccination
PO-12 Procijepljenost prema provedbenom programu obveznog cijepljenja

2015. godine u Primorsko - goranskoj županiji
Dorotea Gastović-Bebić1, Danijela Lakošeljac1,2, Dobrica Rončević1, Andrea
Šuran1
1
Nastavni zavod za javno zdravstvo Primorsko - goranske županije, Rijeka,
Hrvatska
2
Medicinski fakultet Sveučilišta u Rijeci, Rijeka, Hrvatska
Stopa procijepljenosti populacije je od posebnog značaja u sprječavanju širenja

epidemija cijepljenjem preventabilnih bolesti. Kako bi se zaštitila cjelokupna
populacija i postigla dostatna kolektivna imunost treba postići razinu
procijepljenosti od 90%, a za ospice i 95%.
Svi cjepitelji dužni su voditi evidenciju o izvršenom cijepljenju svake osobe koja
podliježe cijepljenju prema Provedbenom programu obveznog cijepljenja za
određenu godinu protiv difterije, tetanusa, hripavca,dječje paralize, ospica,
zaušnjaka, rubeole, tuberkuloze, hepatitisa B i bolesti izazvanih Haemophilus infl.
tipa b., te o tome godišnje dostaviti podatke odsjeku za cijepljenje epidemiološkog
odjela NZZJZ PGŽ , kao i o broju djece određene dobi koja su u njihovoj skrbi. Nakon
epidemiološke obrade podataka utvrđuje se procijepljenost protiv određenih
bolesti.
156
U 2015. godini procijepljenost je najčešće bila viša od 90%. Zabilježena je smanjena

procijepljenost drugim docjepljivanjem protiv difterije, tetanusa i pertussisa kojem
podliježu djeca s navršenih 5 godina starosti, 25,6%. Za sada se ne očekuje
pojavljivanje i moguće širenje ovih bolesti jer je procijepljenost svim ostalim
dozama protiv tih bolesti zadovoljavajuća (iznad 90%).
Zabilježena je i smanjena procijepljenost prvom dozom cjepiva protiv ospica,
rubeole i zaušnjaka, kojem podliježu djeca s navršenih 12 mjeseci, a iznosi 92%.
Ovako niska procijepljenost mogla bi predstavljati potencijalnu opasnost za
pojavnost i širenje Ospica, što se i dogodilo u manjoj mjeri 2015. godine.
Procijepljenost protivTetanusa osoba u dobi iznad 60 godina je izuzetno mala,a
iznosi svega 32,4%.
Ako se analizira procijepljenost unazad šest godina, može se uočiti trend pada
procijepljenosti gotovo protiv svih bolest.
Nastavi li se taj negativni trend uzrokovan sve većim brojem roditelja koji odbijaju
cijepljenje svoje djece, uskoro će se povećati broj neimunih koji će se moći zaraziti
uzročnicima i proširiti bolesti. Time bi se ugrozili oni koji se ne smiju cijepiti zbog
prirode svoje osnovne bolesti, zbog koje bi mogli imati ozbiljne posljedice ukoliko
obole od bolesti preventabilnih cijepljenjem.
Immunization coverage after the implementation of mandatory

childhood vaccination programme in 2015 in Primorje-Gorski Kotar
County
Dorotea Gastović-Bebić1, Danijela Lakošeljac1,2, Dobrica Rončević1, Andrea
Šuran1
1
Teaching Institute of Public Health Primorsko-goranska County, Rijeka,
Croatia
2
University of Rijeka School of Medicine, Rijeka, Croatia
The rate of vaccination of the population is of particular importance in preventing

the spread of epidemic of vaccine-preventable diseases. To protect the entire
population and achieve sufficient collective immunity should achieve the level of
vaccination coverage of 90%, and for measles 95%.
All vaccinators are required to keep a record of completed immunization of any
person subject to the Vaccination program, according to the Implementation of
compulsory vaccination for the year against diphtheria, tetanus, whooping cough,
polio, measles, mumps, rubella, tuberculosis, hepatitis B and diseases caused by
Haemophilus infl. type B., and annually submit the information to Department of
Immunisation of Epidemiological department Teaching institute of Public health of
County Primorsko-goranska, as well as the number of children of a certain age who
are in their care. After epidemiological data processing, vaccination against certain
diseases is determined.
In 2015, the vaccination rate was higher than 90%. There was a reduced
vaccination other booster dose of diphtheria, tetanus and pertussis which are
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subject to children from the age of 5 years of age, 25.6%. For now, it is not
expected appearance and possible spread of these diseases, because the
vaccination all other doses against these diseases is satisfactory (above 90%).
There was a decrease vaccination first dose of the vaccine against measles, rubella
and mumps, which are subject to the children reached the age of 12 months, which
is 92%.. Immunization coverage against tetanus people aged over 60 is extremely
small, and is only 32.4%.
If we analyze vaccination six years back, it can be observed the trend of falling
vaccination against almost any disease.
If this negative trend caused by the growing number of parents who refuse
vaccination of their children continues, it will soon increase the number of non-
immune to be able to infect causes and expand disease.
PO-13 Karditis u lajmskoj boreliozi - sporadičan, no reverzibilan uzrok

atrioventrikularnog bloka
Branimir Gjurašin, Mia Ajduković, Snježana Rakušić, Neven Papić
Karditis u lajmskoj boreliozi rijetka je, no potencijalno opasna manifestacija

infekcije bakterijom Borrelia burgdorferi (Bb). Iako se najčešće manifestira
atrioventrikularnim (AV) blokom različitog stupnja, prisutnost ozbiljnih srčanih
aritmija može uzrokovati iznenadnu srčanu smrt.
Prikazujemo dva bolesnika sa serološki potvrđenim kontaktom sa Bb, podatkom o
recentnom ugrizu krpelja i naglim nastupom smetnji AV provođenja, a bez
anamnestičkog podatka o smetnjama srčanog provođenja od ranije.
U 26-godišnjeg bolesnika, bolest se manifestirala bolom u prsima i dispnejom
(NYHA II) trećeg dana liječenja erythema chronicum migrans (ECM), kojeg je
primjećivao unazad mjesec dana. Liječenje je započeto doksiciklinom.
Elektrokardiografski (EKG) je detektiran AV bok prvog stupnja (PR 260ms). Srčani
enzimi bili su unutar referentnih vrijednosti. Provedeno je intravenozno liječenje
ceftriaksonom u trajanju od tri tjedna. Nakon 48 sati od početka liječenja, dolazi do
nestanka srčanog bloka te je 24-satni Holter-EKG po otpustu bio uredan.
Drugi bolesnik, 46 god., hospitaliziran je zbog naglo nastale sinkope uslijed
potpunog AV bloka, a mjesec dana nakon ugriza krpelja. Hitno mu je ugrađen trajni
srčani elektrostimulator. Koronarografski nalaz i rutinske laboratorijske pretrage
bile su uredne za dob. Dva tjedna nakon otpusta iz bolnice zadobio je novi ugriz
krpelja, zbog čega se posumnjalo da je infekcija Bb uzrok AV bloka, iako se pacijent
nije prisjećao prethodne kožne promjene tipa ECM. Serološkim testovima (ELISA i
WB) potvrđen je kontakt sa Bb u IgM i IgG klasi. Započeto je intravenozno liječenje
ceftriaksonom, te je nakon treće doze EKG pokazao potpunu regresiju AV bloka (PR
180ms, bez ekstrasistola).
158
Prikazom naših bolesnika želimo naglasiti važnost lajmskog karditisa kao razlog
naglo nastalog AV bloka u endemskim područjima za Bb. Pravovremeno
antimikrobno liječenje dovodi do brze regresije poremećaja srčanog provođenja,
čime se može otkloniti potreba za ugradnjom trajnog srčanog elektrostimulatora.
Lyme carditis – a sporadic, but reversible cause of atrioventricular block

Branimir Gjurašin, Mia Ajduković, Snježana Rakušić, Neven Papić
Croatia
Lyme carditis is a rare, but potentially severe manifestation of Borrelia burgdorferi

(Bb) infection. Although it usually presents as a atrioventricular (AV) conduction
block of varying degree, the occurrence of severe cardiac arrhythmias can lead to
sudden cardiac death.
Here we present two male patients with no history or cardiac conduction
abnormalities that had serologically confirmed exposure to Bb, sudden onset of AV
conduction disturbances and a history of recent tick bite.
The 26-year-old patient initially presented with erythema chronicum migrans
(ECM) which appeared one month ago. Third day of doxycycline therapy, he
developed chest pain and dyspnea (NYHA II). His resting electrocardiogram (ECG)
revealed a 1st degree AV block (PR 260ms). Cardiac enzymes were within normal
range. He was treated with intravenous ceftriaxone for 3 weeks. The heart block
reverted to normal rhythm after 48 hours of treatment and 24-hour Holter-EKG
was normal post-discharge.
The second case was a 46-year-old patient that had an episode of syncope one
month after a tick bite. Due to the complete, symptomatic AV block, he underwent
emergent permanent pacemaker insertion. Coronary angiogram was normal for
age, as well as routine laboratory tests. Two weeks after hospital discharge, he had
a new tick bite that raised suspicion on Bb as a cause of AV block, although patient
didn’t recall ECM. Serology was positive for IgM and IgG in ELISA and WB. The
patient started the outpatient ceftriaxone treatment, and after 3rd dose his ECG
showed complete resolution of AV block (PR 180ms, no ES activity).
These cases highlight the importance of Lyme carditis as a cause of sudden onset of
AV block in Bb endemic areas. Since early antibiotic treatment is associated with
rapid resolution of conduction abnormalities, the necessity for permanent
pacemaker can be avoided in majority of cases.
159
PO-14 Osjetljivost uropatogenih izolata Escherichia coli i Enterococcus spp. na

ekstrakte listova planike (Arbutus unedo L.)
Ivana Gobin1, Gabrijela Begić1, Davorka Repac Antić1,2, Karlo Jurica3, Slaviša
Stanković4, Maja Abram1,2
1
Zavod za mikrobiologiju i parazitologiju, Sveučilište u Rijeci, Medicinski
fakultet, Rijeka, Hrvatska
2
3
Uprava za poslove posebne sigurnosti, Ministarstvo unutarnjih poslova,
Zagreb, Hrvatska
4
Zavod za mikrobiologiju, Biološki fakultet, Sveučilište u Beogradu, Beograd,
Srbija
Cilj ovog istraživanja je bio procijeniti antibakterijsko djelovanje ekstrakata listova

planike (Arbutus unedo L.) prema uropatogenim bakterijama. Arbutus unedo L. je
vrsta planike, široko rasprostranjena na mediteranskom području. Poznato je da
listovi planike posjeduju nekoliko bioloških svojstava, kao što su npr.
protuagregirajuće, laksativno, protuupalno itd. Antimikrobni učinak ekstrakata lišća
planike protiv najčešće izoliranih uropatogenih izolata Escherichia coli i
Enterococcus spp. određen je pomoću agar difuzijske i mikrodilucijske metode. Naši
rezultati pokazuju da su svi testirani sojevi Enterococcus spp. visoko osjetljivi prema
ekstraktima lišća planike. No, svi testirani sojevi E. coli i Enterococcus spp. su
osjetljivi na hidrokinon, metaboličku bioaktivnu molekulu, koji se u organizmu
prevodi iz arbutina koji je prisutan u visokoj koncentraciji u lišću planike.
S obzirom na značajan antibakterijski učinak protiv uropatogenih bakterija,
ekstrakti lista planike bi se potencijalno mogli koristiti u prevenciji i kao potpora u
liječenju infekcija mokraćnog sustava.
Susceptibility of uropathogenic strain of Escherichia coli and Enterococcus

fecalis on strawberry tree (Arbutus Unedo L.) leaf extracts
Ivana Gobin1, Gabrijela Begić1, Davorka Repac Antić1,2, Karlo Jurica3, Slaviša
Stanković4, Maja Abram1,2
1
Department of Clinical Microbiology, University Hospital Center Rijeka,
Rijeka, Croatia
2
Department of Clinical Microbiology, Clinical Hospital Centre Rijeka, Rijeka,
Croatia
3
Special Security Operations Directorate, Ministry of the Interior, Zagreb,
Croatia
4
Department of Microbiology, Faculty of Biology, University of Belgrade,
Belgrade, Serbia
The objective of the present study was to evaluate strawberry tree (Arbutus Unedo
L.) leaf extracts for its antibacterial activity against uropathogenic bacteria. Arbutus
unedo L. is a species of strawberry tree, widely represented in the Mediterranean
160
climates. The leaves have been reported to possess several biological properties
such as anti-aggregant, laxative, anti-inflammatory, etc.
The antimicrobial potential of strawberry tree leaves extracts against the most
common uropathogens, Escherichia coli and Enterococcus spp., was determined
using agar well diffusion and microdilution methods. In contrast to mild effect to E.
coli, all Enterococcus strains showed high susceptibility to strawberry tree leaves
extracts. However, all tested E. coli and Enterococcus strains were higly sensitive to
hydroquinone, metabolic bioactive molecule which is converted from arbutin
presented at high concentration in the strawberry tree leaves.
In conclusion, strawberry tree leaves extract showed great antibacterial potential
against tested uropathogenic bacteria and could be used in the prevention and as
support in the treatment for urinary tract infections.
PO-15 Neurotoksičnost aciklovira u bolesnice na redovitoj hemodijalizi liječene

zbog zoster encefalitisa
Lari Gorup1, Božidar Vujičić2, Biserka Trošelj Vukić1
1
Klinika za infektivne bolesti, Klinički bolnički centar Rijeka, Rijeka, Hrvatska
2
Zavod za nefrologiju, dijalizu i transplataciju bubrega Klinike za internu
medicinu, Klinički bolnički centar Rijeka, Rijeka, Hrvatska
Prikazan je slučaj 58-godišnje bolesnice poremećenog stanja svijesti s terminalnom

bubrežnom bolesti hospitalizirane u Klinici za infektivne bolesti , KBC Rijeka.
Proteklih 6 godina liječila se redovitom hemodijalizom. Zbog pojave herpes zostera
na desnoj strani grudnog koša, tri dana pred prijem započela je liječenje
aciklovirom (200 mg pet puta dnevno). Dan pred prijem bolesnica je postala
smetena uz nerazgovjetan govor. Odmah po prijemu učinjena je lumbalna punkcija
kojom je u likvoru nađena blaga mononuklearna pleocitoza uz blagu proteinorahiju,
a naknadno je detektirana i DNK Varicella-zoster virusa (Real-Time PCR).
Nastavljeno je liječenje aciklovirom 1x300 mg intravenski što je u idućih nekoliko
dana rezultiralo poboljšanjem stanja svijesti. Od sedmog dana hospitalizacije kod
bolesnice je ponovno nastupilo pogoršanje stanja svijesti koje se kretalo od
smetenosti uz psihomotorni nemir do stupora. Budući da su neurološki simptomi
najvjerojatnije bili uzrokovani neurotoksičnim djelovanjem aciklovira, primjena
istog je obustavljena te je učinjeno intenzivirano intermitentno hemodijalizno
liječenje nakon kojeg je uslijedio brzi oporavak neuroloških simptoma.
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Neurotoxicity of acyclovir in a hemodialyzed patient with zoster

encephalitis
Lari Gorup1, Božidar Vujičić2, Biserka Trošelj Vukić1
1
Infectious Diseases Department, University Hospital Center Rijeka, Rijeka,
Croatia
Department of Nephrology, Dialysis and Kidney Transplantation, Clinic of
Internal Medicine, University Hospital Center Rijeka, Rijeka, Croatia
The case of 58-year-old female patient with end-stage renal disease who was
admitted to the Infectious Diseases Department with altered mental status is
reported. She was on regular hemodyalisis (HD) for previous 6 years. Three days
before admission she developed herpes zoster on the right side of her chest and
oral acyclovir (200 mg five times daily) was initiated. One day before admission she
became confused with slurred speech. Immediately after the admission a lumbar
puncture was performed and the cerebrospinal fluid (CSL) analysis showed mild
mononuclear pleocytosis with slightly elevated protein level , and subsequently
Varicella-zoster virus DNA was detected in CSL by Real-Time PCR. Acyclovir therapy
in a dose od 300 mg intravenously once daily was continued and the patient´s
mental status improved over the next few days. From the seventh day of hospital
stay deterioration of her mental status was noted again starting with confusion and
agitation and progressing to stupor. Acyclovir neurotoxicity was considered the
most likely cause of neurological symptoms . Therefore acyclovir was stopped and
intensified intermittent HD treatment was performed after which there was rapid
recovery from the neurological symptoms.
PO-16 Različite značajke pandemijske influence kod odraslih bolesnika u

2009/10 i 2011/12.
Svjetlana Grgić1,2, Siniša Skočibušić1,2, Elvira Čeljuska-Tošev3, Jadranka
Nikolić1,2, Jurica Arapović1,2, Ilija Kuzman3
1
Klinika za infektivne bolesti, Sveučilišna klinička bolnica Mostar, Mostar,
Bosna i Hercegovina
2
Medicinski fakultet Sveučilišta u Mostaru, Mostar, Bosna i
Hercegovina
3
Klinika za infektivne bolesti „Dr. Fran Mihaljević“, Medicinski fakultet
UVOD: Infekcija uzrokovana virusom Influence A H1N1pdm09 prezentira se

epidemiološki i klinički kao teška bolest uglavnom praćena razvojem upale pluća,
što je rezultiralo visokom stopom smrtnosti. Svrha ovog rada bila je istražiti i
usporediti epidemiološke i kliničke osobitosti influence A H1N1pdm09 virusne
162
infekcije u bolesnika hospitaliziranih tijekom pandemije (2009/10) i post-

pandemijske sezone (2010/11).
METODOLOGIJA: Analizirani su podaci u odraslih bolesnika s laboratorijski
potvrđenim virusom influence A H1N1pdm09 hospitaliziranih i liječenih u Klinici za
infektivne bolesti Dr. Fran Mihaljević u Zagrebu u prve dvije sezone izgleda.
REZULTATI: U usporedbi s pandemijskom sezonom, u post-pandemijskoj sezoni
pacijenti su bili hospitalizirani dulje, imali su više vrijednosti upalnih parametara i
češće su liječeni antibioticima. Ukupan broj rizičnih čimbenika u bolesnika nisu se
značajno razlikovali između dvije sezone. U pandemijskoj sezoni je zabilježen
znatno veći broj pretilih bolesnika i bolesnika s kroničnom bolesti pluća, dok je u
post-pandemijskoj sezoni statistički značajan veći broj bolesnika s kroničnim
srčanim i neuromuskularnim bolestima. Primarna virusna pneumonija često je
registrirana u mlađih odraslih osoba tijekom pandemijske sezone, dok je u post-
pandemijskog sezone zabilježen veći broj bolesnika s bakterijskom upalom pluća.
ZAKLJUČAK: U pandemijskoj sezoni influenca je bila znatno teža i smrtonosnija
bolest u usporedbi sa sezonskom, s rijeđim bakterijskim komplikacijama u odraslih
bolesnika. U postpandemijskoj sezoni zabilježili smo niz epidemioloških i kliničkih
odstupanja od prethodne pandemijske sezone s postupnim približavanjem
karakteristikama sezonske influence.
Different features of influenza A H1N1pdm09 virus infection among

adults in 2009/10 and 2010/11
Svjetlana Grgić1,2, Siniša Skočibušić1,2, Elvira Čeljuska-Tošev3, Jadranka
Nikolić1,2, Jurica Arapović1,2, Ilija Kuzman3
1
Clinic for Infectious Diseases, University Hospital Mostar, Mostar, Bosnia
and Herzegovina
2
Faculty of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
3
University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, University
INTRODUCTION: Influenza A H1N1pdm09 virus infection causes an

epidemiologically and clinically severe disease mostly characterized by pneumonia,
resulting in a high mortality rate. The purpose of this study was to investigate and
compare epidemiological and clinical characteristics of influenza A H1N1pdm09
virus infection in patients hospitalized during the pandemic (2009/10) and post-
pandemic seasons (2010/11).
METHODOLOGY: The data of patients with laboratory-confirmed influenza A
H1N1pdm09 virus infection hospitalized and treated at the University Hospital for
Infectious Diseases „Dr. Fran Mihaljević“ in Zagreb, Croatia in the first two seasons
of appearance were analyzed.
RESULTS: Compared to the pandemic season, in the post-pandemic season,
patients were hospitalized longer, had higher values of inflammatory parameters,
and were more often treated with antibiotics. The total number of risk factors in
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patients did not vary significantly between the two seasons. In the pandemic
season, a significantly higher number of obese patients and patients with chronic
lung disease was observed, whereas in the post-pandemic season, a statistically
significant number of patients presented with symptoms of chronic cardiac and
neuromuscular diseases. Primary viral pneumonia was frequently registered in
younger adults during the pandemic season, whereas in the post-pandemic season,
there were more cases of bacterial pneumonia.
CONCLUSIONS: During the pandemic season, the influenza A H1N1pdm09 virus
infection caused a severe disease with rare bacterial complications, especially in
adult patients. The common characteristics of the influenza A H1N1pdm09 virus
were lost in the post-pandemic season, assuming the shape and characteristics of
the seasonal influenza A virus.
PO-17 Izolati Aerococcus urinae u Kliničkom bolničkom centru Sestre

milosrdnice-laboratorijska dijagnostika i klinički značaj
Ana Gverić Grginić1, Carmen Prohaska Potočnik1, Vinko Vrdoljak2, Iva
Butić3
1
Zavod za mikrobiologiju, parazitologiju i bolničke infekcije, KBC Sestre
milosrdnice, Zagreb, Hrvatska
2
Klinika za pedijatriju, KBC Sestre milosrdnice, Zagreb, Hrvatska
3
UVOD. Aerococcus urinae je Gram-pozitivna bakterija s makroskopskim

karakteristikama viridans grupe streptokoka i nekih enterokoka jer kultivacijom na
krvnom agaru stvara α-hemolizu i nema katalazu. Stoga je radi mogućnosti greške u
laboratorijskoj obradi ovakvih kolonija potrebno pregledati preparat jer za razliku
od ovih vrsta koje diobom bakterijske stanice čine parove i lance, vrste iz roda
Aerococcus dijele se stvarajući nakupine i imaju mikroskopsku morfologiju
stafilokoka.
Aerococcus urinae uzrokuje infekcije mokraćnog sustava s često opisanim
komlikacijama sepsom i endokarditisom, te rijetko infekcije mekog tkiva,
spondilodiscitis i peritonitis.
CILJ. Utvrditi broj klica i klinički značaj izolata Aerococcus urinae.
METODE. Provedeno je prospektivno istraživanje primarno sterilnih uzoraka i
uzoraka urina u razdoblju od 2012. do 2016. u Zavodu za mikrobiologiju KBC Sestre
milosrdnice.
Uzorci su inokulirani na 5%-krvnom agaru. Sojevi izoliranih α-hemolitičnih kolonija
koji su bojanjem po Gramu u mikroskopskom preparatu imali izgled nakupina
identificirani su ApiStrep sustavom (bioMerieux, France). Dodatna identifikacija
masenom spektrofotometrijom Vitek MS (bioMerieux) učinjena je u Zavodu za
kliničku mikrobiologiju Klinike za infektivne bolesti. Iz uzoraka urina obrađivani su
164
izolati s ≥105 CFU/ml. Antimikrobna osjetljivost sojeva određena je EUCAST

metodom. Klinički značaj izolata procijenjen je pregledom povijesti bolesti.
REZULTATI. Izolirana su 4 bakterijska soja Aerococcus urinae iz uzoraka urina. Dvoje
bolesnika liječeno je u Klinici za dječje bolesti zbog infekcije mokraćnog sustava.
Izolati kod dva odrasla izvanbolnička bolesnika predstavljali su asimptomatsku
bakteriuriju.
ZAKLJUČAK. Aerococcus urinae je rijedak izolat i uzročnik infekcija. Dijagnostika
infekcija mokraćnog sustava predstavlja izazov jer se ova vrsta može zamijeniti
vrstama normalne urogenitalne mikrobiote. Svi izolati α-hemolitičnih kolonija kod
kojih je mikroskopijom postavljena sumnja na Aerococcus urinae trebaju se
identificirati automatiziranim sustavom. Klinički značaj izolata iz urina ovisi o
bolesniku, kliničkoj slici i leukocituriji.
Budući da nismo pronašli do sad objavljene podatke, ovo je prvi uzvještaj o
Aerococcus urinae u Hrvatskoj.
Aerococcus urinae isolates in University Hospital Center Sestre

milosrdnice-microbiology diagnostics and clinical significance
Ana Gverić Grginić1, Carmen Prohaska Potočnik1, Vinko Vrdoljak2, Iva
Butić3
1
Department of microbiology, parasitology and hospital infection, Clinical
Hospital Center "Sisters of Mercy", Zagreb, Croatia
3
Department of Pediatrics, Clinical Hospital Center "Sisters of Mercy",
Zagreb, Croatia
Croatia
Introduction. Aerococcis urinae is a Gram-positive coccus, with macroscopic

characteristics of streptococci and microscopic features of staphylococci. It
produces α-hemolysis on blood agar, is catalase negative and may be mistaken for
viridans group streptococi. Unlike streptococcal microscopic form of pairs and
chains, Aerococcus species cells devide forming clusters as stapylococci do.
Aerococcus urine causes urinary tract infections with sepsis and endocarditis
compications, and rarely soft tissue infections, spondilodiscitis and peritonitis.
Aim. To establish number and clinical significance of isolates.
Methods. Prospective study of primary sterile and urine samples in period between
2012. and 2016. In Departement of Microbiology in University Hospital Centre
Sestre milosrdnice. Samples were inoculated on 5%-blood agar. Gram's stain of α-
hemolytic colonies was performed. Clusters formed morphology isolated were
identified using automated system ApiStrep (bioMerieux, France) and refferd for
further identification by mass spectrophotometry method Vitek MS (bioMerieux) in
Department of Clinical Microbiology in University Hospital for Infectious Diseases,
Zagreb. Urine samples with significant growth count ≥105 CFU/ml were further
processed. Antibiotitic susceptibility testing was performed according to EUCAST
165
standards. Clinical significance of isolates was estimated by reviewing patients'

charts.
Results. Four strains of Aerococcus urinae were isolated from urine samples. Two
pediatric patients had urinary tract infection and two strains isolated in urine
samples of adult outclinic patients represented asymptomatic bacteriuria.
Conclusion. Aerococcus urinae is rare isolate and causative agent of infection.
Diagnostics of urinary tract infection represent a challenge. Reasons are same
colony appearance of Aerococcus urinae and some normal urogenital microbiota
species. α-hemolitic colonies showing microscopic morphology of Gram-positive
cocci arranged in clusters should be identified by automated identification system.
Clinical significance should be estimated by patients' symptoms and leukocyturia in
urine samples.
Since we coluld not find any published data, this research presents first report on
Aerococcus urinae in Croatia.
PO-18 Klorheksidin u njezi usne šupljine mehanički ventiliranih bolesnika-utjecaj

na incidenciju pneumonija povezanih s mehaničkom ventilacijom
Ana Gverić Grginić1, Velimir Torbica2, Ivona Bete2, Marina Domijan2,
Jasminka Vukelić2, Saša Bareta2, Mirela Dobrić2, Tatjana Beker2, Zoran
Lončar2, Ana Budimir3
1
Zavod za mikrobiologiju, parazitologiju i bolničke infekcije, KBC Sestre
milosrdnice, Zagreb, Hrvatska
2
Zavod za anesteziologiju, reanimatologiju i intenzivno liječenje, Klinika za
traumatologiju, KBC Sestre milosrdnice, Zagreb, Hrvatska
3
Klinički zavod za kliničku i molekularnu mikrobiologiju, KBC-a Zagreb,
Zagreb, Hrvatska
UVOD. Pneumonija povezana s mehaničkom ventilacijom je najčešća infekcija

povezana sa zdravstvenom skrbi u jedinicama intenzivnog liječenja. Uzrok je
povećanju broja dana ventilator-dana, produženom bolničkom liječenju,
povećanom atributivnom riziku smrtnosti i povećanju troškova liječenja.
Prevencija uključuje različite postupke udružene u snopove skrbi. Jedan od
postupaka je njega usne šupljine. Budući da oralna i gastrointestinalna mikrobiota
ima značajnu ulogu u patogenezi pneumonije povezane s mehaničkom
ventilacijom, smanjenje broja mikroorganizama ovom mjerom prevencije pridonosi
smanjenju incidencije i prevalencije.
U njezi usne šupljine koriste se različita antiseptička sredstva. Neke smjernice za
prevenciju preporučuju upotrebu klorheksidina. Međutim, nema konačnog dokaza
o utjecaju određenog antiseptičkog sredstva na prevenciju pneumonija povezanih s
mehaničkom ventilacijom.
166
CILJ. Ispitati utjecaj pripravaka s klorheksidinom u postupku njege usne šupljine na

incidenciju pneumonije u mehanički ventiliranih bolesnika.
METODE. Intervencijska „prije i poslije“ kohortna studija provedena je u Jedinici
intenzivnog liječenja Klinike za traumatologiju Kliničkog bolničkog centra Sestre
milosrdnice. U studiju su uključeni svi bolesnici koji su mehanički ventilirani.
Incidencija pneumonije povezane s mehaničkom ventilacijom određivana je
kvartalno u razdoblju od listopada 2014. do lipnja 2016. U predintervencijskom
razdoblju u njezi usne šupljine upotrebljavani su pripravci hidrogena i Salvia
officinalis. Početkom travnja 2015. umjesto njih, u postupak je uveden pripravak s
klorheksidinom. Druge metode prevencije nisu se mijenjale tijekom studije.
REZULTATI. Incidencija pneumonije povezane s upotrebom klorheksidina u kvartalu
prije intervencije bila je 34.6 na 1000 ventilator-dana. Nakon uvođenja
klorheksidinskog pripravka incidencija se smanjila i iznosila je 17. 4, 10, 6, 4.5 i 19. 1
na 1000 ventilator-dana u slijedećim kvartalima.
ZAKLJUČAK. Uvođenje klorheksidinskog pripravka u njegu usne šupljine imalo je
značajan utjecaj na smanjenje incidencije pneumonije povezane s mehaničkom
ventilacijom u bolesnika liječenih u našoj jedinici intenzivnog liječenja. Potrebno je
provesti daljnja istraživanja kojima bi potvrdili naš zaključak i procijeniti utjecaj
različitih strategija prevencije na pneumonije povezanih s mehaničkom
ventilacijom.
Chlorhexidine in mechanically ventilated patients` oral care-impact on

VAP incidence
Ana Gverić Grginić1, Velimir Torbica2, Ivona Bete2, Marina Domijan2,
Jasminka Vukelić2, Saša Bareta2, Mirela Dobrić2, Tatjana Beker2, Zoran
Lončar2, Ana Budimir3
1
Department of microbiology, parasitology and hospital infection, Clinical
Hospital Center "Sisters of Mercy", Zagreb, Croatia
2
Department of anesthesiology, reanimatology and intensive care, Clinic
for traumatology, Clinical Hospital Center "Sisters of Mercy", Zagreb,
Croatia
3
INTRODUCTION. Ventilator-associated pneumonia (VAP) is the commonest health-

care associated infection in intensive care units, resulting in increased number of
ventilator days, prolonged hospital stay, increased attributable risk of death and
hospital treatment costs.
Prevention strategies include the bundle of methods, among which is oral care.
Since the oral and GI tract microbiota play important role in the VAP pathogenesis,
reduction of microorganisms with this measure should contribute to the reduction
VAP incidence and prevalence.
167
Different antiseptic agents are used for oral care. Numerous guidelines recommend
use of chlorhexidine, but there is no definitive evidence on impact of specific
antiseptic agents on VAP prevention. Besides this, there are other controversies on
this subject, depending on a study design and patients' profile.
AIM. To evaluate the impact of chlorhexidine-based solution use in oral care on
VAP incidence.
Methods. Intervention “before-and-after” cohort study was conducted in Intensive
Care Unit in Traumatology Clinic of University Hospital Centre Sestre milosrdnice.
All mechanically ventilated patients were included in the study. VAP incidence was
calculated quarterly between October 2014. and July 2016. During pre-intervention
period, hydrogen and Salvia officinalis were used for oral care. Chlorhexidine-based
solution was introduced in oral care on April 1st 2015. All other prevention
measures remained the same as prior to intervention.
RESULTS. Prior to chlorhexidine-based solution use, quarter VAP incidence was 34.6
per 1000 ventilator-days. After the introduction of chlorhexidine based solution in
every oral care procedure, VAP incidence decreased to 17.4, 10, 6, 4.5, 7.5 and 19.1
per 1000 ventilator-days in consecutive quarters of 2015. and 2016.
CONCLUSION. Initiation of chlorhexidine-based solution in oral care had a
significant impact on reduction of VAP incidence in mechanically ventilated
patients in our intensive care unit.
Further studies are needed to confirm our conclusion, and to evaluate different
approaches to VAP prevention.
PO-19 Smrtni ishod uzrokovan Mycobacterium gordonae kod bolesnice s

angioimunoblastičnim T limfomom
Hrvoje Holik1, Ivana Vučinić Ljubičić2, Sabina Novaković1, Božena Coha1
1
Odjel za hematologiju i onkologiju, Opća bolnica „Dr. Josip Benčević“,
Slavonski Brod, Hrvatska
2
Dom zdravlja Zagreb Centar, Zagreb, Hrvatska
75-godišnja bolesnica s angioimunoblastičnim T limfomom u 3B stadiju liječena je

kemoterapijski po CHOP (ciklofosfamid, doksorubicin, vinkristin, metilprednizolon)
protokolu s vrlo dobrim odgovorom, postignutom parcijalnom remisijom bolesti. Tri
tjedna nakon završetka zadnjeg ciklusa bolesnica je primljena u lokalnoj bolnici s
obostranom pneumonijom, radiološki intersticijski plućni crtež.
Obzirom na pogoršanje stanja po završetku antibiotskog liječenja (koamoksiklav),
bolesnica je upućena u našu ustanovu zbog sumnje na recidiv bolesti. Nakon
učinjene dodatne obrade u našoj ustanovi te u tercijarnom centru nismo našli
jasnog uzroka intersticijske plućne bolesti. Liječena antibiotskom terapijom
(azitromicin, piperacilin-tazobaktam), antifungalnom (flukonazol) te
kortikosteroidima (metilprednizolon) ali bez poboljšanja stanja te bolesnica umire
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četiri mjeseca od posljednjeg kemoterapijskog ciklusa pod slikom respiratorne

infekcije. Mjesec dana nakon smrti pristiže nalaz kulture iskašljaja s izolacijom
Mycobacterium gordonae. Mišljenja smo kako je upravo navedeni izolat odgovoran
za smrtni ishod u naše pacijentice. Naime pacijentica je imala
imunokompromitirajuću bolest T stanični angioimunoblastični limfom te je primala
i kemoterapiju koja je dodatno kompromitirala njezin imunitet. Također je obzirom
na znakove zahvaćenosti plućnog intersticija nejasne etiologije dodatno u terapiju
uveden kortikosteroid s također nepovoljnim učinkom na imunitet osobito na
ionako kompromitirane T limfocite.
Možemo zaključiti kako kod teško imunokompromitiranih bolesnika a kod kojih
sumnjamo na infektivno zbivanje te nemamo pravog izolata moramo uvijek
pomišljati na saprofitne mikobakterije za koje je potreban dugi period izolacije kako
potencijalno izlječiv pacijent ne bi završio fatalno.
Death caused by possible Mycobacterium gordonae infection in a patient

with angioimmunoblastic T-cell lymphoma
Hrvoje Holik1, Ivana Vučinić Ljubičić2, Sabina Novaković1, Božena Coha1
1
Department of Hematology and Oncology, General Hospital „Dr. Josip
Benčević“, Slavonski Brod, Croatia
2
Healt Centre Zagreb Centar, Zagreb, Croatia
Here we present possible death caused by Mycobacterium gordonae infection in a

patient with angioimmunoblastic T-cell lymphoma. Our patient was severely
immunocompromised in whom we suspect to an infection but we did not have
isolates until she died. After she died we recived positive sputum culture of
Mycobacterium gordonae. We can conclude that in severely immunocompromised
patients in whom we suspect to an infection but we do not have real isolates we
must always think of saprophytic mycobacteria. These mycobacteria requires a long
period of isolation but patients with this mycobacteria are potentially curable if we
apply the appropriate treatment for a sufficiently long period
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PO-20 Antifungalna osjetljivost in vitro, Klinički bolnički centar Zagreb, 2011. –

2016
1
Klinički zavod za kliničku i molekularnu mikrobiologiju, Klinički bolnički
centar Zagreb, Zagreb, Hrvatska
2
Studij medicinsko laboratorijske dijagnostike, Zdravstveno veleučilište
Zagreb, Zagreb, Hrvatska
Liječenje fungalnih infekcija je dugotrajno i skupo.

Izolirani fungi identificirani su morfološkim testovima: ID32, YST Vitek 2
(BioMerieux) i MALDI-TOF MS Bruker. In vitro testovi osjetljivosti provedeni su
metodom minimalne inhibitorne koncentracije (MIK) ATB Fungus 4 i AST Vitek 2
(BioMerieux). Testovi metodom MIK učinjeni su prema protokolima CLSI i EUCAST.
Ukupno je provedeno 6.925 testova metodom MIK: kvasaca, aspergilusa i
oportunističkih plijesni (3.961, 2.644, 320). Broj testova ovisi o količini dostupnih
financijskih sredstava. Primjerice, od ukupno izoliranih C. albicans i C. glabrata
testovi su provedeni samo u 6% i 43% uzoraka. Iz JIL je ukupno učinjeno 3.646
testova, a iz odjela 3.279. Ukupno testova gljiva provedeno je prema mjestu
izolacije: 3884 iz dubokoga dišnog sustava, 792 iz sterilnih tekućina, 639 iz urina i
609 iz rana.
Podaci su za najčešće gljive, bez duplikata: C. albicans (497 MIK) in vitro su
osjetljive na sve antifungike; C. glabrata (1.082 MIK), C. kruzei (471 MIK), C
parapsilosis (303 MIK) in vitro osjetljive su na amfotericin B > 97%. Sve 3 vrste
Candida osjetljive su na ehinokandine (93%, 97%, 97%). C. glabrata su
intermedijarno osjetljive na flukonazol i vorikonazol (82% i 23%), te rezistentne na
flukonazol i vorikonazol (18%, 19%). C. kruzei su intermedijarno osjetljive na
vorikonazol (14 %) te rezistentne na flukonazol i vorikonazol (100%, 7%). C.
parapsilosis su intermedijarno osjetljive na flukonazol i vorikonazol (3 % i 15 %) te
rezistentne na flukonazol i vorikonazol (22%, 6%).
A. fumigatus, A. flavus, A. niger osjetljivi su in vitro na vorikonazol >95% i na
amfotericin B (71%, 2%, 90%).
In vitro osjetljivost funga na antifungike doprinosi odluci o vrsti terapije. Problem je
premali broj testova osjetljivosti i protokoli koji još nisu završeni.
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Antifungal susceptibility in vitro, Zagreb University Hospital Center, 2011 -

2016
1
2
Laboratory Medical Diagnostics, University of Applied Health Sciences
Zagreb, Croatia
Fungal infections treatment is time-consuming and expensive.

Isolated fungi were identified using morphological tests: ID32, YST Vítek 2
(BioMerieux) and MALDI-TOF MS Bruker. In vitro susceptibility tests were done by
the method of the minimum inhibitory concentration (MIC) of ATB Fungus 4 and
AST Vitek 2 (BioMerieux). MIC tests were carried out according to the CLSI and
EUCAST protocols.
A total of 6,925 MIC tests were performed: yeasts, aspergillus, and opportunistic
molds (3,961, 2,644, 320, respectively). The number of tests performed depends on
the amount of funds available for the analysis. For example, out of a total number
of isolated C. albicans and C. glabrata, tests were performed only in 6% and 43%
samples, respectively. A total of 3,646 tests were done from ICUs and 3,279 MIC
tests were performed on samples from hospital departments. According to
isolation site, tests of fungi were performed as follows: 3,884 from the deep
respiratory tract, 792 from sterile liquids, 639 from urine samples, and 609 from
wounds.
MIC analysis according to the types of fungi was made without copy strains. The
data refer to the most common fungi: C. albicans (497 MIC) in vitro were sensitive
to all antifungals. C. glabrata (1,082 MIC), C. kruzei (471 MIC), C. parapsilosis (303
MIC) in vitro were sensitive to amphotericin B > 97%. All 3 types of Candida were
sensitive to echinocandins (93%, 97%, 97%). C. glabrata were intermediately
sensitive to fluconazole and voriconazole (82% and 23%, respectively), and
resistant (18%, 19%, respectively). C. kruzei fungi were intermediately sensitive to
voriconazole (14%), and resistant (100%, 7%, respectively). C. parapsilosis was
intermediately sensitive to fluconazole and voriconazole (3%, 15%, respectively),
and resistant (22%, 6%, respectively).
A. fumigatus, A. flavus, A. niger in vitro were sensitive to voriconazole > 95% and to
amphotericin B (71%, 2%, 90%, respectively).
In vitro susceptibility of fungi to antifungals contributes to the decision on the type
of therapy. The problem is a too small number of MIC tests performed, and
protocols which have not been completed yet.
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PO-21 Invazivne BHS-A infekcije u djece: naše kliničko iskustvo u razdoblju od

siječnja 2000. do siječnja 2016. godine
Andrea Kalaba
Svrha rada: Beta-hemolitički streptokok grupe A je važan patogen dječje dobi sa

širokim rasponom kliničkih prezentacija – od benignih tonzilofaringitisa do životno
ugrožavajućih invazivnih infekcija. Ovaj rad će prikazati naša klinička iskustva sa
invazivnom BHS-A bolešću u djece.
Metode: Prikupili smo podatke iz otpusne dokumentacije pacijenata
hospitaliziranih u Klinici za infektivne bolesti Zagreb, u periodu od siječnja 2000 do
siječnja 2016. godine. Svi su pacijenti imali invazivnu streptokoknu bolest. Kriterij za
dijagnozu bio je izolat BHS-A iz hemokulture i/ili drugog primarno sterilnog uzorka.
Rezultati: U navedenom razdoblju je ukupno 24 djece liječeno pod dijagnozom
invazivne BHS-A bolesti u našoj ustanovi. 16 djece je bilo hospitalizirano (67%), a 8
ih je liječeno putem Dnevne bolnice (33%). Glavne kliničke dijagnoze bile su sepsa –
5 djece; bakterijemija – 4 djece; celulitis sa osteomijelitisom – 4 djece;
osteomijelitis – 3 djece; celulitis – 3 djece; TSS – 2 djece; meningitis 2 djece i
limfadenitis – 1 dijete. Najčešći simptomi pri prijemu bili su febrilitet (96%), lokalno
crvenilo i otok (54%), izrazita lokalizirana bol (29%) i osip (21%). Akutnoj bolesti su
prethodile vodene kozice u 5 djece (20%), streptokokni faringitis u 4 djece (17%).
12 djece je primalo monoterapiju (beta-laktamski antibiotik), a 12 je liječeno
kombiniranom terapijom beta-laktamom i klindamicinom. Jedno dijete je uz to bilo
liječeno kirurški. Jedno dijete sa TSS-om je umrlo, a jednom je djetetu zaostala
pareza facijalisa nakon meningitisa.
Zaključak: Tijekom promatranog razdoblja bilo je 24 djece liječeno zbog invazivne
BHS-A bolesti u našoj Klinici. Većina je bila hospitalizirana, a polovica pacijenata je
liječena kombinacijom beta-laktama i klindamicina. Jedno je dijete umrlo.
Ograničenje ovog rada je relativno malen broj slučajeva, ali je naglašena važnost
pravovremene dijagnoze i liječenja.
Invasive group A streptococcal (iGAS) infection in children: our clinical

experience in the period from January 2000 to January 2016
Andrea Kalaba
Croatia
Background: Group A Streptococcus is an important pathogen in children with a

wide range of clinical manifestations – from benign tonsillopharyngitis to life-
threatening invasive infections. This paper presents our clinical experience with
invasive streptococcal disease in children in the last 16 years.
Methods: We collected data from hospital discharge papers of patients hospitalized
at the University Hospital for Infectious Diseases Zagreb, Croatia, for the period of
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January 2000 to January 2016. All patients had a diagnosis of invasive streptococcal
infection. The criteria for diagnosis was positive blood and/or other primary sterile
site culture.
Results: A total of 24 children were treated for iGAS infection in our Hospital during
the above mentioned period. 16 (67%) children were hospitalized, and 8 (33%)
were treated through day hospital. The main clinical diagnoses were sepsis - 5
children; bacteremia - 4 children; cellulitis with osteomyelitis – 4 children,
osteomyelitis – 3 children, cellulitis – 3 children, toxic shock syndrome (TSS) - 2
children; meningitis - 2 children and lymphadenitis – 1 child. The most common
symptom at the admission was fever (96%), erythema and edema (54%), severe
localized pain (29%) and rash (21%). Varicella preceded streptococcal invasive
disease in 5 children (20%), streptococcal pharyngitis in 4 children (17%).
12 children were treated with monotherapy (beta-lactam antibiotic) and 12
children with a combination of beta-lactam and clindamycin. One child was treated
surgically. A fatal outcome was recorded in one child with TSS, while one child had
facial paresis after meningitis.
Conclusion: During the observation period there were 24 children treated in our
Hospital for iGAS infection. Most of the patients required hospitalization, half of
whom were treated with a combination therapy. Fatal outcome was recorded in
one child. The limitation of this study is a relatively small number of cases, but it
emphasizes the importance of prompt diagnosis and treatment.
PO-22 Analiza uzročnika i antibiotske terapije u bolesnika s febrilnom

neutropenijom uslijed kemoterapije
Hana Kalinić Grgorinić
Opća bolnica Pula, Pula, Hrvatska
UVOD: Febrilna neutropenija je najznačajnija komplikacija u pacijenata s malignom

bolesti koji se liječe kemoterapijom. Ovom retrospektivnom studijom se analizirala
pojavnost bakterija u slučajevima febrilne neutropenije, kao i odabir antibiotske
terapije na Odjelu onkologije s hematologijom u Općoj bolnici Pula.
PACIJENTI I METODE: Studija je obuhvatila pacijente koji su na Odjelu onkologije s
hematologijom liječeni zbog vodeće dijagnoze febrilna neutropenija, u
trogodišnjem razdoblju (od srpnja 2013.g. do srpnja 2016.g.).
REZULTAT: Uključena su 32 pacijenta (ukupno 36 epizoda) s vodećom dijagnozom
febrilna neutropenija.
Febrilna neutropenija je zabilježena u 13 pacijenata (40.6%) s hematološkom
malignom bolesti, i 19 (59.3%) sa solidnim tumorom. Od hematoloških pacijenata,
11 ih je imalo limfom i 2 leukemiju. Među 19 pacijenata sa solidnim tumorom,
febrilna neutropenija se najčešće javila u pacijenata liječenih kemoterapijom zbog
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maligne bolesti debelog crijeva (3), pluća (3), dojke (3), potom jajnika (2), prostate
(2) i u 6 ostalih lokacija.
Infekcija je klinički i/ili mikrobiološki ustanovljena u 22 pacijenta (68.8%), dok u
preostalih 10 (31.2%) nije otkriven uzrok. Najčešće kliničko žarište je bila upala
mokraćnih puteva (6 slučajeva), donjeg dišnog puta (upala pluća u 6 pacijenta) i
gornjeg dišnog puta (4 slučaja). 9 mikrobioloških analiza uzoraka je bilo pozitivno. U
dvije hemokulture izoliran je uzročnik (Klebsiella pneumoniae, Bacillus species), dok
je u urinokulturi u 5 slučajeva izolirana Escherichia coli, jedan Proteus mirabilis i
Enterococcus faecalis.
Po postavljenoj dijagnozi febrilne neutropenije i prijemu na Odjel, prvi izbor
empirijske terapije je bio piperacilin+ tazobaktam (20 pacijenata), meropenem (4
pacijenta), te dvojna terapija ciprofloksacin s amoksicilinom+klavulanskom
kiselinom ili klindamicinom, ili pak monoterapija ciprofloksacin odnosno
amoksicilin+ klavulanska kiselina.
U slučaju pozitivnog rezultata mikrobiološke analize pravovremeno je deeskalirana
antimikrobna terapija.
U 5 slučajeva je prva empirijska antibiotska terapija uslijed neučinkovitosti
zamijenjena. Drugi izbor je predstavljao piperacilin+tazobaktam, karbapenem ili
vankomicin.
Dva pacijenta s epizodom febrilne neutropenije (i značajno uznapredovalom
malignom bolesti) su umrla tijekom liječenja.
ZAKLJUČAK: G-uzročnici su i dalje najčešći izolati u pacijenata s febrilnom
neutropenijom, i radi se o sojevima osjetljivim na uobičajene, prve antibiotske
linije. Budući je mikrobiološki rezultat bio pozitivan u tek 7 uzoraka, a febrilna
neutropenija je vezana uz veliki mortalitet, opravdano je liječenje započeti
širokospektralnim antibioticima usmjerenim prvenstveno prema G-uzročnicima.
The analysis of causative pathogens and antibiotic therapy in patients

with febrile neutropenia undergoing chemotherapy
Hana Kalinić Grgorinić
General Hospital Pula, Pula, Croatia
INTRODUCTION: Febrile neutropenia is the most important complication in patients

treated with cytotoxic chemotherapy. This retrospective study analyzed bacteria
frequency, and choice of antibiotic therapy in patients hospitalized on the
Department for Oncology and hematology in General Hospital Pula.
PATIENTS AND METHODS: Patients with febrile netropenia as leading diagnosis,
during three years period (July 2013- July 2016).
RESULT: 32 patient were included (36 episodes) with febrile neutropenia as leading
diagnosis.
Febrile neutropenia was noted in 13 patients (40.6 %) with hematological
malignant disease and in 19 (59.3%) with solid tumor. Among hematology patients,
11 had lymphoma and 2 leukemia. In 19 patients with solid tumor, febrile
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neutropenia occured in 3 with colorectal carcinoma, 3 with lung cancer, 3 with

breast cancer, 2 with ovarian cancer, 2 with prostate cancer and in 6 patients with
cancer located elsewhere.
Infection was clinically/microbiologically established in 22 patients (68.8%), while in
10 patients etiology remained unknown .The most frequent infection source was
urinary tract (6 cases), lower respiratory tract (pneumonia in 6 patients) and upper
respiratory tract (4 cases). Microbiology analysis was positive in 9 cases; blood
culture was positive in 2 cases (Klebsiella pneumoniae, Bacillus species), and urine
culture in 7 (5 Escherichia coli, 1 Proteus mirabilis and 1 Enterococcus faecalis).
First empirical antibiotic choice was piperacillin tazobactam (20 patients),
meropenem (4 patients), then dual antibiotic therapy ciprofloksacin with
amoxicillin+clavulanic acid or klindamicin, or monotherapy with ciprofloxacin or
amoxicillin clavulanate.
In case of positive microbiology analysis antibiotic was deescalated according
antibiogram.
Due to lack of clinical succes, in 5 patients first choice empirical antibiotic therapy
was replaced with carbapenem, piperacillin tazobactam or vancomycin.
Two patients with febrile neutropenia (and advanced malignant disease) died
during hospitalization.
CONCLUSION: G negative rods were the most frequent islolates in patients with
febrile neutropenia, and they are still susceptible on usual, first line antibiotics.
Since microbiological specimen was positive in only 9 cases, and febrile
neutropenia is high mortality condition, it is justfied to choose empirically broad-
spectrum antibiotic directed in the first place towards G negative bacteria.
PO-23 Plućni apsces u djece - prikaz bolesnika s kratkim osvrtom

Ivica Knezović, Leo Markovinović, Srđan Roglić, Goran Tešović
Plućni apsces u djece nije česta bolest. U većini slučajeva posrijedi je komplikacija
bakterijske pneumonije iz opće populacije. Primarni se plućni apsces javlja u
prethodno zdravoga djeteta, a sekundarni se plućni apsces javlja u onih s drugim
osnovnim bolestima / komorbiditetima i raznim kondicionirajućim stanjima. I
aerobni i anaerobni mikroorganizmi mogu biti uzročnici plućnog apscesa.
Streptococcus pneumoniae najčešći je uzročnik primarnog plućnog apscesa u djece.
Dijagnoza plućnog apscesa postavlja se na temelju anamneze, kliničke slike i
laboratorijskih pretraga, a potvrđuje se radiogramom i/ili ultrazvukom i
kompjutoriziranom tomografijom (CT) prsnoga koša. Liječenje plućnog apscesa u
djece najčešće je konzervativno (antimikrobno) i uspješno je u 90% slučajeva. U
maloga broja bolesnika u kojih je konzervativno liječenje neuspješno, potrebno je
175
učiniti radiološki vođenu perkutanu drenažu i eventualno kiruršku resekciju.

Prikazujemo 18-mjesečno prethodno zdravo dijete s primarnim plućnim apscesom
kao komplikacijom bakterijske pneumonije iz opće populacije. Etiologija je
potvđena bronhoalveolarnom lavažom (BAL) - iz uzorka je metodom lančane
reakcije polimerazom (PCR) dokazan Streptococcus pneumoniae. Dijete je prva dva
tjedna uspješno liječeno intravenskom primjenom ceftriaksona, a potom još četiri
tjedna peroralnom primjenom cefpodoksima. Klinički je učinak bio povoljan i u
našeg bolesnika nije bilo posljedica plućnog apscesa. Dodatnom obradom nisu
nađene predisponirajuće bolesti ni imunodeficijencije. Roditelji djeteta su
savjetovani o cijepljenju djeteta konjugiranim cjepivom protiv pneumokoka
(PCV13).
Lung abscess in children - a case report and brief overview

Ivica Knezović, Leo Markovinović, Srđan Roglić, Goran Tešović
Department of Pediatric Infectious Diseases, University Hospital for
Infectious Diseases „Dr. Fran Mihaljević“, Zagreb, Croatia
Lung abscess is not common in pediatric patients. In most cases it is a complication

of bacterial community acquired pneumonia (CAP). The primary lung abscess
occurs in a previously healthy patient with no underlying conditions. The secondary
lung abscess occurs in patients with underlying disorders or predisposing
congenital or acquired conditions. The etiology depends on pathophysiology of
pediatric lung abscess and various risk factors present in patients with particular
underlying condition. Both aerobic and anaerobic microorganisms can cause
pulmonary abscess in children. The most common pathogen of primary lung
abscess in children is Streptococcus pneumoniae. The diagnosis of lung abscess is
based on medical history, clinical presentation and laboratory analysis, and is
confirmed by chest radiography and/or ultrasonography and computerized
tomography (CT) scan. The treatment of lung abscess in children is mostly
conservative (i.e. antimicrobial therapy) with 90% success. Only a small number of
patients unresponding to conservative treatment require image-guided
percutaneous drainage or surgical resection. We report a 18-month-old previously
healthy male child with primary lung abscess as a complication of bacterial CAP.
The bronchoalveolar lavage (BAL) sample revealed etiology: Streptococcus
pneumoniae was confirmed by polymerase chain reaction (PCR) method. The child
was for the first two weeks successfully treated with intravenous ceftriaxone,
followed by a four-week course of oral cefpodoxime. At the follow up visit, there
were no lung abscess sequelae, no underlying predisposing conditions nor
immunodefficiencies found in our patient. Additionally, the parents of our patient
were advised about active immunization of their child with pneumococcal
conjugate vaccine (PCV13).
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PO-24 Sustavna bartoneloza u bolesnika s transplantiranom jetrom - prikaz

slučaja
Samira Knežević, Biserka Trošelj Vukić, Ivica Poljak
Infekcije su vodeći uzrok smrti u bolesnika s transplantiranom jetrom. Brojni

mogući uzročnici infekcija vezani su uz vrijeme proteklo od transplantacije te
stupanj imunosupresije. Svaka vrućica u transplantiranog bolesnika signal je za
neophodnu brzu dijagnostiku i liječenje. Povišena tjelesna temperatura može biti i
znak odbacivanja transplantata ili upućivati na razvoj hematoloških i drugih
malignih bolesti kojima su ovi bolesnici skloni.
Prikazujemo bolesnika koji je liječen u našoj Klinici zbog vrućice nejasnog uzroka
dvije godine nakon transplantacije jetre. Mezenterijalna limfadenopatija te
splenomegalija sa žarišnim lezijama u slezeni i jetri upućivali su na
limfoproliferativnu bolest ili metastaze malignog tumora. Zbog epidemiološkog
podatka o kontaktu s mačkom učinjena je serologija na Bartonellu henselae koja je
potvrdila infektivnu etiologiju bolesti. Liječenje je provedeno ciprofloksacinom tri
tjedna a nastavljeno doksiciklinom tijekom tri mjeseca. U tijeku liječenja uslijedila je
potpuna klinička, laboratorijska i radiološka regresija bolesti. Osamnaest mjeseci
nakon infekcije bolesnik je u dobrom općem stanju, a transplantirana jetra uredno
funkcionira.
Disseminated Bartonella infection in a liver transplant recipient - a case

report
Samira Knežević, Biserka Trošelj Vukić, Ivica Poljak
Clinic for Infectious Diseases, University Hospital Center Rijeka, Rijeka,
Croatia
Infections are leading cause of death in liver transplant patients. A number of

possible causes of infection is related to the time when transplantion was done and
immunosuppression. Any fever in transplant patients means that rapid diagnostic
tests need to be done and treatment started promptly. Fever can also be a sign of
transplant rejection or hematological and other malignant diseases for which these
patients have an increased incidence of.
We report a case of a patient who has been treated at our clinic for fever of
unknown origin two years following liver transplantation. Mesenteric
lymphadenopathy and splenomegaly with focal lesions in the spleen and liver
pointed to lymphoproliferative disease or metastases of a malignant tumor. Due to
epidemiology information of contact with a cat, Bartonella henselae serology was
done which confirmed the infectious etiology of the disease.
The patient was treated with ciprofloxacin for three weeks followed by doxycycline
over the next three months. Clinical, laboratory and radiological signs of infection
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have regressed over observed period of time. Patient is currently alive with a well
functioning liver graft 18 months following this infection.
PO-25 Epidemiološki prikaz karbapenemaza producirajućih enterobakterija u

Varaždinskoj Županiji
Iva Košćak, Sonja Obranić, Tamara Kukovec, Suzana Smrekar Sironić,
Ksenija Vugrinec-Kunštek
Zavod za javno zdravstvo Varaždinske županije, Varaždin, Hrvatska
Karbapenemaze pripadaju skupini β-laktamaza koje hidroliziraju karbapeneme, kao

i većinu β-laktamskih antibiotika. Geni koji ih kodiraju lako se prenose
horizontalnim prijenosom između različitih bakterijskih vrsta. Infekcije uzrokovane
sojevima koji proizvode karbapenemaze teško se liječe te nose rizik većeg
mortaliteta, zbog čega predstavljaju ozbiljnu zdravstvenu prijetnju zajednici. U
ovom radu predstavljamo pojavu i širenje sojeva enterobakterija koji proizvode
karbapenemaze u Varaždinskoj županiji u radzoblju od 2012. godine do danas.
Prvi klinički soj za kojeg je potvrđeno da proizvodi karbapenemazu izoliran je u
Varaždinskoj županiji 2012. godine. Radilo se o ESBL-izolatu Klebsiella pneumoniae
s metalo-β-laktamazom iz skupine VIM. Dva dodatna izolata koja su proizvodila
karbapenemaze potvrđena su 2012. godine (ESBL-izolati K. pneumoniae,
karbapenemaza KPC). U sljedeće dvije godine, potvrđeno je ukupno 6 izolata koji
proizvode karbapenemaze (u svih šest potvrđeno je prisustvo metalo-β-laktamaze,
tip NDM).
2015. godine izolirano je ukupno 66 sojeva koji su proizvodili karbapenemaze. U
većini sojeva pronađen je enzim OXA-48 (58). U četiri izolata pronađena je metalo-
β-laktamaza iz skupine NDM, dok je u preostala četiri izolata potvrđeno prisustvo
metalo-β-laktamaze, tip VIM. U razdoblju od siječnja do kraja kolovoza 2016.
godine u Varaždinskoj županiji izolirana su 22 soja koja su proizvodila
karbapenemaze. U svim slučajevima izolirani su sojevi K. pneumoniae, 21 soj je
proizvodio karbapenemazu OXA-48 i jedan soj u kojem je dokazana metalo-β-
laktamaza, tip NDM. Većina patogena u kojima je 2015. i 2016. godine dokazano
prisustvo karbapenemaza izolirana je iz bolničkog okruženja (74%).
Lokalni epidemiološki podaci prikazani u ovom radu upućuju na nagli porast
pojavnosti patogena koji proizvode karbapenemaze u razdoblju od posljednje dvije
godine. Vrlo je izgledno da će nastaviti takav trend. Zbog toga je od velike važnosti
identifikacija pacijenata koji nose sojeve koji proizvode karbapenemaze te
sprečavanje daljnjeg širenja tih opasnih mikroorganizama. To je moguće primjenom
detaljne kontrole bolničkih infekcija i racionalizacije uporabe antibiotika.
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Epidemiologic Report of the Carbapenemases Producing Enterobacteria in

Varazdin County
Iva Košćak, Sonja Obranić, Tamara Kukovec, Suzana Smrekar Sironić,
Ksenija Vugrinec-Kunštek
Institute of Publich Health of Varaždin County, Varaždin, Croatia
Carbapenemases are β-lactamases that hydrolyse carbapenems and most other β-

lactam antibiotics. Genes encoding these enzymes are easily transferable among
bacterial species through horizontal transfer. Infections caused by carbapenemase
producers have limited treatment options and carry the risk of higher mortality,
therefore posing a serious health threat to the community. In this work we present
the emergence and spread of carbapenemases-producing enterobacteriaceae in
the Varaždin County, Croatia, from the year 2012 till the present day.
The first clinical strain with a confirmed carbapanemase in Varaždin County was
isolated in 2012. It was an ESBL-producing Klebsiella pneumoniae isolate expressing
VIM metallo-β-lactamase. Two additional carbapenemase isolates were confirmed
in 2012, both ESBL-producing K. pneumoniae expressing KPC carbapenemase. In
the two following years the total of 6 carbapenemase-producing isolates have been
confirmed, all of them expressing NDM metallo-β-lactamase.
In the year of 2015 the total of 66 strains expressing carbapenemase enzymes were
isolated, majority of them (58) expressing OXA-48 carbapenemase. Four isolates
were expressing NDM metallo-β-lactamase, and the remaining four had the
presence of VIM metallo-β-lactamase confirmed. In the year of 2016 (January –
August) the total of 22 carbapenemase-producing isolates were confirmed in the
Varaždin County. All of them were K. pneumoniae strains including 21 OXA-48
producers and one NDM metallo-β-lactamase producing strain. The majority of
carbapenemase-producing pathogens isolated in 2015 and 2016 were found in the
hospital setting (74%).
Local epidemiology data presented in this work shows a rapid increase in the
incidence of carbapenemase-producing pathogens during the past two years. It is
very likely that this trend will be continued in the years to come. Therefore, it is of
great importance to identify patients carrying carbapenemase-producing strains
and prevent the further spread of these threatening microorganisms. This can be
done through in-depth control of hospital infections and rational antibiotic use.
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PO-26 Prikaz uporabe SPAD-a za liječenje teške hiperbilirubinemije kod

bolesnika s Weilovom bolešću
Viktor Kotarski, Marko Kutleša, Marija Santini, Renata Josipović Mraović,
Anđa Novokmet, Bruno Baršić
Najteži oblik leptospiroze, poznat kao Weilova bolest, zahvaća više organskih
sustava i među ostalim uključuje poremećaj funkcije bubrega i jetre. Neovisno o
etiologiji, disfunkcija jetre je rizični faktor za povećani broj komplikacija i povećanu
smrtnost. Mnogi toksini koji se akumuliraju pri zatajenju jetre slabo su topljivi u
vodi te se u serumu transportiraju vezani za albumine. Budući da je nemoguće
pratiti koncentraciju svih toksina koji se vežu za albumine, umjesto toga se koristi
koncentracija bilirubina u serumu kao zamjenski marker. Iako se u suportivnoj
terapiji Weilove bolesti često provodi hemodijaliza, ta metoda nema značajnog
utjecaja na serumske koncentracije bilirubina i ostalih toksina vezanih uz albumin.
Kako bi se eliminirali slabo topljivi toksini, potrebne su dodatne metode. Postoji
nekoliko ekstrakorporalnih sustava za podršku funkcije jetre koji se baziraju na
albuminu; Molecular Adsorbents Recirculating Systems (MARS) i Fractionated
Plasma Separation and Adsorption (FPSA), tržišnog naziva Prometheus. Oba
sustava smanjuju hiperbilirubinemiju i dovode do poboljšanja encefalopatije kod
bolesnika s akutnim zatajenjem jetre, ali oba su sustava skupa i za rukovanje njima
potrebno je posebno osposobljeno osoblje. Kao alternativa, SPAD (single-pass
albumin dialysis) u više se in vivo i in vitro studija pokazao kao učinkovita metoda
eliminacije bilirubina i ostalih toksina vezanih za albumine. Glavna prednost te
metode jest što se može provesti uporabom standardnih uređaja za kontinuiranu
hemodijalizu. U SPAD metodi koristi se dijalizat s visokom koncentracijom albumina
koji samo jednom prođe kroz uređaj za hemodijalizu. U više radova je opisano
korištenje SPAD-a kod bolesnika s akutnim i kroničnim zatajenjem jetre. U ovom
radu opisana je upotreba SPAD-a za smanjenje hiperbilirubinemije i poboljšanje
encefalopatije kod bolesnika s Weilovom bolešću.
The use of single-pass albumin dialysis (SPAD) to correct severe

hyperbilirubinemia in Weil's disease: a case report
Viktor Kotarski, Marko Kutleša, Marija Santini, Renata Josipović Mraović,
Anđa Novokmet, Bruno Baršić
Croatia
Severe leptospirosis, also known as Weil's disease, is characterized by multiorgan

involvement, including acute kidney injury and liver dysfunction. Liver failure,
regardless of the cause, carries a high risk of morbidity and mortality. Numerous
toxins that are accumulated in liver failure are poorly water-soluble and are
transported through the serum by being bound to albumin. Since it is impossible to
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monitor the concentrations of all possible albumin-bound toxins, the concentration

of bilirubin is used as a surrogate. Although management of Weil disease often
includes renal replacement therapy serum concentration of bilirubin and other
albumin-bound toxins is not significantly altered by hemodyalisis. In order to
eliminate bilirubin and other albumin-bound toxins from the serum, additional
detoxification methods are needed. There are several artificial extracorporeal liver
support systems based on the principle of albumin , such as Molecular Adsorbents
Recirculating Systems (MARS) and Fractionated Plasma Separation and Adsorption
(FPSA), commercialized as Prometheus. Both systems reduce hyperbilirubinemia
and improve encephalopathy in patients with liver failure but both are expensive
and require operators with special training. The use of single-pass albumin dialysis
(SPAD) has been shown to be an effective method of eliminating bilirubin and other
albumin-bind toxins in several studies in vitro and in vivo. The main advantage of
this method is that it can be performed using conventional renal replacement
therapy devices. SPAD dialyzes blood against albumin-rich dialysate in a single pass
through the dialyzer. There have been several reports of using SPAD in patients
with liver disease, including acute and chronic liver failure. In this report, the
authors report a case of Weil's disease, in which SPAD was used to correct severe
hyperbilirubinemia and improve encephalopathy.
PO-27 Trombocitopenija i pseudotrombocitopenija tijekom infektivnih bolesti

Sanja Kozić Dokmanović, Vedrana Jukić, Marija Burela, Renata Laškaj
Klinika za infektivne bolesti „Dr. Fran Mihaljević, Zagreb, Hrvatska
Trombocitopenija se definira kao broj trombocita manji od 150x109/L, iako se

klinički pojam trombocitopenije uglavnom odnosi na nalaze trombocita manje od
100x109/L. Trombocitopenija u infektoloških bolesnika može biti posljedica
djelovanja infektivnih uzročnika (virusi, bakterije) i/ili primijenjenih lijekova. Stanje
postaje složenije uz popratnu heparinom uzrokovanu trombocitopeniju (HIT),
diseminiranu intravaskularnu koagulaciju (DIK), maligne bolesti, hipersplenizam ili
alkoholizam.
Pseudotrombocitopenija je lažno smanjen broj trombocita izbrojan od strane
hematološkog analizatora nastao zbog stvaranja nakupina trombocita. Mogući
uzroci pseudotrombocitopenije su neodgovarajući način vađenja krvi, nedovoljno
miješanje uzorka, ali i prisutnost antitijela aktiviranih hlađenjem uzorka i/ili
antitijela aktiviranih u prisutnosti antikoagulansa etilendiaminotetraoctene kiseline
(EDTA). Noviji hematološki analizatori uglavnom signaliziraju prisutnost nakupina
trombocita (Platelet clumps).
Zadatak hematološkog laboratorija je jasno razlučivanje radi li se o pravoj ili o
lažnoj trombocitopeniji. U Odjelu za biokemiju i hematologiju Klinike za infektivne
bolesti "Dr. Fran Mihaljević", Zagreb, trombocitopenije kod hitno traženih analiza
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se rješavaju u dogovoru s liječnicima (saznaju se anamnestički podaci, dob

pacijenta, način uzorkovanja), a nakon toga se odlučuje treba li uzorkovanje
ponoviti. Trombocitopenije kod ostalih uzoraka se analiziraju svjetlosnom
mikroskopijom u cilju dokazivanja prisutnosti nakupina trombocita. Ukoliko su
nakupine trombocita mikroskopski dokazane, preporuka je vađenje novog uzorka s
ciljem pretraživanja na EDTA ovisnu pseudotrombocitopeniju.
Od srpnja 2015. godine tijekom godine dana analizirano je 37156 kompletnih
krvnih slika (KKS), a od toga je 2757 uzoraka imalo broj trombocita manji od
100x109/L, što čini 7,4% od ukupnog broja. Nakupine trombocita mikroskopski su
potvrđene u 93 (0,3%) uzoraka, a EDTA ovisna trombocitopenija potvrđena je u
uzorcima 5 bolesnika.
Iako produžava vrijeme izdavanja nalaza, mikroskopski pregled razmaza periferne
krvi je nezaobilazna pomoć u razlučivanju trombocitopenije i
pseudotrombocitopenije.
Thrombocytopenia and pseudothrombocytopenia during infectious

diseases
Sanja Kozić Dokmanović, Vedrana Jukić, Marija Burela, Renata Laškaj
Croatia
Thrombocytopenia is defined as platelet count less than 150x109/L, although

common cutoff value in clinical practice is 100x109/L. Thrombocytopenia in
patients with infectious diseases can be the result of infectious agents presence
(viruses, bacteria) and/or administered drugs. The situation becomes more
complex with accompanying heparin-induced thrombocytopenia (HIT),
disseminated intravascular coagulation (DIC), malignant disease, hypersplenism or
alcoholism.
Pseudothrombocytopenia is falsely reduced platelet count (expressed by the
hematology analyzer) caused by the platelet clumping. Possible causes for this
laboratory artefact are: invalid blood collection, inappropriate blood and
anticoagulant mixing or the presence of antibodies activated by sample cooling
and/or antibodies activated in the presence of anticoagulant called
ethilenediaminetetraacetic acid (EDTA). The hematology analyzers of the new
generation usually indicate the presence of platelet clumps.
Responsibility of the laboratory is to make a clear distinction between the real and
the false thrombocytopenia. The Department of Biochemistry and Hematology in
Hospital for Infectious Diseases "Dr Fran Mihaljević", Zagreb, solves
thrombocytopenia as follows: 1) in urgently required analysis, laboratory workers
always consult the physician (asking about medical history, patient age, sampling
method) when they consider re-collecting sample, 2) in regularly required samples
peripheral blood smears are analyzed by light microscopy to check for the platelet
182
clumps presence. If platelet clumps are confirmed, re-collecting of blood sample is

recommended in order to check for EDTA-dependent pseudothrombocytopenia.
Since July 2015, in the period of one year, total of 37156 samples were analyzed for
complete blood count (CBC). 2757 out of 37156 samples (7.4%) had a platelet
count less than 100x109/L. Platelet clumps were confirmed by microscopic
examination in 93 (0,3%) samples. EDTA-dependent pseudothrombocytopenia was
confirmed in samples from 5 different patients. Although examination of peripheral
blood smear prolongs the time for patients results, it is important tool in
thrombocytopenia and pseudothrombocytopenia distinction.
PO-28 Clostridium neonatale kao uzročnik novorođenačkog meningitisa: prikaz

slučaja
Nina Krajcar, Srđan Roglić, Andrea Kalaba, Marija Gužvinec, Ivica Knezović,
Goran Tešović
Klinika za infektivne bolesti ˝Dr. Fran Mihaljević˝, Zagreb, Hrvatska
Tijekom prva dva mjeseca života, neke od najčešće izoliranih anaeroba iz uzoraka
stolica prematurusa, upravo su različite vrste bakterija iz roda Clostridium. Osim
kao sastavni dio crijevne mikroflore, povezuju se i s nizom kliničkih entiteta
uključujući neonatalnu bakterijemiju i nekrotizirajući enterokolitis novorođenčadi.
2002. godine prvi put je opisana vrsta Clostridium neonatale nakon što je izolirana
iz uzoraka krvi i stolica šestero novorođenčadi s dokazanim nekrotizirajućim
enterokolitisom u vrijeme manje epidemije navedene bolesti u jedinici intenzivnog
liječenja u Kanadi, te se od tada dovodi u vezu isključivo s tom bolešću. U našem
radu prikazujemo slučaj muškog novorođenčeta u dobi od 20 dana koji je uspješno
liječen u Jedinici za intenzivno liječenje djece pri Klinici za infektivne bolesti „Dr.
Fran Mihaljević“ zbog gnojnog meningitisa, a čiji je uzročnik C. neonatale dokazan iz
likvora. Prikazani slučaj ističe potrebu za daljnjim istraživanjem C. neonatale
obzirom da pitanja vezana uz načine akviriranja, puteve njenog širenja i
sposobnosti izazivanja teških oblika infekcija u djece, kao i pitanja o mogućnostima
liječenja, ostaju otvorena.
Neonatal meningitis due to Clostridium neonatale: a case report

Nina Krajcar, Srđan Roglić, Andrea Kalaba, Marija Gužvinec, Ivica Knezović,
Goran Tešović
Croatia
Various species of the Clostridium genus are anaerobes commonly found in fecal
samples of premature neonates during the first two months of life. Despite the fact
that clostridia are part of normal microbial intestinal flora in premature newborns,
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they have also been associated with severe diseases like neonatal bacteriemia and
necrotizing enterocolitis. Clostridium neonatale is a novel species of Clostridium
first described in 2002, after being isolated from blood cultures and stools of
premature neonates during an outbreak of necrotizing enterocolitis in a Canadian
neonatal intensive care unit. Since then, this bacteria has been implicated as a
pathogen causing necrotizing enterocolitis in newborns. We report a case of
purulent meningitis caused by Clostridium neonatale in a 20-day-old infant who
was admitted and successfully treated in the Pediatric Intensive Care Unit of the
University Hospital for Infectious Diseases "Dr. Fran Mihaljević". In conclusion, this
presented case reveals that many questions concerning ways of acquiring and
spreading C. neonatale infection, its ability to cause invasive bacterial diseases in
children and its treatment, remain unclear.
PO-29 Učestalost infekcije respiratornim sincicijskim virusom u Istarskoj županiji

tijekom 2015. i 2016. godine
Jasmina Kučinar1, Lorena Lazarić-Stefanović1, Željko Stipić1, Tatjana Vilibić-
Čavlek2
1
Zavod za javno zdravstvo Istarske županije; Pula, Hrvatska
2
Respiratorni sincicijski virus (RSV) je, iako prisutan u svim dobnim skupinama,
najčešći virus koji uzrokuje respiratorne infekcije u dojenčadi i male djece. Većina ih
se inficira do druge godine života. Infekcija obično uzrokuje blage prehlade. Kod
osoba povećanog rizika (imunodeficijentni bolesnici, transplantirani, nedonoščad,
djeca s kongenitalnim srčanim bolestima, kao i ona sa kroničnom plućnom bolesti)
RSV uzrokuje teže infekcije donjeg respiratornog sustava, najčešće pneumoniju i
bronhiolitis.
Cilj rada je prikazati učestalost RSV infekcije u djece testirane na Odjelu za
serološko-imunološku dijagnostiku Zavoda za javno zdravstvo Istarske županije.
Tijekom 2015. i 2016. godine obrađeno je 90 nazofaringealnih (NF) aspirata
prikupljenih od 84 bolesnika (49 muškog i 35 ženskog spola) u dobi do 3 godine,
koji su hospitalizirani na Odjelu za pedijatriju Opće bolnice Pula. Najčešće uputne
dijagnoze bile su: pneumonija, bronhitis, bronhiolitis, otitis i prehlada.
Svi su uzorci testirani brzim testom za detekciju antigena (BTDA): RSV Respi-Strip
(Coris BioConcept, Gembloux, Belgium). Test je membranska tehnologija sa
koloidnim zlatnim nanočesticama, a sadrži protutijela protiv dva različita epitopa F
proteina RSV.
Pozitivno je bilo 32 (35,55%), a negativno 58 (64,44%) NF aspirata. Svi pozitivni
uzorci bili su iz dobne skupine do 6 mjeseci.
Dio uzoraka (44) je dodatno analiziran u direktnom imunofluorescentnom testu
(DFA): RSV Direct IF (ID) (bioMérieux, Marcy-l'Etoile, France). Od 44 NF aspirata,
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pozitivno je bilo 24 (54,54%), a negativno 20 (45,45%). Kod jednog bolesnika u dobi

od 2 mjeseca je BTDA bio negativan, a DFA je dao pozitivan rezultat, dok je jedna
bolesnica u dobi 4 mjeseca imala BTDA pozitivan, a DFA negativan test.
Brzi testovi BTDA pokazali su dobre rezultate kao testovi probira "point-of-care" u
akutnoj fazi bolesti. Testiranje na RSV treba svakako uključiti u dijagnostiku
infekcija respiratornog sustava, posebno kod malene djece i osoba s povećanim
rizikom stjecanja teže RSV infekcije.
Prevalence of respiratory syncytial virus infection in Istria County during

2015 and 2016
Jasmina Kučinar1, Lorena Lazarić-Stefanović1, Željko Stipić1, Tatjana Vilibić-
Čavlek2
1
Institute of Public Health of Istra County, Pula, Croatia
2
Although present in all age groups, respiratory syncytial virus (RSV) is the most
common cause of respiratory infections in infants and young children. Most of
them are infected by the age of two years. The infection usually causes mild cold. In
high risk groups (immunodeficient and transplant patients, premature babies,
children with congenital heart disease and those with chronic pulmonary disease),
RSV causes more severe infections of the lower respiratory tract, most commonly
pneumonia and bronchiolitis.
The aim of this study is to analyze the prevalence of RSV infections in children
tested at the Department of Sero-Immunological Diagnostics of the Istria County
Public Health Institute.
During 2015-2016, 90 nasopharyngeal (NP) aspirates collected from 84 patients (49
males and 35 females) aged up to 3 years were tested. Patients were hospitalized
at the Department of Pediatrics of the General Hospital Pula. The most common
clinical diagnosis were: pneumonia, bronchitis, bronchiolitis, otitis and cold. All
samples were analyzed with rapid antigen detection test (RADT): RSV Respi-Strip
(Coris BioConcept, Gembloux, Belgium). The test is based on a membrane
technology with colloidal gold nanoparticles and contains antibodies directed
against two different epitopes of the RSV F protein .
There were 32 (35.55%) positive samples and 58 (64.44%) negative NP aspirates. All
positive samples were from the age group up to 6 months.
A subset of samples (44) was further analyzed by direct immunofluorescence assay
(DFA): RSV Direct IF (ID) (bioMérieux, Marcy-l'Etoile, France). Out of 44 NP
aspirates, there were 24 (54.54%) positive and 20 (45.45%) negative samples. One
2-month-old male patient had the RADT test negative, but the DFA gave a positive
result, while one 4-month-old female patient had the RADT test positive and the
DFA test negative.
The RADT rapid tests showed good results as screening tests "point-of-care" in the
acute phase of disease. Testing for RSV should be included in the diagnosis of
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respiratory tract infections, mainly in small children and people at increased risk of
acquiring severe RSV infection.
PO-30 Uloga dekompresijske kranijektomije u liječenju malignog edema mozga

u bolesnika s herpes simpleks virusnim encefalitisom
Marija Kusulja, Marija Santini
Herpes simpleks virus uzročnik je 10-20% svih encefalitisa. Uvođenjem aciklovira u

liječenje ove bolesti smanjena je smrtnost, no ona i dalje ostaje značajna, uglavnom
zbog razvoja edema i hernijacije mozga.
Dekompresijska kranijektomija opisana je kao metoda liječenja edema mozga u
moždanom udaru, traumatskim ozljedama mozga, subarahnoidalnom krvarenju, no
jedini objavljeni radovi vezani uz ulogu ovog neurokirurškog postupka u encefalitisu
su prikazi slučajeva.
U ovom radu prikazani su slučajevi dvaju odraslih bolesnica koje su zbog herpes
simpleks encefalitisa liječene u Klinici za infektivne bolesti „dr.Fran Mihaljević“, uz
potvrdu dijagnoze nalazom cerebrospinalnog likvora. U obje bolesnice je bolest
progredirala uz poremećaj svijesti te respiratornu insuficijenciju. Neuroradiološkom
slikovnom dijagnostikom utvrđen je edem mozga koji se pogoršavao do prijeteće
hernijacije mozga, kada je indicirana i učinjena dekompresijska kranijektomija.
Nakon operacije je uslijedio zamjetan fizički oporavak, no u obje bolesnice su
prisutni trajni neuropsihološki poremećaji.
Prikazi ovih slučajeva doprinose dosadašnjim saznanjima o pozitivnoj ulozi
dekompresijske kranijektomije u smanjenju mortaliteta od malignog edema kao
komplikacije encefalitisa. Potrebna su daljnja, veća istraživanja kako bi se jasno
definirale indikacije i vrijeme postupka, kao i kriteriji za praćenje oporavka.
The role of decompressive craniectomy in the treatment of malignant

brain edema in patients with herpes simplex virus encephalitis
Marija Kusulja, Marija Santini
Croatia
Herpes simplex virus is the most common cause of encephalitis, making up to 10-
20% of all cases. Introduction of acyclovir into the treatment of this infectious
disease significantly reduced mortality, however mortality still remains significant,
mostly as a consequence of brain oedema and subsequent herniation.
Decompressive craniectomy has been described in the treatment of brain oedema
consequential to stroke, traumatic brain injury and subarachnoid hemorrhage. In
186
the setting of encephalitis, however, this procedure has only been described in
case reports.
This dissertation includes case reports of two adult female patients suffering from
Herpes simplex viral encephalitis, treated in University Hospital for Infectious
Diseases „Fran Mihaljević“. Diagnosis was confirmed with lumbar punction results.
Both patients' condition worsened with deteriorating level of consciousness and
respiratory insufficiency. Neuroradiological imaging confirmed brain oedema which
progressed to threatening herniation, when decompressive craniectomy was
indicated and performed. Postoperatively, physical recovery was remarkable;
however, both patients remain permanently psychologically impaired.
These two case reports contribute to the current scarce amount of published work
on the positive effect decompressive craniectomy has on reducing mortality from
brain oedema as a complication of encephalitis. Further, larger research is
necessary to define clear indications and timing of this procedure, as well as
recovery criteria.
PO-31 Glavna obilježja i čimbenici povezani s kasnim uključenjem u skrb u osoba

zaraženih HIV-om u Hrvatskoj u razdoblju 2007.-2015.
Lavel A, Iva Lisičar, Davorka Lukas, Tomislav Maretić, Šime Zekan, Josip
Begovac
Hrvatska ima centralizirani sustav skrbi za HIV pozitivne bolesnike u kojem se svi
zbrinjavaju u Klinici za infektivne bolesti ‘Dr. Fran Mihaljević’ (KIB) u Zagrebu.
Analizirani su podaci iz baze podataka Ambulante za oboljele od HIV-a prikupljeni
od 2007. od 2015. godine. U razdoblju od 2007. do 2015. godine 731 HIV-pozitivna
osoba ušla je u skrb KIB-a, od čega je 688 bolesnika ušlo u skrb po prvi put. Broj HIV
pozitivnih pacijenata koji su prvi put ušli u skrb se od 2007. godine (n=53) do 2015.
godine (n=116) više nego udvostručio. Od 688 bolesnika koji su u skrb uključeni po
prvi put 683 je bilo >18 godina, a 11% starije od 50 godina. U Zagrebu i okolici je
živjelo 39.8% ispitanika (n=688). Najčešći način prijenosa HIV-a bio je spolni odnos
između muškaraca (80%), što je ujedno i vodeći način prijenosa u više od 85%
odraslih bolesnika koji su u skrb uključeni u 2014. i 2015. godini. Medijan
vrijednosti CD4+ limfocita prilikom uključenja u skrb odraslih osoba (n=683) bio je
najniži 2011. godine (208.5/mm3), nakon čega se bilježi rast, te je 2015 .godine
iznosio 355/mm3. Udio bolesnika koji su se prilikom uključenja u skrb prezentirali s
AIDS-om bio je najviši 2010. i 2011. godine (28.4%), a najniži 2015. godine (15.5%).
Multivarijantnom analizom sljedeći su čimbenici povezani s kasnim uključenjem u
skrb (n=654): mjesto stanovanja izvan Zagreba (OR = 1.62 [95% interval
pouzdanosti, 1.16 do 2.26]), heteroseksualni način prijenosa (OR= 2.22 [95% IP,
1.15-4.28]) i starija dob (OR= 1.84 [95% IP, 1.53-2.22] po 10.g.). Dobiveni podaci
187
upućuju na potrebu osnaživanja prevencije u populaciji muškaraca koji imaju

spolne odnose s drugim muškarcima. Da bi se ranije otkrila zaraza HIV-om,
potrebno je češće pomišljati na HIV-infekciju u starijih osoba i u onih koji žive izvan
Zagrebu te u heteroseksualnih pojedinaca.
Main characteristics and factors related to late presentation to care in

HIV-infected persons entering care in Croatia in the period 2007-2015
Alexandra Lavel, Iva Lisičar, Davorka Lukas, Tomislav Maretić, Šime Zekan,
Josip Begovac
Croatia
Croatia has a centralized system of care for HIV infected persons and all patients
receive care at the University Hospital for Infectious Diseases (UHID) in Zagreb.
Data from the electronic HIV-database at UHID was used for the analysis of
patients who entered care in the period 2007-2015. A total of 731 persons entered
care for HIV/AIDS at UHID in the period 2007-2015 of whom 688 persons entered
care for the first time. The number of HIV positive persons entering care for the
first time per calendar year more than doubled from 2007 (n=53) to 2015 (n=116).
Of 688 patients, 683 were adults (> 18 years) and 11% were older than 50 years.
The proportion of persons living in Zagreb or the Zagreb county was 39.8% (n=688).
The main mode of transmission was sex between men (overall: 80%) and this was
the mode of transmission in more than 85% of adults entering care for the first
time (n=683) in 2014 and 2015. The median CD4+ cell count at entry into care was
lowest in 2011 (208.5/mm3), however, since then it has increased and reached
355/mm3 in 2015. The proportion of persons presenting with clinical AIDS was
highest in 2010 and 2011 (28.4%), and lowest in 2015 (15.5%). On multivariable
analysis, the following factors were associated with late presentation to care
(n=654): not living in Zagreb (OR = 1.62 [95% confidence intervals, 1.16 to 2.26]); -
heterosexual mode of transmission (OR= 2.22 [95% CI, 1.15-4.28] and older age per
10 years (OR= 1.84 [95% CI, 1.53-2.21]). Our data suggest that there is an increasing
need for enhancing prevention efforts in men who have sex with men. To improve
earlier HIV-diagnosing the focus should be on older persons, persons living outside
Zagreb and heterosexuals.
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PO-32 Bolničke infekcije uzrokovane respiratornim sincicijskim virusom u dječjoj

bolnici
Amarela Lukić-Grlić1, Matea Kos2, Nikolina Blatarić3, Jasna Grbavac2
Nosocomial respiratory syncytial virus infections in children's hospital
1
Klinika za dječje bolesti Zagreb, Medicinski fakultet Sveučilišta u Zagrebu,
Zagreb, Hrvatska
2
Klinika za dječje bolesti Zagreb, Zagreb, Hrvatska
3
Zdravstveno veleučilište u Zagrebu
Respiratorni sincicijski virus (RSV) najznačajniji je uzročnik infekcija dišnog sustava u

dojenčadi. Također je, uz rota virus, uzročnik velikog broja bolničkih infekcija na
dječjim odjelima. Prema podacima iz literature, učestalost bolničkih RSV infekcija
na pedijatrijskim odjelima je 20-40%, a u neonatalnim jedinicama iznosi 30-70%.
Cilj ovog rada bio je odrediti učestalost RSV bolničkih infekcija u dječjoj bolnici,
njihovu raspodjelu po dobi, spolu i odjelima, dužinu hospitalizacije koja je
prethodila stjecanju infekcije te kliničku sliku kojom se infekcija prezentirala.
Ovo retrospektivno istraživanje provedeno je u Klinici za dječje bolesti Zagreb u
periodu od 01.01.2013. do 30. 06.2016.
RSV je dokazan u nazofaringealnom sekretu bolesnika brzim testovima za detekciju
antigena: imunokromatografskim testom za dokaz RSV-a i adenovirus (BioGnost,
Zagreb) i mariPOC respi test-om (ArcDia International Oy Ltd., Finska).
U navedenom razdoblju 11% (35/315) pozitivnih RSV infekcija stečeno je u bolnici.
Bolničke RSV infekcije najčešće su dokazane u ženske dojenčadi dobi 1-6 mjeseci.
Što se distribucije po odjelima tiče, najviše ih je bilo na općim pedijatrijskim
odjelima (24/35; 69%). U navedenom razdoblju većina pacijenata infekciju je stekla
tijekom hospitalizacije u siječnju i veljači. Infekcija se manifestirala kliničkom slikom
bronhiolitisa u njih 63% (22/35). Prosječno trajanje hospitalizacije koje je prethodilo
infekciji iznosilo je 25 dana.
RSV značajan je bolnički patogen u dječjoj bolnici te i dalje zahtijeva pažnju
zdravstvenih djelatnika.
Nosocomial respiratory syncytial virus infections in children's hospital

Amarela Lukić-Grlić1, Matea Kos2, Nikolina Blatarić3, Jasna Grbavac2
1
Children's Hospital Zagreb, University of Zagreb School of Medicine,
Zagreb, Croatia
2
Children's Hospital Zagreb, Zagreb, Croatia
3
University of Applied Health Sciences, Zagreb, Croatia
Respiratory syncytial virus (RSV) is the major cause of respiratory infections in

infants. Together with rotavirus, it is the most common cause of nosocomial
infections at pediatric wards. According to literature, incidence of RSV nosocomial
infections is 20-40% at pediatric wards and 30-70% in neonatal units.
189
The aim of this study was to determine incidence of nosocomial RSV infections in
children's hospital, their distribution concerning age, sex and hospital ward, the
lenght of hospital stay preceding the acquisition of infection and clinical
presentation of infection.
This retrospective study was conducted in Children's Hospital Zagreb from January
2013 to June 2016.
RSV was detected in nasopharyngeal aspirates using rapid antigen detection tests:
immunochromatographic test for RSV and adenovirus (BioGnost, Zagreb) and
mariPOC respi test (ArcDia International Oy Ltd., Finland).
Out of 315 RSV positive infections found in above mentioned period, 35 (11%) were
acquired during hospitalization. Nosocomial RSV infections were most common in
female infants aged 1-6 months. Majority of infections was acquired at general
pediatric wards (24/35; 69%), mainly during January and February. Nosocomial RSV
infection was manifested as bronchiolitis in 63% (22/35) of children. The average
lenght of hospital stay prior the infection was 25 days.
Our results show that RSV remains an important nosocomial pathogen in children's
hospital and requires further hospital staff attention.
PO-33 Potvrđeni ujedi paukova iz porodice Clubiondiae (Cheiracanthium

punctorium) u Hrvatskoj
Tomislav Maretić1, Anamarija Štambuk2
1
2
Biološki odsjek, Prirodoslovno-matematičkog fakulteta Sveučilišta u
Araneizam u Hrvatskoj vezan je uz ujed pauka Latrodectus tredecimguttatus ili crne

udovice, a u znatno manjoj mjeri Cheiracanthium punctorium (kirakantij, šarni
ostrugar, yellow sac spider). Spominju se i drugi pauci kao uzročnici araneizma u
nas i šire u Europi kao npr. Lycosa tarantula (pauk vučjak), a ustanovljeno je da i
Steatoda paykulliana (lažna udovica) može zadati otrovni ujed nekim sisavcima dok
u ljudi kod nas takvi slučajevi nisu ustanovljeni. U Europi se spominju i neki drugi
paukovi čiji ujed može biti bolan no bez većeg medicinskog značenja (Araneus
diadematus - pauk krstaš, Argiope lobata - vrtni pauk, Argiope bruennichi - osasti
pauk, Segestria florentina, Agelena labyrynthica, Loxosceles rufescens, Aranea
sexpunctata).
Araneizam se u Hrvatskoj pojavljuje u obalnom to jest primorskom području.
Ovdje opisujemo 7 bolesnika s kirakantizmom stečenim u samom Zagrebu ili
njegovoj blizini. Troje bolesnika donijeli su ubijenog pauka (jedan odmah, a dva
naknadno) te je arahnološkim metodama detektiran species Cheiracanthium
punctorium. U ostala 4 slučaja opisan je žućkasti pauk s dlakavim nožicama, a
190
simptomatologija je odgovorala kirakantizmu. Zanimljivo je da su sva tri

identificirana pauka bila mužjaci.
U svih 7 bolesnika simptomi su bili slični: jaka lokalna bol u području uda, ruke ili
noge koja se širila do lokalnih limfnih čvorova i bila jaka kroz više sati (12 do 48h)
unatoč analgeticima. Lokalni nalaz nije bio znatan, tek blago crvenilo i neznatni
otok bez nekroze. Bolesnici su osjećali trnce i utrnulost u prstima na mjestu ujeda
do 7 dana, a dvoje bolesnika spominjalo je povremene trnce i nekoliko godina
poslije ujeda.
Zaključak: Kirakantizam je u nas prvi opisao Zvonimir Maretić 1959. te predložio
ovaj termin (analogno latrodektizmu) koji je prihvaćen. Kasnije (1956.-1983.) je
liječio 36 bolesnika s kirakantizmom s istarskog područja. Prevladavala je lokalna
bol i otok uz katkada bolnost regionalnih limfnih čvorova. Lokalna bol ponekad je
sijevala u cijeli ekstremitet. Vrlo rijetki slučajevi ujeda sa sličnom
simptomatologijom poznati su na temelju osobnih priopćenja u nekim predjelima
sjeverne i središnje Hrvatske. Međutim, dosada to nije dokazano, jer nije bio
identificiran pauk te su ovi bolesnici prvi potvrđeni slučaj kirakantizma u sjevernoj
Hrvatskoj. Kirakantizam nije čest u kontinentalnoj Hrvatskoj, a vjerojatno su u
kliniku došli teži slučajevi.
Kod spomenute simptomatologije potrebno je razmišljati o araneizmu i kad pauk
nije zamijećen. Terapija je simptomatska.
Verified bites by yellow sac spiders (Cheiracanthium punctorium) in

Croatia
Tomislav Maretić1, Anamarija Štambuk2
1
Croatia
2
Department of Biology, University of Zagreb, Faculty of Science, Zagreb,
Croatia
A spider bite (arachnidism) in Croatia is related to the bite of the black widow
spider (Latrodectus tridecemguttatus) and to a much lesser extent to
Cheiracanthium punctorium (yellow sac spider). Some other spiders are mentioned
as causing araneism in Europe (Lycosa tarantula and Steatoda paykulliana), and
several other have been registered but without medical significance (Araneus
diadematus - spider cruiser, Argiope lobata - garden spider, Argiope bruennichi,
Segestria florentina, Loxosceles rufescens, Aranea sexpunctata).
Arachnidism in Croatia mainly occurs in the coastal area.
We describe 7 patients with Cheiracanthium spider bites acquired in the Zagreb city
area or its surroundings in the period from 2003 up to 2015. Three patients
brought killed spiders (one immediately and two later) that were detected by
arachnological methods as Cheiracanthium punctorium. Four other patients
described the bite of a yellowish spider and the symptomatology was the same as
in other patients with chiracanthism. All three identified spiders were males.
191
The symptoms in all seven patients were similar: strong local pain at the bite site
that spread to local lymph nodes and was strong for several hours (12 to 48 h)
despite analgesics. Local finding was not significant, only a slight redness without
necrosis. Patients felt tingling and numbness in fingers at bite site for up to 7 days,
and two patients mentioned the occasional tingling even several years after the
bite.
Conclusion: Cheiracanthism in Croatia was first described by Zvonimir Maretić in
1959 who proposed this term (analogous to latrodectism). Later on (from 1956 to
1983) he treated 36 patients with cheiracanthism in the Istrian region. Local pain
and swelling were present in all described cases and the pain spread to the regional
lymph nodes or even the whole extremity.
Cases of cheiracanthism were described as possible but not proven in some areas
of northern and central Croatia. The spiders were not identified but the
symptomatology was convincing. Cheiracanthism is not common in continental
Croatia, and the patients admitted to our Clinic were probably more severe cases.
When described symptoms are present cheiracanthism should be considered even
when spiders have not been noticed. The therapy is symptomatic.
PO-34 Zaboravili smo tuberkulozu?

Dubravka Matanić Lender, Veljko Flego, Samira Knežević, Sandra Glavaš,
Tanja Šafar-Balić, Ljiljana Bulat-Kardum, Helena Smokrović
Klinika za infektologiju, Klinika za internu medicinu, KBC Rijeka, Rijeka,
Hrvatska
Tuberkuloza donjeg režnja često se zamjenjuje s upalom pluća.

Prikazujemo slučaj pacijentice, u dobi od 24 godine, dojilje, koja je oko mjesec dana
suho kašljala, a posljednjih 7 dana povišenu temperaturu. Do 39 uz zimicu i
tresavicu. Zbog tih tegoba učinila je preglednu snimku grudnih organa. Infiltracija u
donjem dijelu desnog pluća opisana je kao upala pluća. Započeta je terapija
antibiotikom. Nakon 5 dana liječenja antibiotikom, azitromicinom, i dalje je febrilna
i počinje iskašljavati krv.
Učinjena je bronhoskopija, iz aspirata bronha izoliran je acidorezistentni bacil (2+).
Tuberkuloza donjeg režnja javlja se u 2 do 9% slučajeva. Češća je u mlađih žena, a
trudnoća se smatra i jednim od riziko faktora. U trudnoći i postpartalnom periodu,
zbog supresije Th1 proinflamatornog odgovora veća je sklonost infekcijama kao i
reaktivaciji tuberkuloze.
Iako je incidencija tuberkuloze u našoj zemlji u padu,u slučaju radiološkog nalaza
infiltracije u donjem režnju pluća ne smijemo zaboraviti
192
We forgot to tuberculosis?
Dubravka Matanić Lender, Veljko Flego, Samira Knežević, Sandra Glavaš,
Tanja Šafar-Balić, Ljiljana Bulat-Kardum, Helena Smokrović
Clinic for Infectious Diseases, Clinic for Internal Medicine, University
Hospital Center Rijeka, Rijeka, Croatia
Tuberculosis of the lower lobe is often replaced with pneumonia.

We report a case of a women, aged 24 years which was nursing a nine month
infant. Medical history was presented by cough without expectoration which lasted
for a month, high fever up to 39C for 7 days followed by chills and shivering. In
diagnostic process a chest x.ray overview of thoracic organs was made in which we
apparent inflammatory infiltrate in the lower part of the right lung. After 5 days of
treatment with antibiotic azithromycin fever persisted and she began to cough up
blood. Bronchoscopy with bronchoaspiration was performed in which we isolated
acid-fast bacilli (+2). Tuberculosis of lower lobe occurs in 2-9% of cases, it is more
common in younger women, and pregnancy is often considered as one of the risk
factors. Due to suppression of Th1 proinflammatory responses in the pregnancy
and puerperal period greater risk of infection and reactivation of tuberculosis is
expected . Although the incidence of tuberculosis in our country is declining, in the
case of radiological suspected inflammatory infiltration in the lower lobe of the
lung, we should not forget a tuberculosis.
PO-35 Epidemija s Clostridium difficile ribotip 176 u Općoj bolnici Zadar 2015.
godine
Ivanka Matas1, Ines Leto2, Boris Dželalija2, Biljana Perica1, Branka Tomčić1
1
Zavod za javno zdravstvo Zadar, Zadar, Hrvatska
2
UVOD: Clostridium difficile vodeći je uzročnik proljeva povezanog sa zdravstvenom

skrbi te doprinosi značajnom morbiditetu i mortalitetu. U svijetu se unazad više od
deset godina opisuju epidemije, poglavito one uzrokovane hipervirulentnim sojem
ribotipa 027 na području SAD, Kanade i zemalja zapadne Europe.
Ovo je prvi izvještaj o epidemiji proljeva uzrokovanog sa C. difficile ribotip 176 na
području Hrvatske.
CILJ: Ukazati na važnost ranog prepoznavanja infekcije uzrokovane sa C. difficile , te
implementirati preporučene snopove skrbi kako bi se učinkovito spriječilo i
kontroliralo širenje infekcije. Definirati najvažnije čimbenike rizika za razvoj
infekcije povezane sa C. difficile.
METODE: Promatrani period obuhvaća vrijeme od 22.02.2015. kada bilježimo
pozitivan rezultat testiranja na C. difficile za pretpostavljeni indeksni slučaj, pa do
193
26.10.2015. kada bilježimo pozitivan rezultat testiranja za pacijenta čiji je izolat

posljednji u nizu tipiziranih.
Mikrobiološka dijagnostika provedena je na uzorcima stolice pacijenata sa
simptomima proljeva, a prema postojećim preporukama u dva koraka – enzimskim
imunotestom na glutamat dehidrogenazu (GDH) kao testom probira, te se u slučaju
pozitivnog rezultata uzorak stolice testirao enzimskim imunotestom na toksin A i B
(Immunocard, Meridian Bioscence). Svaki pozitivni uzorak stolice kultivirao se na
kromogenu ploču (chromID C. difficile, Biomerieux) te su se karakteristične kolonije
supkultivirale na Brucella agar za anaerobni uzgoj.
18 izolata iz različitih perioda trajanja epidemije te iz različitih odjela Službe za
interne bolesti poslano je na tipizaciju u Nacionalni laboratorij za zdravje, okolje in
hrano, Maribor, Slovenija gdje je provedena PCR ribotipizacija temeljena na
elektroforezi u agaroznom gelu. Na tipizaciju je poslan i jedan izolat pacijentice sa
simptomima proljeva sa Zaraznog odjela bolnice.
Tim za bolničke infekcije tijekom izvida provodi protuepidemijske mjere prema
izvoru epidemije i putevima širenja te donosi snop postupaka skrbi prema
preporukama i smjernicama dostupnim iz strane literature.
REZULTATI: U periodu od 22.02.2015. do 31.10.2015. godine na Internom odjelu
Opće bolnice Zadar zabilježeno je 47 pacijenata sa simptomima proljeva i
pozitivnim rezultatom testiranja uzoraka stolice na prisutnost toksina C. difficile. Od
toga je bilo 15 osoba ženskoga spola prosječne dobi 78.1 godina, te 32 osobe
muškog spola prosječne dobi 73.1 godine. Udio oboljelih bolesnika u promatranom
periodu u odnosu na broj izloženih pacijenata iznosio je 0.9% za Interni odjel
bolnice.
Za 18 izolata porijekla od pacijenata sa internističkih odjela određen je PCR ribotip
176. Za izolat porijekla od pacijentice sa Zaraznog odjela određen je PCR ribotip
014/020.
Retrospektivnom analizom podataka dobivenih iz medicinske dokumentacije
prikazat ćemo koje smo čimbenike rizika definirali kao najkritičnije za razvoj
infekcije uzrokovane sa C. difficile.
ZAKLJUČAK: Za učinkovitost mjera za uspješnu kontrolu i sprečavanje širenja
infekcije uzrokovane sa C.difficile neophodno je pravovremeno i ispravno
postavljanje dijagnoze infekcije uz implementaciju i pridržavanje odgovarajućih
postupaka snopova skrbi.
Ističemo klinički značaj C. difficile PCR ribotip 176 koji pokazuje izraziti epidemijski
potencijal širenja unutar zdravstvenih institucija.
194
Outbreak of Clostridium difficile PCR ribotype 176 in General Hospital

Zadar, Croatia
Ivanka Matas1, Ines Leto2, Boris Dželalija2, Biljana Perica1, Branka Tomčić1
1
Public Health Institute Zadar, Zadar, Croatia
2
General Hospital Zadar, Zadar, Croatia
Background: Clostridium difficile remains the leading cause of healthcare-

associated diarrhea with substantial morbidity and mortality. There've been
several outbreaks worldwide associated with the emergence of PCR ribotype 027,
in USA and Canada, as well as in some EU countries.
This is the first report of outbreak associated with Clostridium diffcile ribotype 176
in Croatia.
Objective: We emphasize the relevance of early diagnosis of infection,
implementation of recomended bundle strategies for the management of C.
difficile infection and identifying the most important risk factors for CDI.
Methods: Observed period encompasses the time between February 22nd 2015
when we registered the positive test result for C. difficile toxin in the presumed
index case, and October 26th 2015 when was the date of isolation of the last isolate
sent for typing. The outbreak took place in General hospital Zadar on several
medical internal wards.
We tested only stools from patients with diarrhea in two-step algorithms using
glutamate-dehydrogenase (GDH) screening test with subsequent toxin A/B enzyme
immunoassay (Immunocard C. difficile GDH and Immunocard toxins A&B, Meridian
Bioscience Europe). We cultivated every toxin positive stool sample on
chromogenic agar (chromID C. difficile, Biomerieux) and characteristic colonies
subcultivated on in-house prepaired Brucella agar.
19 isolates were sent for typing to the National Laboratory for Health, Environment
and Foodstuffs in Maribor, Slovenia where the agarose gel-based electrophoresis
PCR ribotyping was performed. These were isolates from different outbreak period
and from different medical wards.
Infection control team implemented measures for controling and preventing the
spread of the infection and defined bundle care procedures as recommended by
the guidelines made of experts in the field.
Results: In observed outbreak period 47 hospitalized patients met the case
definition of C. difficile associated infection: 15 females with median age 78.1 years
and 32 males with median age 73.1 years. The rate of infected in relation to total
number of hospitalization was 0.9% by the time of outbreak period and for medical
internal wards.
Of 19 isolate, 18 belonged to PCR ribotype 176, and 1 isolate from outpatient
belonged to PCR ribotype 014/020.
By retrospective analysis of medical records and active surveillance of all patients
with the case definition of C. difficile infection we will show the identified risk
factors for the CD infection.
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Conclusion: The effectiveness of the measures to prevent and control the spread of
infection associated with C. difficile requires a timely diagnosis with the
implementation and compliance with bundles of care.
We highlight the cliinical relevance of C. difficile PCR ribotype 176 and its capacity
to spread within a healthcare facility.
PO-36 Serološki profili hepatitisa B i C kod donora i primatelja bubrežnog

presadka
Anna Mrzljak, Bojana Gardijan, Petra Dinjar, Mladen Knotek, Ljubica Čakalo
Klinička bolnica Merkur, Medicinski fakultet Sveučilišta u Zagrebu, Zagreb,
Hrvatska
Uvod: Probir na hepatitis B (HBV) i hepatitis C (HCV) nužan je kod transplantacije

organa temeljem čega se formira odluka o prihvaćanju i alokaciji organa donora,
kao i liječenju primatelja. HBV i HCV značajni su uzročnici hepatitisa, do čije
transmisije može doći prilikom transplantacije. Cilj ove studije bio je utvrditi
serološke profile kohorte donora i primatelja bubrega, te utvrditi prevalenciju
imunosti HBV primatelja.
Metode: Analizirani su HBV i HCV serostatusi donora i primatelja prije
transplantacije bubrega (TB) u razdoblju od 6/2007 do 06/2016 godine iz baze
podataka u Kliničkoj bolnici Merkur.
Rezultati: U analiziranom razdoblju učinjeno je 452 transplantacija bubrega (TB)
(muškaraca 294 (65%), srednje dobi 49.5±12.5 godina). 7 (1.5%) primatelja bilo je
hepatitis B surface antigen (HBsAg) pozitivno, a 10 (2.2%) primatelja antiHCV
pozitivno. Kod 156 (34.5%) primatelja nije utvđena imunost na HBV. 167 (36.9%)
primatelja bilo je antiHBs pozitivno; prethodno cijepljeno, dok 10 (2.2%) je bilo
samo hepatitis B core antitijelo (antiHBc) pozitivno. 5 (1.1%) primatelja bilo je
HBsAg i antiHCV pozitivno. HBV procijeljenost primatelja tijekom analiziranog
razdoblja (2007-2011 vs 2012-2016) nije se mijenjala (p=0,28). Od ukupnog broja
presadaka (403 (89.2%) kadaveričnih), njih 40 (8.8%) bilo je antiHBc pozitivno. Niti
jedan presadak nije bio HBsAg ili antiHCV pozitivan.
Zaključak: Prevalencija procijepljenosti protiv HBV u analiziranoj kohorti je niska i
nije se bitno mijenjala tijekom promatranog razdoblja. Prevalencija antiHCV kod
bubrežnih bolesnika je niska. Ova analiza ukazuje na potrebu poboljšanja programa
procijepljivanja bolesnika prije transplantacije.
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Serological profiles of hepatitis B and C in donors and kidey transplant

recipients
Anna Mrzljak, Bojana Gardijan, Petra Dinjar, Mladen Knotek, Ljubica Čakalo
Clinical Hospital „Merkur“, University of Zagreb School of Medicine,
Zagreb, Croatia
Introduction: Screening for hepatitis B (HBV) and hepatitis C (HCV) is a requirement

in organ transplantation. The information acquired influences organ allocation and
further recipient treatment. The goal of this study was to determine the serological
profile of the kidney graft recipient and donor cohort, as well as the HBV immunity
status.
Methods: Analysis was conducted using University Hospital Merkur transplant
database. HBV HCV pretransplantation serology profiles were obtained for kidney
transplant donors and recipients from May 2007 to June 2016. There were 452
kidney transplantations (294 male recipients, mean age 49.5 ± 12.5 yrs.)
Results: In the analyzed period there were 7 (1.5%) hepatitis B surface antigen
(HbsAg) positive recipients. 34.5% of the recipients were not immune to HBV. 36,
9% of the recipients were just anti-HBs positive due to vaccination. 10 of the
recipients (2.2%) were just Anti-HBc positive. HBV immunity in the observed period
did not change significantly (2007-2011 vs. 2012-2016, p=0, 28). There were 10
(2.2%) anti-HCV positive recipients. Further 5 of the recipients (1.1%) were both
HBsAg and anti-HCV positive. From the total number of kidney grafts, 40 (8.85)
were anti-HBc positive. No grafts were HBsAg or antiHCV positive.
Conclusion: HBV immunity in the cohort is low and it has not changed significantly
in the observed period. Prevalence of anti-HCV in CKD patients undergoing
transplantation is low. This analysis suggests greater efforts should be made in
pretransplantation vaccination.
PO-37 Transplantacija jetre donorima pozitivnim na antitijela na sržni antigen

virusa hepatitisa B
Anna Mrzljak1,3, Petra Dinjar Kujundžić1, Miletić Lovrić Manuela2, Ostojić
Ana1, Iva Košuta1, Nino Kunac1, Tajana Filipec Kanižaj1,3, Nikola Sobočan1,
Zrinka Mišetić Dolić1, Ivan Bogadi1, Miloš Lalovac1, Danko Mikulić1, Jadranka
Pavičić Šarić1, Ljubica Čakalo1, Branislav Kocman1
1
Klinička bolnica Merkur, Zagreb, Hrvatska
2
3
Uvod: Primjena jetrenog presatka donora negativnog na površinski antigen virusa

hepatitisa B i pozitivnog na antitijela na sržni antigen, HBsAg-/anti-HBc+, omogućila
je povećanje broja donora za transplantaciju jetre (TJ). Međutim, i dalje je
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kontroverzna zbog nestandardizirane antiviralne profilakse (AP) i nedostatnog

dugoročnog praćenja. Cilj ove analize je prikazati naše iskustvo s anti-HBc+
donorima jetara.
Metode: Retrospektivna analiza kohorte primatelja anti-HBc+ jetrenih presadaka u
našem centru od 6/2007.-6/2016.
Rezultati: U analiziranom razdoblju učinjeno je 856 TJ. 65 (7,6%) transplantiranih
primilo je HBsAg-/anti-HBc+ presadak, pri čemu je 10.8% bilo HBsAg+ (4.6% bez
podatka o HBsAg). Većina 84.6% su bili HBsAg-; od toga 74.5% HBV naivni (anti-
HBc-/anti-HBs-), 7.3% prethodno cijepljeni (anti-HBs +), 9.1% prethodno inficirani
(anti-HBc+/anti-HBs+), 5.5% samo anti-HBc+, (3.6% HBsAg- bez podataka o
antiHBc/anti-HBs). Od ukupnog broja primatelja HBsAg-/anti-HBc+ presatka, 84.6%
primalo je AP: 94.5% lamivudin (LAM), 3.6 % tenofovir (TDF), 1.8% entekavir (ETV)
(1 bez podataka o AP). Kod 52 primatelja LAM, 7.7% postalo je HBsAg+, njih 50%
imalo je HBV-DNA breakthough >2000 IU/mL. Od toga, 75% je bilo HBV naivno.
Liječenje de novo HBV (DNHBV) nastavljeno je LAM kod svih (1 uz dodatak
adefovira, kasnije TDF). Svi bolesnici postali su HBV-DNA-. Kod 9 primatelja bez AP,
33.3% postalo je HBsAg+ uz HBV-DNA > 2000 IU/mL, od toga 66.7% bilo je HBV
naivno. 2 DNHBV bolesnika liječena su LAM uz negativizaciju HBV-DNA, a 1 ETV.
Preživljenje bolesnika u 1. i 3. godini nakon TJ iznosilo je 86% i 80%, a presadaka
83% i 77%. Nije bilo gubitaka presadaka ili smrti zbog DNHBV.
Zaključak: Monoprofilaksa lamivudinom uspješna je u preveniranju DNHBV kod
većine bolesnika nakon TJ tijekom dugoročnog praćenja. Nedostatak profilakse
doveo je do DNHBV kod trećine bolesnika. Anti-HBc+ presatci mogu se sigurno
koristiti kod anti-HB- primatelja bez povećanja mortaliteta i gubitka presatka uz
neophodnu dugoročnu profilaksu, suradljivost bolesnika i kontinuirano praćenje.
Hepatitis B core antibody-positive donors in liver transplantation

Anna Mrzljak1,3, Petra Dinjar Kujundžić1, Miletić Lovrić Manuela2, Ostojić
Ana1, Iva Košuta1, Nino Kunac1, Tajana Filipec Kanižaj1,3, Nikola Sobočan1,
Zrinka Mišetić Dolić1, Ivan Bogadi1, Miloš Lalovac1, Danko Mikulić1, Jadranka
Pavičić Šarić1, Ljubica Čakalo1, Branislav Kocman1
1
Clinical Hospital „Merku“, Zagreb, Croatia
2
3
Introduction: The use of hepatitis B surface antigen (HBsAg) negative and hepatitis
B core antibody (HBcAb) positive liver donors has expanded the donor pool.
However, the antiviral prophylaxis (AP) in this setting, still remains controversial
due to a lack of long-term follow-up data. The aim of this study is to present our
experience with HBcAb+ liver grafts.
Methods: Retrospective analysis of adult HBcAb positive liver graft recipients from
6/2006 to 6/2006 at University Hospital Merkur.
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Results: In the study period, total of 856 liver transplantations (LT) were
performed. 65 (7,6%) recipients received HBsAg-/HBcAb+ graft, 10.8% of them
were HBsAg+ (4.6% w/o HBsAg data). The majority of recipients (84.6%) were
HBsAg-; 74.5% HBV naive (HBsAg-/HBcAb-), 7.3% previously vaccinated (HBsAb+),
9.1% previously infected (HBsAb+/, HBcAb+), 5.5% only HBcAb+ (for 3.6% HBsAg-
pts no HBsAb/HBcAb/ data was available). Of total HBsAg-/HBcAb+ graft recipients,
84.6% received an AP: 94.5% lamivudine (LAM), 3.6% tenofovir (TDF), 1.8%
entecavir (ETV) (1 pt w/o AP data). Of 52 LAM recipients, 7.7% became HBsAg+,
and 50% of them had HBV DNA breakthough > 2000 IU/mL. 75% of them were HBV
naive. De novo HBV (DNHBV) infection was treated with LAM (1addition of
adefovir, later TDF). All pts became HBV-DNA-. Of 9 recipients without the AP,
33.3% developed HBsAg+ with HBV DNA> 2000 IU/ml, of which 66.7% were HBV
naive. 2 DNHBV pts treated with LAM became HBC-DNA negative, and 1 pt is
currently on ETV. 1- and 3-year patient and graft survivals were 86%,80% and
83%,77%, respectively. There were no grafts loss or death due to DNHBV.
Conclusion: Antiviral lamivudine monoprophylaxis is successful and safe in
prevention of DNHBV in majority of patients after LT during long-term follow-up.
Lack of AP led to DNHBV in one third of patients. Thus, HBcAb positive liver grafts
can be safely used without the increase of mortality and graft loss, but necessary
long-term prophylaxis, patient compliance and careful patient monitoring are
mandatory.
PO-38 Prikaz bolesnice s encefalopatijom uzrokovanom virusom influence

Ljiljana Perić, Dubravka Lišnjić, Mario Duvnjak, Danijel Šimašek, Ilija Rubil,
Dario Sabadi
Klinika za infektologiju, KBC Osijek, Osijek, Hrvatska
Encefalopatija povezana s virusom influence je akutna, neupalna bolest SŽS-a

prezentirana napadima ili komom u prvom ili drugom danu gripe. Prikazali smo
osamnaestogodišnju bolesnicu hospitaliziranu u našoj Klinici u tijeku epidemije
gripe koja je dan prije prijema postala febrilna do 40ºC uz blage kataralne
simptome, a primljena je u komi (GCS 3) uz retenciju urina. Učinjenom
dijagnostičkom obradom (CT mozga, MR mozga, UZV abdomena i rutinski
laboratorijski testovi) isključena je upalna, vaskularna, metabolička ili toksična
etiologija bolesti. Lumbalna punkcija po prijemu je bila uredna. Na MR mozga
opisan je blaži edem sluznice nosnih honika uz polipoidno zadebljanje desno.
Rutinskim laboratorijskim testovima (leukopenija, trombocitopenija i CRP 11,2)
postavljena je sumnja na virusnu etiologiju bolesti, odnosno na infekciju virusom
influence što je i dokazano obriskom nazofarinksa iz kojeg je izoliran tip B virusa
influence. Do potpune normalizacije stanja svijesti došlo je tijekom prvog dana
boravka, a tijekom boravka provedena je terapija oseltamivirom uz
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antiedematoznu terapiju. Tijek boravka prošao je uredno, bez komplikacija i

neuroloških incidenata. Na kontrolnom pregledu, mjesec dana nakon
hospitalizacije, uredan je somatski i neurološki status. Kod bolesnice se radilo o
prolaznoj encefalopatiji u sklopu akutne infekcije virusom influence tip B.
Patient with Encephalopathy Caused by the Influenza Virus, Case Report

Ljiljana Perić, Dubravka Lišnjić, Mario Duvnjak, Danijel Šimašek, Ilija Rubil,
Dario Sabadi
Clinic for Infectious Diseases, University Hospital Center Osijek, Osijek,
Croatia
Influenza virus associated encephalopathy is an acute, non-inflammatory disease of

CNS presented with seizures or a coma during the first two days of influenza. We
reported on an eighteen year old female patient hospitalized in our clinic during
the flu epidemic, who, on the day prior to admission, became febrile with 40°C with
mild catarrhal symptoms and was admitted in a coma (GCS 3) with an urinary
retention. Diagnostic methods (CT of the brain, MRI, ultrasound of the abdomen
and routine laboratory tests) excluded an inflammatory, vascular, metabolic or
toxic aetiology of the disease. The lumbar puncture results after her receipt were
normal. The MRI described an alleviated nasal mucosal oedema with polypoid
thickening on the right side. Suspected was a viral aetiology of the disease or
infection with the influenza virus due to routine laboratory tests (leucopoenia,
thrombocytopenia and CRP 11.2). That was later proven, with a nasopharyngeal
swab, from which the type B influenza virus was isolated. A complete normalization
of consciousness occurred during the first day and during the stay we conducted
therapy with oseltamivir and an antiedematous therapy. The course of her
hospitalization went by without complications and without neurological incidents.
On the follow-up examination, one month after the hospitalization, the somatic
and neurological status´ were normal. In this patient it was a transient
encephalopathy in an acute infection with the influenza virus type B.
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PO-39 Probir na TORCH infekcije tijekom trudnoće u Primorsko-Goranskoj

županiji
Dolores Peruč1,2, Silvana Udović-Gobić1, Nilija Volarević1, Blanka Pružinec-
Popović1
1
Mikrobiološki odjel, Nastavni zavod za javno zdravstvo Primorsko-goranske
županije Rijeka, Medicinski fakultet Sveučilišta u Rijeci, Rijeka, Hrvatska
2
Zavod za mikrobiologiju i parazitologiju, Medicinski fakultet Sveučilišta u
Rijeci, Rijeka, Hrvatska
UVOD: TORCH sindrom [Toxoplasma gondii (TG), ostali uzročnici, rubeola (RV),
citomegalovirus (CMV) i herpes simpleks virus (HSV)] uključuje najčešće
kongenitalne i perinatalne infekcije.
CILJ: 1. Odrediti učestalost akutnih infekcija s TORCH uzročnicima kod trudnica.
2. Odrediti postotak trudnica koje nikada nisu bile zaražene s TORCH uzročnicima.
UZORCI I METODE: Retrospektivno smo analizirali rezultate pretraga uzoraka
seruma dobivenih od trudnica u Primorsko-Goranskoj županiji u 2015. godini.
Uzorci seruma testirani su na prisutnost IgM i IgG protutijela na TG (n=2174), CMV
(n=1159), RV (n=503), VZV (n=17), HSV-1 (n=302) i HSV-2 (n=297) koristeći
uobičajne dijagnostičke testove. Nadalje, uzorci seruma testirani su na prisutnost
HBsAg (n=2091), anti-HCV protutijela (n=1479), HIV-1,2 antigena/protutijela
(n=1489) i protutijela na sifilis (n=1178). 498 vaginalnih briseva je testirano na
prisutnost Streptococcus agalactiae i 410 cervikalnih briseva na prisutnost
Mycoplasma hominis i Ureaplasma urealyticum.
REZULTATI: Seroprevalencije IgM i IgG protutijela su bile za TG 1.24% i 16.1%, za RV
0.6% i 96.2%, za CMV 5.44% i 77.7%, za HSV-1 6.29% i 64.2%, za HSV-2 2.4% i 6.7%.
Nizak indeks aviditeta IgG protutijela utvrđen je u 4 uzorka seruma za TG i u
jednom uzorku seruma za CMV. Pozitivan IgM na HSV-2 potvrđen je imunoblotom
u 4 seruma. 0.24% uzoraka seruma bilo je pozitivno na HBsAg, 0.61% na anti-HCV
protutijela i jedan uzorak na sifilis ukupna protutijela. Herpes zoster je serološki
potvrđen kod dvije trudnice. Svi uzorci bili su negativni na HIV. 11.7% vaginalnih
briseva bilo je pozitivno na Streptococcus agalactiae. 1.5% cervikalnih briseva bilo
je pozitivno na Mycoplasma hominis i 10.2% na Ureaplasma urealyticum.
ZAKLJUČCI: Preporuča se pretrage na TORCH uzročnike učiniti u prvom tromjesečju
trudnoće kako bi se potvrdila ili isključila primarna infekcija. Visoki postotak
seronegativnih trudnica na TG ukazuje na potrebu rutinskog probira i edukacije o
prevenciji infekcije. Ženama fertilne dobi, seronegativnima na VZV, preporuča se
cijepljenje.
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Screening of torch infections during pregnancy in Primorsko-Goranska

county
Dolores Peruč1,2, Silvana Udović-Gobić1, Nilija Volarević1, Blanka Pružinec-
Popović1
1
Department of Microbiology, Teaching Institut of Public Health of
Primorsko-Goranska County, Rijeka, Croatia
2
Department of Microbiology and Parasitology, Faculty of Medicine
University of Rijeka, Croatia
INTRODUCTION: TORCH syndrome [Toxoplasma gondii (TG), Other agents, Rubella

(RV), Cytomegalovirus (CMV) and Herpes Simplex virus (HSV)] includes the most
common congenital and perinatal infections.
OBJECTIVES: 1. To determine the frequency of acute infections with TORCH agents
among pregnant women. 2. To determine the percentage of pregnant women that
have never been infected with TORCH agents.
SAMPLES AND METHODS: We retrospectively analyzed the results of analysis of
serum samples collected from pregnant women in Primorsko-Goranska County
during 2015. Serum samples were tested for the presence of IgM and IgG
antibodies against TG (n=2174), CMV (n=1159), RV (n=503), VZV (n=17), HSV-1
(n=302) and HSV-2 (n=297) using conventional diagnostic kits. Additionally, serum
samples were tested for the presence of HBsAg (n=2091), anti-HCV antibodies
(n=1479), HIV-1,2 antigen/antibody (n=1489) and syphilis antibodies (n=1178).
Furthermore, 498 vaginal and 410 cervical swab samples were tested for the
presence of Streptococcus agalactiae as well as Mycoplasma hominis and
Ureaplasma urealyticum, respectively.
RESULTS: The seroprevalence of IgM and IgG antibodies was against TG 1.24% and
16.1%, RV 0.6% and 96.2%, CMV 5.44% and 77.7%, HSV-1 6.29% and 64.2%, HSV-2
2.4% and 6.7%. IgG avidity index was low for TG in 4 serum samples and in one
sample for CMV. Positive IgM was confirmed with immunoblot in 4 HSV-2 cases.
0.24% serum samples were positive for HBsAg, 0.61% for anti-HCV positive and one
sample for anti-syphilis total antibody. Herpes zoster was confirmed serologically in
two patients. All samples were negative for HIV. Furthermore, 11.7% vaginal swab
samples were positive for Streptococcus agalactiae, 1.5% cervical swab for
Mycoplasma hominis and 10.2% for Ureaplasma urealyticum.
CONCLUSIONS: We suggest that these analyses should be performed within the
first trimester of pregnancy to confirm or to rule out primary infection. A high
percentage of pregnant women seronegative for TG indicates the need for routine
screening and education on prevention of infection. Vaccination should be advised
to women of childbearing age who are seronegative to VZV.
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PO-40 Kliničke, laboratorijske i elektroencefalografske osobitosti non-polio

enterovirusnih (NPEV) meningitisa
Dobrinka Petković, Borislav Vuković, Zdravko Andrić
Opća županijska bolnica Požega, Požega, Croatia
Cilj: usporedba kliničkih, laboratorijskih i elektroencefalografskih karakteristika

NPEV meningitisa između djece i odraslih.
Metode i bolesnici: na Infektološkom odjelu OŽB Požega u 2009. godini provedeno
je retrospektivno istraživanje koje je uključivalo bolesnike s kliničkim simptomima
NPEV meningitisa, potvrđenog citološko-biokemijskom analizom likvora i nalazom
likvorske pleocitoze s predominacijom limfocita te normalnom ili umjerenom
proteinorahijom uz negativan bakteriološki nalaz CSL. Analizirani su parametri: dob,
spol, kalendarski mjesec hospitalizacije, trajanje simptoma bolesti kod prijema i
trajanje hospitalizacije. EEG snimanje obavljeno je unutar prvih 3 dana od prijema,
a kliničke i EEG kontrole do unutra godinu dana. Virološka obrada obavljena je u
Virusološkom laboratoriju HZJZ , Zagreb. U statističkoj obradi podatka korišten je X2
test uz signifikantnost p<0,05.
Rezultati i zaključak: od ukupno 78 bolesnika s aseptičnim meningitisom,
signifikantno je veća incidencija u djece (74%), pogotovo u dječaka, u odnosu na
odrasle (26%). Slični su rezultati za djecu i odrasle s obzirom na trajanje simptoma
kod prijema, trajanje hospitalizacije (prosječno 2, odnosno 7 dana), kao i kliničku
prezentaciju bolesti. Likvorska pleocitoza kretala se u rasponu od 3-3320
leukocita/mm3 s polimorfonuklearima od 1-2496/mm3 i mononuklearima od 4-
1520/mm3 te proteinorahijom od 0,17-1,28 g/L. Nije verificirana statistički značajna
razlika u likvorskoj pleocitozi i distribuciji leukocitnih stanica između dječje i odrasle
populacije, proteinorahija je granično signifikantno viša u odraslih. Limfocitna
predominacija zabilježena je među djecom u 28%, kod odraslih u 40% slučajeva. Uz
uredan neurološki status, dizritmije EEG-a registrirane su u 80% odraslih, statistički
značajno više nego u 33% djece, bez signifikantne razlike u tipu EEG promjena
među ispitanicima, što implicira razvoj subkliničkog encefalitisa i potrebu praćenja
dinamike EEG zapisa. Nakon godinu dana patološki EEG registriran je u 20% odraslih
i 7% djece.
Clinical, laboratory and electroencephalography features in non-polio

enteroviruses (NPEVs) meningitis
Dobrinka Petković, Borislav Vuković, Zdravko Andrić
Objective: to compare the clinical, laboratory and electroencephalographic

characteristics NPEV meningitis among children and adults.
Methods and patients: we condacted a retrospective study of the Department of
Infectology County General Hospital Požega, in 2009., which includes patients with
clinical signs of aseptic meningitis has been confirmed by analysis of the CSF that
203
showed pleocytosis with a predominance of lymphocytes with normal or moderate

proteinorrachia and negative bacteriological finding cerebrospinal fluid. Analyzed
parameters: age, sex, calendar month of hospitalization, duration of symptoms at
admission and length of stay. EEG was conducted within the first 3 days of receipt,
and clinical and EEG controls performed in one year. Virological diagnostics was
made in the Virology laboratory of Croatian Institute of Public Health in Zagreb.
Statistical analysis of data useful X2 test with significance of p <0.05.
Results and conclusions: we describe a total of 78 patients with aseptic meningitis,
with a statistically significantly increased incidence of 74% in children, especially
for boys, compared to 26% of adults. Similar results for children and adults
accoding to the duration of symptoms on admission, as well as duration of
hospitalization and clinical presentation. CSF pleocytosis for patients ranged from
3-3320 leukocytes/mm3 with polymorphonuclear cells of 1-2496/mm3 and the
mononuclear cells of 4-1520/mm3 and the protein value of 0.17-1.28 g/L. Not
verified statistically significant difference in pleocytosis and distribution of
leukocyte cells between children and adults, while the protein value borderline
significantly higher among adults. Lymphocityc predominance was noted in 28%
cases of children and in 40% cases of adult. With normal neurological status,
dysrrhythmia EEG registered in 80% of adults which is significantly more than the
33% of children, but no significant difference in the type of EEG changes among the
studied population, which implies the development of subclinical encephalitis and
the needs of monitoring the dynamics EEG records. After a year of follow-up
registered patology EEG: 20% of adults ,7% children.
PO-41 Karakteristike Mycoplasma genitalium infekcije u pacijenata zagrebačke

regije
Nada Pražić, Sunčanica Ljubin Sternak, Tatjana Marijan, Neda Jarža-Davila,
Ivana Lukšić, Jasmina Vraneš
Mycoplasma genitalium je širom svijeta novo-prepoznati važan uzročnik spolno-

prenosivih infekcija u žena i muškaraca. Nova istraživanja pokazala su da je
infekcija s M. genitalium značajno povezana s nastankom cervicitisa, upalne
zdjelične bolesti, te s preranim porodom, spontanim pobačajem i neplodnošću
žena. Značajan je uzročnik uretritisa, te se utvrđuje u 15-20% slučajeva
negonokoknog uretritisa, i 20-25% neklamidijskog uretritisa u muškaraca. Cilj
istraživanja bio je utvrditi prevalenciju i karakteristike M. genitalium infekcije u
pacijenata zagrebačke regije. Istraživanje je obuhvatilo 5.323 pacijenta (4.910 žena
i 413 muškarca) kod kojih je u razdoblju od sedam mjeseci u Nastavnom zavodu za
javno zdravstvo „Dr. Andrija Štampar“ traženo testiranje na mikoplazme. M.
genitalium je detektirana metodom real-time PCR u uzorcima obriska vrata
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maternice žena u dobi od 16-88 godina, odnosno obrisku mokraćne cijevi

muškaraca u dobi od 18-73 godine. U žena je dokazana u 17 od 4.910 pregledanih
uzoraka obriska vrata maternice (0,35%), dok je kod muškaraca dokazana u četiri
od 413 uzorka obriska mokraćne cijevi (0,97%). Većina pozitivnih uzoraka je
detektirana u dobnoj skupini 20 do 39 godina i kod žena (16/17 pozitivnih) i kod
muškaraca (3/4 pozitivna). Značajno češće utvrđena je ko-infekcija nego što je M.
genitalium utvrđena kao jedini uzročnih (p<0,01). U žena je u samo četiri uzorka od
17 M. genitalium pozitivnih uzoraka ova bakterija utvrđena kao jedini uzročnik
infekcije, dok je u 13 uzoraka dokazan i drugi mikroorganizam, najčešće
Ureaplasma urealyticum (8/17 uzoraka). U muškaraca je M. genitalium kao jedini
uzročnik dokazana u dva uzorka, dok je u druga dva dokazana i Chlamydia
trachomatis. Bakterije je detektirana većinom u spolno-aktivnih mlađih žena i
muškaraca istovremeno zaraženih s još nekim spolno-prenosivim patogenom, a
zapažena je niska prevalencija zbog testiranja velikog broja asimptomatskih
pacijenata koji su u razdoblju istraživanja upućeni na testiranje na mikoplazme.
Characteristics of Mycoplasma genitalium infection in patients in Zagreb

region
Nada Pražić, Sunčanica Ljubin Sternak, Tatjana Marijan, Neda Jarža-Davila,
Ivana Lukšić, Jasmina Vraneš
Andrija Štampar Teaching Institute of Publich Health, Zagreb, Croatia
Mycoplasma genitalium is an emerging cause of sexually transmitted infections of

both sexes worldwide. New published meta-analysis revealed that M. genitalium
infection is significantly associated not only with increased risk of cervicitis and
pelvic inflammatory disease, but also with increased risk of preterm birth,
spontaneous abortion and infertility in women. It is important cause of urethritis
and can be detected in 15-20% of nongonococcal urethritis cases and 20-25% of
nonchlamydial urethritis cases in men. The aim of this study was to determine the
prevalence and characteristics of M. genitalium infection in patients from the
Zagreb region. A total of 5.323 patients were enrolled (4.910 women and 413 men),
tested for mycoplasmas in seven month of study period in „Dr. Andrija Štampar“
Teaching Institute of Public Health. M. genitalium was detected by using real-time
PCR in routinely collected cervical swabs of women 16-88 years of age, and in
urethral swabs of men aged 18-73 years. In women M. genitalium was detected in
17 out of 4.910 tested samples (0.35%), while in men bacteria was detected in four
out of total 413 tested samples of urethral swabs (0.97%). The most positive
samples were detected in 20-39 age group of patients, both in women (16/17) and
in men (3/4). Co-infection was significantly more commonly detected than M.
genitalium was detected as a sole cause of infection (p<0.01). In only four samples
out of 17 M. genitalium positive samples in women M. genitalium was detected as
a sole cause of infection, while in 13 samples additional microorganisms in samples
were detected, most prevalently Ureaplasma urealyticum (8/17). In men M.
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genitalium is detected as a sole microorganism in two samples, while in other two

Chlamydia trachomatis was co-detected. M. genitalium was detected mostly in
young sexually active women and men co-infected with some other sexually
transmitted pathogen, and detected low prevalence could be explain with large
number of asymptomatic patients tested for genital mycoplasmas in study period.
PO-42 Usporedba dva laboratorijska protokola za detekciju karbapenem

rezistentnih enterobakterija
Irina Pristaš, Iva Butić, Silvija Šoprek, Suzana Bukovski, Lada Kalajžić, Deana
Erceg, Arjana Tambić Andrasević
Karbapenem rezistentne enterobakterije sve su češći nalaz u gotovo svim zemljama

svijeta. Centers for Disease Control and Prevention (CDC) laboratorijski protokol za
detekciju karbapenem rezistentnih ili karbapenemaza-producirajućih Klebsiella spp.
i E.coli iz brisa rektuma, preporuča korištenje selektivnih obogaćujućih bujona te
presađivanje na MacConkey agar. Novije, selektivnije podloge za detekciju
karbapenemaza-producirajućih enterobakterija (CPE) omogućile su i njihovu bolju
detekciju. U našem radu usporedili smo dvije različite metode sa naglaskom na
njihovu osjetljivost i specifičnost, te vrijeme potrebno do pozitivnog nalaza, a što je
značajno za uspješnu kontrolu bolničkih infekcija. Dvije stotine uzoraka stolica ili
briseva rektuma, uzetih od pacijenata prilikom primitka na intenzivnu jedinicu
liječenja, bili su inokulirani u obogaćeni bujon sa karbapenemom i presađeni na
MacConkey agar. U drugom protokolu ti su uzorci direktno nasađeni na chromID®
CARBA i chrom IDTM OXA-48 agar ploče (BioMerieux, France). Sve su ploče bile
inkubirane na 37°C a porast kolonija praćen nakon 24h i 48h. Produkcija
karbapenemaza u suspektnim kolonijama potvrđena je CARBA NP testom. Ukupno
je potvrđeno 21 CPE, od toga njih 10 sa oba protokola, 10 samo sa protokolom dva,
te jedan sa protokolom jedan. Nakon 24-satne inkubacije CARBA ploča, detektirano
je 15 CPE, a dodatnih 5 nakon 48-satne inkubacije. Osjetljivost i specifičnost
protokola dva bile su 95.2% (CI=74.1-99.8%) i 97.8% (CI=94.0-99.3%). Osjetljivost i
specifičnost protokola jedan bile su 47.6% (CI=26.4-69.7%) i 72.1% (CI=64.8-78.4%).
U protokolu jedan, prosječno vrijeme do pozitivnog nalaza iznosilo je 4.1 dana
(CI=3.75-4.45), te 1.75 dan (CI=1.33-2.17) u protokolu dva. Uz brzinu, protokol dva
ima i veću osjetljivost i specifičnost. Korištenje obogaćujućeg bujona produljilo je
vrijeme potrebno do pozitivnog nalaza te se pokazalo nepotrebnim ukoliko se
koriste selektivne ploče za dokaz CPE na koje je moguća direktna inokulacija uzorka.
Zahvala: Zahvaljujemo BioMerieux –u koji je donirao selektivne CPE ploče.
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Comparison of two laboratory protocols for detection of carbapenem

resistant enterobacteria
Irina Pristaš, Iva Butić, Silvija Šoprek, Suzana Bukovski, Lada Kalajžić, Deana
Erceg, Arjana Tambić Andrasević
Croatia
Carbapenem resistant bacteria have been increasingly reported worldwide. Centers

for Disease Control and Prevention (CDC) Laboratory Protocol for Detection of
Carbapenem-Resistant or Carbapenemase-Producing, Klebsiella spp. and E.coli
from rectal swabs recommends the use of selective enrichment broth and
MacConkey agar. The arrival of more selective media for detection of
carbapenemase-producing Enterobacteriaceae (CPE) enables more specific
screening for these bacteria. We compared the two protocols with special
emphasis on sensitivity, specificity and time to reporting, both of which are very
important in the successful infection control. Two hundred rectal swabs or stools
were taken from patients upon admission in ICU. Protocol one included an
inoculation of a sample into an enrichment trypticase soy broth with a carbapenem
with subculturing onto MacConkey agar. The second protocol included direct
sample inoculation onto the chromID® CARBA and chrom IDTM OXA-48 agar plates
(BioMerieux, France). All plates were incubated at 37°C and inspected for growth
after 24h and 48h. Carbapenemase production in the suspected colonies was
confirmed by CARBA NP test. Overall 21 CPE were detected, 10 were positive with
both protocols, 10 were positive with protocol two only, and one was positive with
protocol one only. Fifteen CPE strains were detected on carbapenem plates after
24h of incubation, and additional five were detected after 48h incubation.
Sensitivity and specificity of protocol two were 95.2% (CI=74.1-99.8%) and 97.8%
(CI=94.0-99.3%). Sensitivity and specificity of protocol one were 47.6% (CI=26.4-
69.7%) and 72.1% (CI=64.8-78.4%). Average (arithmetic mean) time to positive
reporting was 4.1 days (CI=3.75-4.45) for protocol one, and 1.75 (CI=1.33-2.17) for
protocol two. Protocol two was faster and showed greater sensitivity and
specificity than protocol one. The use of an enrichment broth prolongs time to
positive reporting and has been proved not to be crucial if CPE selective agar plates
are used for direct inoculation.
Acknowledgements: We thank the BioMerieux company for providing CPE selective
agar plates.
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PO-43 Invazivna kandidijaza u djece: kliničke i epidemiološke značajke u

Kliničkom bolničkom centru Split tijekom petogodišnjeg razdoblja (2011.
– 2015.)
Marina Radić, Izabela Vasilj, Anita Novak, Ivana Goić-Barišić, Žana Rubić,
Marija Tonkić, Joško Markić
Klinički zavod za mikrobiologiju i parazitologiju i Klinika za dječje bolesti,
Klinički bolnički centar Split, Sveučilište u Splitu, Medicinski fakultet, Split,
Hrvatska
Kandidemija je najčešća manifestacija invazivne kandidijaze u hospitaliziranih

bolesnika. Invazivna kandidijaza u djece je najčešća u one hospitalizirane u
jedinicama intenzivnog liječenja jer su ona imunokompromitirana, često
podvrgnuta raznim invazivnim procedurama (ugradnja centralnog venskog
katetera, mehanička ventilacija), na terapiji antibioticima širokog spektra,
parenteralnoj prehrani i steroidima. Iako je Candida albicans još uvijek vodeći
uzročnik kandidemije u djece, opaža se porast non-albicans vrsta, među kojima
prednjače C. parapsilosis i C. tropicalis.
Istraživanje je obuhvaćalo retrospektivnu analizu medicinske dokumentacije
pacijenata hospitaliziranih u Klinici za dječje bolesti KBC-a Split u petogodišnjem
razdoblju (1.1 2011 - 31.12 2015). U istraživanje su uključeni bolesnici do 18 godina
u kojih je tijekom hospitalizacije dijagnosticirana kandidemija. Ukupno je bilo
uključeno 17 ispitanika. Analizirani parametri su uključivali spol i dob pacijenata,
duljinu hospitalizacije do Candida pozitivne hemokulture, osnovnu bolest, vrstu
gljivičnog izolata, znakove infekcije, prisutnost invazivnih postupaka, te primjenjene
lijekove.
Istraživanje je pokazalo da su kandidemiju podjednako često uzrokovale C. albicans
i C. parapsilosis (47%), s jednim izolatom Candida species (6%). Općenito,
kandidemija je bila češća kod ženskog spola (70.6%). U muških ispitanika je
pokazana veća učestalost C. parapsilosis (60 %), dok je kod ženskog spola češće
izolirana C. albicans (50%). Candida albicans je bila vodeći uzročnik kandidemije u
djece do 5 godina (60 %), a C. parapsilosis u starijih (66.7%). Trajanje hospitalizacije
do trenutka pozitivne hemokulture je bilo dulje kod infekcije uzrokovane C.
parapsilosis. Vodeći rizični čimbenici za razvoj kandidemije su bile respiratorne
infekcije, neurološki poremećaji, zatim sepsa i operativni zahvati. Zabilježene su
veće prosječne vrijednosti leukocita i C-reaktivnog proteina (CRP) kod infekcija
uzrokovanih C. albicans, ali razlike nisu bile statistički značajne.
Ovo istraživanje prikazuje epidemiološke i kliničke karakteristike kandidemije u
pedijatrijskih bolesnika u našoj ustanovi. Analizom potencijalnih čimbenika rizika,
među njima nije bila utvrđena značajna razlika za nastanak kandidemije s C.
albicans i C. parapsilosis.
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Invasive candidiasis in children: clinical and epidemiological

characteristics in a University Hospital Centre Split over five-year period
(2011 - 2015)
Marina Radić, Izabela Vasilj, Anita Novak, Ivana Goić-Barišić, Žana Rubić,
Marija Tonkić, Joško Markić
Department of Clinical Microbiology and Department of Pediatrics,
Split, Croatia
Candidemia is the most common manifestation of invasive candidiasis in

hospitalized patients. In children, invasive candidiasis most frequently occurs in
those hospitalized in intensive care units, as they are immunocompromised,
require different invasive procedures (central venous catheter, mechanical
ventilation), receive broad-spectrum antibiotics, parenteral nutrition and steroids.
Although Candida albicans is the leading cause of candidemia in children, there has
been increased isolation of non-albicans species, predominantly C. parapsilosis and
C. tropicalis.
A retrospective analysis of medical records of patients hospitalized in the
Department of Pediatrics, University Hospital Centre Split, was done for five-year
period (1.1.2011 – 31.12.2015). The study included 17 patients up to 18 years who
were diagnosed with candidemia. Analysed parameters included patients' gender
and age, hospitalization lenght until time Candida positive blood culture was
detected, underlying disease, yeast species isolated, documented indices of
infection, invasive procedures performed and administered therapy.
The results showed that candidemia was equally caused by C. albicans and C.
parapsilosis (47%), with one isolate of Candida species (6%). Overall, candidemia
was more common in female patients (70.6%). Candida parapsilosis was most
frequently isolated in male patients (60%), while C. albicans prevailed in females
(50%). Candida albicans was the most common cause of candidemia in patients up
to 5 years (60%), and C. parapsilosis in older ones (66.7%). The lenght of
hospitalization until the moment of positive blood culture was prolonged in C.
parapsilosis infection. Respiratory tract diseases, followed by neurological
disorders, sepsis and surgeries were leading risk factors for candidemia. Average
values of leukocytes and C-reactive protein (CRP) were higher in patients having C.
albicans infections, but the differences showed no statistical significance.
Our study showed epidemiological and clinical characteristics of candidemia in
pediatric patients in our institution. Analysis of potential risk factors showed no
significant difference among C. albicans and C. parapsilosis candidemia.
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PO-44 Uloga MALDI-TOF MS u identifikaciji gljivičnih izolata u Kliničkom

bolničkom centru Zagreb
Violeta Rezo Vranješ, Marija Jandrlić, Zoran Herljević, Mirjana Anđelić,
Sanja Pleško, Ivana Mareković
Matrix-assisted laser desorption/ionization time-of- flight masena spektrometrija

(MALDI-TOF MS) je napredna tehnologija za točnu identifikaciju vrste
mikroorganizama. Temelji se na usporedbi karakterističnih struktura proteina,
dobivenih iz mikrobioloških stanica, s bazom podataka referentnog spektra
koristeći različite algoritme ugrađene u nedavno komercijalno dostupne sustave.
Od listopada 2013. godine u Kliničkom bolničkom centru Zagreb u brzoj i pouzdanoj
dijagnostici mikroorganizama u upotrebi je aparat Bruker Daltonik GmBH microflex
LT, kao sastavni dio MALDI Biotyper sustava.
U posljednjih nekoliko godina MALDI-TOF MS je dobila značajnu ulogu u
identifikaciji gljivičnih izolata, osobito kvasaca, ali i nekoliko rodova filamentoznih
gljiva. Metoda je brza, osjetljiva i ekonomična uz jednostavnu primjenu.
U našem kliničkom laboratoriju većina gljivičnih izolata se identificiraju pomoću
konvencionalnih dijagnostičkih metoda. MALDI-TOF MS se koristi samo kada želimo
što je prije moguće utvrditi uzročnika iz sterilnih i klinički značajnih uzoraka te u
identifikaciji izolata koje nismo uspjeli identificirati konvencionalnim metodama.
Gljive se kultiviraju na Sabouraud dekstroza agaru i obrađuju s takozvanom
extended direct transfer (eDT) ciljanom ekstrakcijom prije MALDI-TOF MS analize.
Analizom rezultata dobivenih ovom metodom tijekom razdoblja od tri godine može
se zaključiti da je MALDI-TOF MS značajno unaprijedila identifikaciju gljivičnih
izolata u našem laboratoriju.)
The role of MALDI-TOF MS in identification of fungal isolates in University

Hospital Centre Zagreb
Violeta Rezo Vranješ, Marija Jandrlić, Zoran Herljević, Mirjana Anđelić,
Sanja Pleško, Ivana Mareković
Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

(MALDI-TOF MS) is a high throughput technology for proper microbial species
identification. It is based on the comparison of the characteristic protein patterns
obtained by microbial cells with a database of reference spectra by means of the
use of various algorithms integrated in systems recently made commercially
available.
210
Since October 2013 at University Hospital Centre Zagreb instrument Bruker

Daltonik GmBH microflex LT, integral part of the MALDI Biotyper system, is used for
fast and reliable identification of microorganism.
In the last few years the use of MALDI-TOF MS has arose to identify isolates of
fungi, particularly yeasts, but also a few genera of filamentous fungi. The method is
rapid, sensitive and cost-effectively with easy implementation.
In our clinical laboratory most fungal isolates are identified by conventional
methods. MALDI-TOF MS is used only when we want to identify as soon as possible
agents from sterile-site and clinically relevant sample and in the identification of
isolates that we could not identify by conventional methods. The fungi are
cultivated on Sabouraud dextrose agar and processed with extended direct transfer
(eDT) with on-target extraction prior to MALDI-TOF MS analysis.
Analyzing the results obtained by this method over a period of three years it can be
inferred that the MALDI-TOF MS greatly improved the identification of fungal
isolates in our laboratory.
PO-45 Rekurirajuća postantimikrobna dijareja u trudnice - prikaz slučaja

Mari Rončević Filipović
Odjel za infektivne bolesti, OB Varaždin, Varaždin, Hrvatska
UVOD: Rekurirajuća postantimikrobna dijareja predstavlja terapijski izazov za

liječnike, ali i opasnost za bolesnike s obzirom na tijek bolesti i potencijalne
komplikacije. Procjenjuje se da nakon svake preboljele atake bolesti raste rizik za
nove epizode proljeva (nakon dva recidiva, rizik može biti veći od 50%)(1).
Rekurirajuća infekcija se može definirati kao recidiv zbog klijanja vegetativnih formi
Cl. difficile iz spora zaostalih u kolonu ili kao reinfekcija novim bakterijskim sojem
(2,3).
Cilj je prikazati rekurirajući tijek postantimikrobne dijareje na primjeru ambulantno
liječene trudnice.
Povećani rizik od stjecanja Cl. difficile infekcije u trudnica posljedica je fiziološke
supresije Th1 imunološkog odgovora koji posreduje migraciju neutrofila u sluznicu
kolona te je stoga ključan za kontrolu bolesti (4). U trudnica se, naime, mijenja
imunološki odgovor u korist Th2 mehanizama (4).
PRIKAZ SLUČAJA: U 22-godišnje prethodno zdrave trudnice su, nakon provedene
višekratne antibiotske terapije zbog recidivirajućih faringitisa, zabilježene tri
uzastopne epizode postantimikrobne dijareje - u 18., 23. i 28. tjednu trudnoće.
Liječena je ambulantno vankomicinom per os prema važećim smjernicama (2,3) sa
dobrim kliničkim odgovorom. Nakon drugog recidiva nastavljena je ambulantna
terapija vankomicinom u padajućim i pulsnim dozama do 38. tjedna trudnoće kada
je podvrgnuta carskom rezu zbog fetalne patnje uz provedenu preoperativnu
antibiotsku profilaksu cefazolinom.
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Treći postpartalni dan ponovno je dobila proljev. Liječena je opet vankomicinom

per os u padajućim i pulsnim dozama nakon čega nije zabilježeno novih recidiva.
Klinički, sve tri epizode proljeva su, prema literaturi dostupnim podacima,
prvenstveno odgovarale recidivima uzrokovanima vjerojatno istim bakterijskim
sojem (2,3).
Znakovito je pojavljivanje trećeg recidiva tri dana po prekidu pulsne terapije
vankomicinom, nakon aplicirane samo jedne preoperativne doze cefazolina.
ZAKLJUČAK: Čini se da trudnoća predstavlja stanje povećanog rizika za stjecanje
klostridijske infekcije zbog izloženosti trudnica antibioticima i bolničkom okruženju
(veća incidencija opisana kod žena podvrgnutih carskom rezu) kao i imunološkim
promjenama povezanima sa trudnoćom (4). Štoviše, infekcija Cl. difficile u trudnica
može uzrokovati sistemske manifestacije i predstavljati rizik od komplikacija za
majku i posljedično za fetus (4).
Literatura:
Stepan C, Surawicz CM. Acta Gastroenterol Latinoam. 2007 Sep; 37(3):183-91.
Bauer MP, Kuijper EJ, van Dissel JT. European Society of Clinical Microbiology and
Infectious Diseases (ESCMID): treatment guidance document for Clostridium
difficile infection (CDI). Clin Microbiol Infect 2009; 15: 1067–79.
Beus A. Rekurirajuće infekcije uzrokovane Clostridium difficile: značenje i terapija.
Infektol Glasn 2011; 31: 155–61.
Cózar-Llistó A, Ramos-Martinez A, Cobo J. Infect Dis Ther. 2016 Aug 11. Review
Antibiotic-assotiated recurrent diarrhea in pregnancy - case report

Mari Rončević Filipović
Department for Infective Diseases, General Hospital Varaždin, Varaždin,
Croatia
INTRODUCTION: Antibiotic-associated recurrent diarrhea represents a therapeutic

challenge for physicians, but also poses a threat to the patients considering the
course of the disease and potential complications. It is estimated that after each
episode of diarrhea the risk of relapses increases (after two relapses, the risk may
be greater than 50%) (1).
Recurrent infection can be defined as relapse due to the germination of vegetative
forms of Cl. difficile from residual spores in the colon or reinfection with a new
bacterial strain (2,3).
The aim is to show the recurrent course of antibiotic-associated diarrhea on the
example of an outpatient treated pregnant women.
The increased risk of acquiring Cl. difficile infection in pregnant women is a result of
the physiological suppression of Th1 immune response, which mediates the
migration of neutrophils in the colon mucosa, and is therefore essential for the
control of the disease (4). In pregnant women, in fact, the immune response
changes in favor of the Th2 mechanisms (4).
212
CASE REPORT: In a 22-year-old previously healthy pregnant women three

consecutive episodes of antibiotic-associated diarrhea were recorded after
completing multiple antibiotic therapy for recurrent pharyngitis- in the 18th, 23rd
and the 28th week of pregnancy. Outpatient treatment with oral vancomycin was
carried according to the current guidelines (2,3) with good clinical response. After
the second recurrence outpatient treatment with oral vancomycin was continued
in the drop-down and pulse doses up to the 38th week of pregnancy when she
underwent a caesarean section due to fetal distress including preoperative
antibiotic prophylaxis with cefazolin.
On the third day postpartum she got diarrhea again. She had repeatedly undergone
oral vancomycin treatment in the drop-down and pulse doses, after which there
was no new relapses.
Clinically, all three episodes of diarrhea, according to the literature available data,
primarily resemble a recidive, probably caused by the same bacterial strain (2,3).
Significantly, the third relapse appeared three days after the termination of pulse
vancomycin therapy, following a single preoperative dose of cefazolin.
CONCLUSION: It appears that pregnancy is a condition with increased risk of
acquisition of clostridial infections due to exposure to antibiotics and the hospital
environment (higher incidence described in women undergoing caesarean section)
as well as to the immune changes associated to pregnancy (4). Moreover, Cl.
difficile infection in pregnant women can cause systemic manifestations and pose
the risk of complications for the mother and consequently for the fetus (4).
Refferences:
Stepan C, Surawicz CM. Acta Gastroenterol Latinoam. 2007 Sep; 37(3):183-91.
Bauer MP, Kuijper EJ, van Dissel JT. European Society of Clinical Microbiology and
Infectious Diseases (ESCMID): treatment guidance document for Clostridium
difficile infection (CDI). Clin Microbiol Infect 2009; 15: 1067–79.
Beus A. Rekurirajuće infekcije uzrokovane Clostridium difficile: značenje i terapija.
Infektol Glasn 2011; 31: 155–61.
Cózar-Llistó A, Ramos-Martinez A, Cobo J. Infect Dis Ther. 2016 Aug 11. Review
PO-46 Prikaz bolesnika s povišenim antistreptolizinskim titrom (AST-O) liječenih

u Klinici za infektologiju, KBC Osijek
Dario Sabadi, Ilija Rubil, Barbara Grubišić, Veronika Vukičević, Zdravka
Adamović
Klinika za infektologiju, KBC Osijek, Osijek, Hrvatska
Patients with an increased antistreptolysin titar (AST-o) treated at the

Clinic for Infectious Diseases, University Hospital Centre Osijek
Dario Sabadi, Ilija Rubil, Barbara Grubišić, Veronika Vukičević, Zdravka
Adamović
Clinic for Infectious Diseases, University Hospital Center Osijek, Croatia
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PO-47 Q groznica kao uzrok senzorne polineuropatije – prikaz slučaja pacijenta iz

Istre (Hrvatska)
Branka Sep Ševerdžija
Zavod za javno zdravstvo Istarske županije, Pula, Hrvatska
UVOD: Q-groznica je jedna od najčešćih antropozoonoza, raširena po cijelom

svijetu. Uzročnik Q groznice je Coxiella burnetii, bakterija, vrlo infekciozna i otporna
na nepovoljne životne uvjete. Primarni rezervoari ove infekcije su goveda, ovce i
koze. Najvažniji put prijenosa infekcije je udisanje infektivnog aerosola te direktan
kontakt sa zaraženom životinjom i njezinim reproduktivnim tkivima. Poznate su
različite kliničke manifestacije Q groznice, od akutnih oblika do rijeđe prisutnih
kroničnih oblika bolesti.
PRIKAZ SLUČAJA: Prikazan je slučaj 49-godišnjeg pacijenta iz Istre koji je zbog
visoke temperature, pulzirajuće glavobolje, zimice, opće slabosti i bolova u
mišićima hospitaliziran. Pri prijemu laboratorijski nalazi i rtg pluća bili su u
granicama normale.Pacijent je bio izložen udisanju aerosola na farmi ovaca gdje je
prije nekoliko dana započeo raditi kao traktorist. Uvedena je antibiotska terapija
(doksiciklin 2x100 mg). Dijagnoza Q groznice je potvrđena serološkom metodom-
indirektna imunofluorescencija (IFA). Na kontrolnom pregledu bio je afebrilan ,ali je
imao konstantan umor i bolove u mišićima nogu, tipa žarenja.uz izraženu slabost.
Tijekom narednih kontrola navedene smetnje bile su sve intenzivnije. Neurološkom
obradom potvrđena je senzorna polineuropatija i uvedena terapija Lyrica caps a 75
mg. Opsežnom obradom isključena su druga diferencijalno dijagnostička stanja
polineuropatije.
RASPRAVA: Od neuroloških manifestacija zapaženih u tijeku akutne Q groznice
najčešće su pulzirajuće glavobolje, dok su meningitis, meningoencefalitis i periferne
neuropatije rijeđe zastupljene.
Rustscheff opisao je slučaj pacijenta iz Švedske koji je razvio senzornu
polineuropatiju i sindrom kroničnog umora nakon što mu je dijagnosticirana Q
groznica. Naš pacijent je, također, imao kronični umor i senzornu polineuropatiju.
Serološko testiranje na C.burnetii trebalo bi izvesti kod svih slučajeva
meningoencefalitisa, limfocitnog meningitisa i perifernih neuropatija, uključujući
sindrom Guillain-Barre i mijelitis.
Q- fever as a cause of sensory polyneuropathy-case report from Istria

(Croatia)
Branka Sep Ševerdžija
Institute of Public Health of Istra County, Pula, Croatia
INTRODUCTION: Q- fever is one of the most common worldwide zoonosis. The

causal agent is Coxiella burnetii, a very infectious bacterium, very resistant to
adverse environmental conditions. Domestic ruminants, especially cattle, sheep
and goats are considered the main reservoir for Coxiella burnetii.The greatest risk
214
of transmission occurs at parturition by inhalation of aerosols generated from

infected placentas and body fluids or through direct contact with infected animals.
The clinical presentation of Q-fever is very pleomorfic, from acute to rarely chronic
infection.
CASE REPORT: A patient, 49 years of age, from Istria, was hospitalized due to high
fever, headache, chills, weakness and myalgia. The initial laboratory tests and chest
x-ray were normal.The patient has been exposed to aerosols on a sheep farm
where he was employed a few days earlier as a tractor driver. Empiric antibiotics
therapy (doxyciklin 2x100 mg) was initiated. The diagnosis of Q- fever was
confirmed by serological analysis-the indirect immunofluorescence assay (IFA).
On the follow up examination the patient was without fever, but experienced
fatigue and pain in his feet and legs, followed by weakness. During the next control
examinations, the specified disorders were more intense. Sensory polyneuropathy
of the legs was confirmed by neurological treatment and therapy was introduced
(Lyrica a 75 mg). By differential diagnostics we excluded other causes of
polyneuropathy.
DISCUSSION: Neurological manifestations range from the more common headaches
to rare manifestations such as meningitis, meningoencephalitis and peripheral
neuropathy.
Rustscheff described the case from Sweden when the patient developed sensory
polyneuropathy and chronic fatigue syndrome by infection with Q-fever.
Similarities exist to our patient who also developed chronic fatigue and pain in his
lower legs. Serological testing for Coxiella burnetii should be performed in cases of
meningoencephalitis, peripheral neuropathy, including Guillain-Barre syndrome
and myelitis.
PO-48 Viša prevalencija citomegalovirusne infekcije u osoba koje ubrizgavaju

droge
Siniša Skočibušić1,2, Jurica Arapović1,2, Igor Azinović2, Dragana Karan2,3,
Jadranka Nikolić1,2
1
Klinika za infektivne bolesti, Svučilišna klinička bolnica Mostar, Mostar,
Bosna i Hercegovina
2
Medicinski fakultet Sveučilišta u Mostaru, Mostar, Bosna i Hercegovina
3
Zavod za patologiju, citologiju i forenzičnu medicinu, Sveučilišna klinička
bolnica Mostar, Mostar, Bosna i Hercegovina
Uvod: Citomegalovirus (CMV) je najistraživaniji herpesvirusni patogen koji se

prenosi u krvlju i spolno prenosivim bolestima. S druge strane, poznato je da
dugotrajno ubrizgavanje heroina donosi rizik ozbiljnih medicinskih komplikacija kao
što su brojne krvlju prenosive bolesti (npr. hepatitis C, hepatitis B i dr.). Cilj je ovoga
istraživanja bio (1) usporediti prevalenciju CMV seropozitivnih osoba koje
215
ubrizgavaju droge (OKUD) i uključene su u opijatski supstitucijski tretman s

prevalencijom CMV seropozitivnih zdravih dragovoljnih darovatelja krvi i (2)
provjeriti ima li razlike u seroprevalenciji CMV između hepatitis C virus (HCV)
pozitivnih i HCV negativnih OKUD.
Ispitanici i metode: U presječno je istraživanje uključeno 125 OKUD obaju spolova
koji su sudjelovali u opijatskom supstitucijskom tretmanu (metadon i buprenorfin)
na području Hercegovačko-neretvanske županije i Zapadnohercegovačke županije
smještenih na jugu Bosne i Hercegovine i 124 zdrava dragovoljna darovatelja krvi.
Svi su testirani na postojanje IgG protutijela HCV i CMV.
Rezultati: Od ukupnoga broja OKUD, 93,6 % (117 od 125) bilo je pozitivno na
protutijela CMV IgG, a učestalost je protutijela CMV IgG među dragovoljnim
darovateljima krvi bila značajno niža (Tablica 1). Seroprevalencija CMV nije bila
statistički značajno različita u odnosu na serološki HCV status (podatci neprikazani).
Tablica 1. Distribucija seroprevalencije protutijela CMV IgG između OKUD i

kontrolne skupine.
OKUD Kontrolna skupina
CMV+ 117 (93,6 %)* 105 (84,7 %)*
CMV- 8 (6,4 %) 19 (15,3 %)
Ukupno 125 (100 %) 124 (100 %)
*(χ2 = 47 260; s.s. = 1; p < 0,001)
Zaključak: Ubrizgavanje je heroina pokazalo veću prevalenciju za stjecanje CMV u

OKUD koji su u visokom riziku stjecanja spolnih i krvlju prenosivih bolesti.
Iznenađujuće, seroprevalencija CMV između HCV + i HCV - OKUD nije bila značajno
različita, što ukazuje na to da bi CMV mogao biti dodatni rizični čimbenik za
stjecanje HCV infekcije.
Higher prevalence of cytomegalovirus infection among people who inject

drugs
Siniša Skočibušić1,2, Jurica Arapović1,2, Igor Azinović2, Dragana Karan2,3,
Jadranka Nikolić1,2
1
2
University of Mostar School of Medicine, Mostar, Bosnia and Herzegovina
3
Department of patology, citology and forensic medicine, University Clinical
Hospital Mostar, Mostar, Bosnia and Herzegovina
Background: The cytomegalovirus (CMV) has been the most investigated

herpesviral pathogen that could also be acquired as a blood- or sexually-
transmitted disease. On the other hand it is known that long-term heroin use
carries a risk of serious medical complications, such as acquisition of numerous
blood-borne diseases (e.g., Hepatitis C, Hepatitis B, etc.). The aim of this study was
216
(1) to compare the prevalence of CMV-seropositivity among people who inject

drugs (PWID) included in opiate substitution treatment with the prevalence of
CMV-seropositivity in healthy blood-donors; (2) to test if there is any difference in
seroprevalence of CMV among hepatitis C virus (HCV) positive or HCV negative
PWID.
Material/methods: A cross-sectional study included 125 PWID adults of both sexes
who participated in the opiate substitution treatment program (methadone and
buprenorphine) on the territory of Herzegovina-Neretva and West Herzegovina
Cantons in the southern parts of Bosnia and Herzegovina, and 124 healthy blood
donors. They were all tested on the presence of IgG antibody for HCV and CMV.
Results: Among the total number of PWID, 93.6 % (117 of total 125 subjects) were
positive for anti-CMV IgG whereas occurrence of anti-CMV IgG among blood
donors was significantly lower (Table 1). The seroprevalence of CMV did not vary
significantly between groups in relation to serological HCV status (data not shown).
Table 1. Distribution of seroprevalence anti-CMV IgG between PWID and healthy

controls.
PWID Control
CMV+ 117 (93.6%)* 105 (84.7 %)*
CMV- 8 (6.4 %) 19 (15.3 %)
Total 125 (100 %) 124 (100 %)
*(χ2=47 260; s.s.=1; p<0.001)
Conclusions: Intravenous heroin use showed higher prevalence for acquistion CMV
among PWID who are at high risk for acquiring of sexually and blood-borne
diseases. Surprisingly, the seroprevalence of CMV among HCV+ and HCV- PWID
adults did not vary significantly implying that CMV could not be the additional risk
factor for acquiring of HCV infection.
PO-49 Monoterapija hroničnog hepatitisa B nukleoz(t)idnim analozima

Vildana Stojić, Sead Ahmetagić, Ena Karabegović, Jasminka Petrović, Arnela
Smriko Nuhanović, Dilista Piljić, Nijaz Tihić, Suada Kavgić
Klinika za infektivne bolesti, Univerzitetski klinički centar Tuzla, Tuzla,
Bosna i Hercegovina
Uvod: Monoterapiju hroničnog hepatitisa B trenutno predstavljaju interferoni ili

nukleoz(t)idni analozi. S pojavom nukleoz(t)idnih analoga počinju se liječiti pacijenti
bez odgovora na interferon.
Metode: Analizirani su podaci o efikasnosti monoterapije lamivudinom,
entekavirom i tenofovirom za 47 pacijenata koji su liječeni od hroničnog hepatitisa
217
B u Klinici za infektivne bolesti Univerzitetskog kliničkog centra. Rezistencija na

lamivudin je testirana za sve pacijente prije početka terapije.
Rezultati: Kompletni virološki odgovor (KVO) nakon 48 sedmica terapije postigla su
33 od 47 pacijenata (70,2%). Tokom navedenog perioda nije bilo značajne razlike u
KVO (p=0,53) među grupama. Pacijenti sa rezistencijom na lamivudin nisu imali
inferiorniji antiviralni odgovor u entekavir grupi (p=0,46), niti tenofovir grupi
(p=0,42), ali u 80% pacijenata entekavir grupe koji nisu imali odgovor na terapiju
bila je prisutna rezistencja na lamivudin (svi prethodno liječeni lamivudinom).
Zaključak: Terapija entekavirom u pacijenata koji su prethodno imali potvrđenu
rezistenciju na lamivudin nije efikasna, može biti opcija za pacijente koji su ranije
liječeni lamivudinom, ali za slučajeve gdje nije došlo do razvoja rezistencije na
lamivudin.
Nucleoside/nucleotide analogues monotherapy in the treatment of

chronic hepatitis B
Smriko Nuhanović, Dilista Piljić, Nijaz Tihić, Suada Kavgić
Introduction: The treatment of chronic hepatitis B (CHB) infection includes

monotherapy with either interferons (IFNs) or nucleos(t)ide (NUC) analogs. With
the availability of NUCs, IFN-intolerant patients began to be treated.
Methods: We evaluated the efficacy of lamivudin, entecavir and tenofovir
monotherapy in 47 patients treated at Clinic for infectious diseases, University
clinical centre Tuzla. Prior lamivudin resistance was tested.
Results: The overall cumulative proportion of complete virologic response (CVR)
was 33 of 47 patients (70.2%) at 48 weeks of treatment. During the follow-up
period of 48 weeks, there was no significant difference in CVR rate (P = 0.53)
between the monotherapy groups. Patients with lamivudin resistance did not
showed inferior antiviral responses to entecavir (p=0.46) or tenofovir (p=0.42), but
in 80.0% of entecavir treatment failure lamivudine resistence was observed (all
lamivudin-experienced).
Conclusion: Entecavir should not be used in patients with previous lamivudine-
resistance, yet it may still be an option in lamivudine-experienced patients in case
lamivudine-resistance never developed.
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PO-50 Cijepljenje protiv žute groznice - izmjene međunarodnih zdravstvenih

propisa
Mario Sušanj1, Danijela Lakošeljac1, Đana Pahor1, Radovan Vodopija2,
Dorotea Gastović Bebić1
1
Nastavni zavod za javno zdravstvo Primorsko-goranske županije, Rijeka,
Hrvatska
2
Žuta groznica je jedna od najčešćih zaraznih bolesti i jedan od najvećih

javnozdravstvenih problema zemalja tropskog pojasa Afrike i Južne Amerike gdje
godišnje oboli oko 200 000 ljudi. Za tu bolest koja ima postotak smrtnosti postoji
cjepivo koje je uvedeno u praksu 1938 g. Danas je potvrda o procjepljenosti
obavezna za ulazak u 19 zemalja a još 23 njih preporuča cijepljenje. Do sada u
Hrvatskoj nije zabilježen ni jedan importirani slučaj.
Dosadašnja dugogodišnja praksa je bila revakcinacija svakih 10 godina. Brojne
kliničke studije proteklih desetljeća su dokazale da je jedno cjepivo dovoljno za
cijeli život pa je Svjetska zdravstvena organizacija na osnovu preporuke svog
strateškog savjetodavnog ekspertnog tima pokrenula niz aktivnosti da sve zemlje
članice službeno prihvate nove propise što je stupilo na snagu dana 11.7.2016.
Cijepljenje protiv žute groznice u Hrvatskoj se provodi u državnom i županijskim
zavodima za javno zdravstvo. U radu je prikazan broj cijepljenja u Nastavnom
zavodu za javno zdravstvo Primorsko-goranske županije u proteklih 15 godina.
Cijepljeno je 8443 osobe. Od toga 6821 ili 80,7% su pomorci koji su profesija što
najčešće putuju u tropske zemlje.
Početak uvođenja novih promjena u praksi je naišao na neinformiranost pomoraca i
nesnalaženje brojnih pomorskih kompanija i agencija što je rezultiralo pojačanim
angažmanom djelatnika epidemiološke službe zavoda i izradom posebnih
dokumenata radi sigurnosti prilikom ulaska u rizične zemlje zbog krutosti i
korumpiranosti graničnih službi.
U budućnosti se zbog cjeloživotne zaštite očekuje smanjeni broj cijepljenja
pomoraca. Sa druge strane raste broj cjepljenja putnika zbog neslućenih i povoljnih
mogućnosti putovanja kao i ljudi koji idu diljem svijeta u potrazi za poslom što je
danas realnost naše zemlje.
219
Vaccination against yellow fever – amendments in international health

regulations
Mario Sušanj1, Danijela Lakošeljac1, Đana Pahor1, Radovan Vodopija2,
Dorotea Gastović Bebić1
1
Teaching Institut of Public Health of Primorsko-Goranska County, Rijeka,
Croatia
2
Yellow fever is one of the most frequent infectious diseases and one of the biggest
public health problems in the tropical belt of Africa and Latin America where it is
endemic with an incidence of around 200,000 human cases per year. This disease
has a high mortality rate. The vaccine against yellow fever is in use since 1938.
Today, the certificate of vaccination is mandatory for entry into 19 countries, and
for another 23 it is recommended. Until now, there have been no imported cases
of yellow fever in Croatia.
The practice until now has been to revaccinate potentially exposed persons every
10 years. Numerous clinical studies conducted in the past decades have proven,
however, that one vaccination is sufficient for the lifetime. In accordance with
these findings and reccomandation from strategic advisory group of experts the
WHO initiated a range of activities to force all its member states to officially accept
new regulations. This decision has entered into force on July 11th, 2016.
Vaccination against yellow fever in Croatia can be received in the Croatian National
Institute of Public Health and all county Institutes of Public Health. In this paper, we
present the number of vaccinations in the Teaching Institute of Public Health of the
Primorje-Gorski Kotar County in the past 15 years. In this period a total of 8443
persons were vaccinated. Of this number, 6821 or 80.7% are seamen who, by the
nature of their profession, must travel to tropical countries.
The seamen as well as maritime companies and agencies were uninformed and
confused about the new regulations. This demanded an additional effort by the
staff of the epidemiological departments of the Institute of Public Health and the
production of special certificates in order to ensure the entry of seafarers into
certain high-risk countries, due to rigidity and corruption of their border officials.
Due to the abolishment of the need for revaccination we expect a reduced number
of vaccinations of seamen in the future. On the other hand, we observe a growing
number of vaccinations of other categories of travellers who take advantage of
favourable possibilities of travel, or persons who travel on business, which is
becoming an increasing reality for Croatia, too.
220
PO-51 Rizični faktori smrtnosti od Clostridium difficile infekcije

Vedrana Terkeš1, Ivanka Matas2, Ana Marija Markulin1, Miro Morović1,
Boris Dželalija1
1
2
Zavod za javno zdravstvo Zadar
Clostridium difficile je jedan od vodećih uzroka smrtnosti bolničkih infekcija. Glavni

rizični faktori obolijevanja i smrtnosti od CDI su prethodna antimikrobna terapija,
hospitalizacija, starija dob, te poslijednjih godina pojava hipervirulentnog soja 176,
koji luči oba toksina A i B. Uz porast učestalosti CDI posljednjih godina na
zadarskom je području zabilježena i prva veća bolnička epidemija.
Risky factors of CDI

Vedrana Terkeš1, Ivanka Matas2, Ana Marija Markulin1, Miro Morović1,
Boris Dželalija1
1
General Hospital Zadar, Zadar, Croatia
2
Public Health Institute Zadar, Zadar, Croatia
Clostridium difficile is one of the leding causes of mortality in hospital infectiones.

The key risky factors of getting ill and mortality from CDI are previus antimicrobical
therapy, hospital residance, elderly age, and lately apperance of hipervirulent
rybotyp 176, that spouts toxins A and B. By a recently grouth of CDI there has been
the first hospital epidemic recorded in Zada area.
PO-52 Sporotrix schenckii, "bolest ružinog trna" - prikaz slučaja

Maja Tomić Paradžik1, Božana Kožul2, Emilija Mlinarić Missoni3, Ljiljana
Čičmek3
1
Služba za kliničku mikrobiologiju, ZZJZ Brodsko-posavske županije,
2
Odjel za infektologiju i dermatovenerologiju, OB "Dr. Josip Benčević",
3
Odsjek za mikološku dijagnostiku, Služba za mikrobiologiju, Hrvatski zavod
za javno zdravstvo, Zagreb, Hrvatska
Sporotrix je temperaturno dimorfna gljiva proširena po cijelom svijetu, izolirana iz

tla, biljaka i biljnog otpada, drveća i tresetišta. Povremeno je nalazimo i kao
uzročnika infekcija kod ljudi. Teleomorf ove gljive (seksualna, reproduktivna faza,
poput kvasaca) je Ophiostoma stenoceras (askokarp), dok je Sporotrix schenckii
njena anamorfna faza (aseksualna, reproduktivna faza, poput plijesni). Unatoč
proširenosti po cijelom svijetu, sporotriks je ipak češći na nekim zemljopisnim
221
područjima poput Perua koji je hiper endemsko područje po učestalosti infekcija

izazvanih ovom gljivom.
Danas, zahvaljujući genotipizaciji znamo da rod Sporotrix sadrži samo jednu vrstu –
Sporotrix schenckii i on je patogena, termalno dimorfna gljiva koja uzrokuje
sporotrihozu. U narodu uvriježen naziv ove infekcije, „bolest ružinog trna“, bolest
rukovatelja ružama“ ishodište ima u zanimanjima kod kojih se ova vrsta infekcije
najčešće registrira a to su poljoprivrednici, agronomi, vrtlari, cvjećari, plantažeri,
šumski radnici, hortikulturisti, uzgajivači orhideja, zidari, veterinari i laboratorijski
djelatnici u mikrobiološkim laboratorijima. Međutim, infekciju mogu steći i ljudi koji
su na bilo koji način izloženi kontaminiranim površinama, bilju, mahovini, pšenici,
slami, ljuskama kukuruza, trski, ugrizu glodavaca ili ubodima insekata.
Najčešći oblik infekcije je kožni/potkožni oblik sporotrihoze s kroničnim tijekom, ali
najčešće bez progresije. Infekcija počinje ulaskom gljive kroz sitna i često
neprimijećena oštećenja kože kod prethodno zdravih osoba. Nakon ulaska u
potkožje, infekcija se dalje može širiti limfnim putem te se često javlja nodularni
limfangitis i limfadenopatija čvorova najbližih inficiranom anatomskom području.
Plućne infekcije i infekcije zglobnih tijela, granulomatozni tendosinovitis, sindrom
karpalnog kanala, infekcije burse, endoftalmitis, meningitis, invazivni sinuitis i
diseminirane infekcije opisane su uglavnom kod imunokompromitiranih osoba dok
kod imunokompetentnih ostaje uglavnom kao lokalizirana, kožna infekcija.
Fungemija sa smrtnim ishodom opisana je kod bolesnika s dijabetesom i
alkoholičara.
Prikazati ćemo slučaj infekcije sa Sporotrix schenckii nastale nakon uboda na trn
ruže u ružičnjaku na području južne Hercegovine, kod prethodno zdrave djevojčice.
Sporotrix schenckii, „rose handler's disease“ - case report

Maja Tomić Paradžik1, Božana Kožul2, Emilija Mlinarić Missoni3, Ljiljana
Čičmek3
1
Department of Clinical Microbiology, Croatian Institute of Public Health,
Zagreb, Croatia
2
Department of dermatovenerology and Infectious Diseases, General
Hospital „Dr. Josip Benčević“, Slavonski Brod, Croatia
3
Department of Micology Diagnostics, Department of Clinical Microbiology,
Sporotrix is a thermally dimorphic fungus which is distributed worldwide and

isolated from soil, living and decomposing plants, woods and peat moss. Sporotrix
schenckii is an occasional cause of human infections. Ophiostoma stenoceras is the
teleomorph (sexual, reproductive phase, yeast - like) of Sporotrix sp. and Sporotrix
schenckii is the anamorph (asexual, reproductive phase, such as mold. Despite the
existence of the fungus worldwide, infections due to Sporotrix schenckii are more
common at certain geographical areas. Peru is an area of hyperendemicity for S.
schenckii infections.
222
Today, thanks to genotyping, we know that genus Sporotrix contains only one
species - Sporotrix schenckii, pathogenic, thermal dimorphic fungus that causes
sporotrichosis. The conventional term of this infection, „rose handler's disease“,
has origin in occupations where this type of infection usually occurs and which
includes farmers, agriculturist, gardener, florist, planters of trees, forestry workers,
horticulturist, orchids growers, masonry, veterinarians and laboratory workers
(microbiologist). The infection can be acquired in people involved in activities and
exposure to contaminated soils, vegetations, wood, sphagnum moss, wheat, straw,
corn husks, rodent bites and puncture of insects.
The most common type of sporotrichosis is subcutaneous infection with a common
chronic and rare profressive course. The infection starts following entry of the
infecting fungus throught the skin via minor trauma and may affect an otherwise
healthy individual. Following entry, the infection may spread via the lymphatic
route and nodular lymphangitis may develop. Pulmonary and osteoarticular
infections, granulomatous tenosynovitis and carpal tunnel syndrome, bursal
infections, endophthalmitis, meningitis, invasive sinusitis and disseminated
sporotrichosis have been described. In immunocompetent patients infection
remains localized but immunocompromised patients may develop fungemia and
disseminated, fatal infections. Fatal fungemia may develop in patients with
diabetes mellitus and alcoholism.
We will show a case of subcutaneous infection with Sporotrix schenckii in
previously healthy girl acquired after the bite on a rose thorn in the rose garden
during the family trip to southern Herzegovina.
PO-53 MALDI TOF masena spektrometrija u identifikaciji bakterija - iskustva u

KBC Zagreb
Vesna Tripković1, Lidija Žele-Starčević1, Dijana Varda-Brkić1, Aleksandra
Presečki-Stanko1, Sanja Pleško1, Ivana Mareković1,2
1
2
Klasična identifikacija bakterija iz kliničkih uzoraka temelji se na uzgoju na krutim i

tekućim podlogama, karakteristikama rasta pojedinih uzročnika, preparatu po
gramu i biokemijskim osobitostima. Dio tih testova se može izvesti u vrlo kratkom
vremenskom roku, međutim uzgoj bakterija i identifikacija pomoću klasičnih
biokemijski testova, zahtjevaju prekonoćnu inkubaciju. Dosadašnjim dijagnostičkim
postupcima za konačni rezultat nam treba barem 48-72h, a za anaerobne izolate i
više. U međuvremenu, bolesnici dobivaju empirijsku antimikrobnu terapiju, koja je
ponekad neodgovarajuća.
223
Zbog toga se oduvijek težilo za brzim, točnim i cijenom pristupačnim metodama za

identifikaciju mogućih uzročnika infekcija.
Posljednjih godina nova tehnologija, MALDI-TOF masena spektrometrija, izazvala je
pravu revoluciju u identifikaciji patogena. Ova metoda omogućuje mikrobiološkim
laboratorijima identifikaciju različitih patogena s većom točnošću nego dosadašnji,
klasičan način identifikacije. Osim toga, MALDI-TOF MS omogućuje identifikaciju
bakterija u roku nekoliko minuta direktno iz kolonija poraslih na uobičajenim
mikrobiološkim podlogama. Priprema uzoraka za identifikaciju je vrlo jednostavna i
zahtijeva minimalnu obuku osoblja. Ovaj način identifikacije omogućuje brže
uključivanje ciljane terapije i posljedično uspješnije liječenje, kraću hospitalizaciju i
niže troškove liječenja.
U ovom radu želimo prikazati naša iskustva u identifikaciji bakterija na Bruker
Biotyper MS aparatu koji je u našem laboratoriju u upotrebi od listopada 2013.g.
MALDI-TOF MS in the Identification of Bacteria - Our Experience in the

CHC Zagreb
Vesna Tripković1, Lidija Žele-Starčević1, Dijana Varda-Brkić1, Aleksandra
Presečki-Stanko1, Sanja Pleško1, Ivana Mareković1,2
1
Clinical Hospital Centre Zagreb, Department for Clinical and Molecular
Microbiology Zagreb, Zagreb, Croatia
2
Medical School University of Zagreb, Zagreb, Croatia
Bacterial identification is routinely based on phenotypic tests, including Gram

staining, culture, growth and biochemical characteristics. Although some of these
tests are performed within minutes, for complete identification the overnight
incubation is required. With current diagnostic methods, final results are available
between 24 and 48 hs after sampling and for anaerobes more than 72 hs.
Meanwhile, patients are treated with empirical antibiotics, which are sometimes
inappropriate. Therefore, clinical microbiology laboratories require rapid, reliable,
and cost effective methods for identification of potential pathogens so that
appropriate antimicrobial therapy may be initiated as soon as possible.
In the last years, a novel technology has dramatically changed the identification of
pathogens by the clinical microbiology laboratory. Matrix-assisted laser
desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) enables
the rapid identification to the species level of gram-positive and gram-negative
bacteria. MALDI-TOF MS can identify bacteria within minutes directly from colonies
grown on culture plates. Sample preparation for identification is very simple and
requires minimal staff training. This radically new approach profoundly reduces the
cost of consumables and time spent on diagnostics, and most important, allows
timely treatment.
In this paper we want to present our experience in the identification of bacteria
using Bruker Biotyper MS, which is in use in our laboratory since October 2013.
224
PO-54 Ospice i rubela na području Hrvatske, 2001.-2015. godine

Tatjana Vilibić-Čavlek1, Jelena Ivančić-Jelečki2, Dubravko Forčić2, Andrea
Babić-Erceg1, Maja Šantak2, Irena Tabain1, Goran Tešović3, Gordana
Vojnović1, Ljiljana Milašinčić1, Snježana Artl1, Bernard Kaić1
1
2
Centar za istraživanje i prijenos znanja u biotehnologiji, Sveučilište u
3
U Hrvatskoj, cijepljenje protiv ospica uvedeno je u obvezni program cijepljenja

1968. godine, a 1976. godine je zamijenjeno kombiniranim cjepivom protiv ospica-
parotitisa-rubele (MPR). Od 2004. godine, cjepni obuhvat za prvu dozu iznosi >94%,
a za drugu dozu >97%. U prevakcinalnom razdoblju, godišnje je registrirano 5.000-
20.000 slučajeva ospica i rubele. U posljednja se dva desetljeća bilježi manje od 10
slučajeva ospica svake godine s iznimkom tri epidemije povezane s importiranim
slučajem (2003/2004., 2008. i 2014/2015. godine). U 2002. godini zabilježena su
četiri slučaja subakutnog sklerozirajućeg panencefalitisa. Rubela se pojavljivala
samo sporadično uz jednu epidemiju u 2007. godini. Nije prijavljen niti jedan slučaj
sindroma kongenitalne rubele. Seroepidemiološko istraživanje provedeno u
razdoblju od 2005-2009. godine pokazalo je da je 94,6% žena generativne dobi u
Hrvatskoj imuno na rubelu. Međutim, nakon 2012. godine, dolazi do pada cjepnog
obuhvata.
Posljednja je veća epidemija ospica započela u prosincu 2014. godine kada su
ospice dijagnosticirane u 6-godišnjeg dječaka (vjerojatno importirane iz Berlina).
Njegov je brat razvio simptome 11 dana kasnije. Dva daljnja člana obitelji s
dijagnosticiranim ospicama čine prvo obiteljsko grupiranje (4 bolesnika). Do ožujka
2015. godine, potvrđeno je 17 grupiranja (2-15 slučajeva). Većinom su obolijevali
članovi necijepljene romske populacije u kojih je cjepni obuhvat vrlo nizak (<50%),
koji su imali brojne kontakte s članovima obitelji iz Bosne i Hercegovine kao i
autohtoni slučajevi unutar romske populacije. No, zabilježeni su i sporadični
slučajevi izvan romske populacije. Šest zdravstvenih djelatnika zarazilo se na
radnom mjestu. U 30 bolesnika učinjeno je sekvenciranje virusnog genoma i svi su
posjedovali identične ili vrlo slične sekvence nukleotida što je upućivalo da je
epidemiju uzrokovao jedan soj ospica genotipa D8. U skladu s podacima iz drugih
europskih zemalja, sojevi virusa ospica detektirani u Hrvatskoj pripadaju genotipu
D4 (epidemija 2003. i 2008. godine), B3 (jedan importirani slučaj u 2014. godini) i
D8 (epidemija 2014/2015. godine, jedan slučaj 2016. godine).
225
Measles and rubella in Croatia, 2001-2015

Tatjana Vilibić-Čavlek1, Jelena Ivančić-Jelečki2, Dubravko Forčić2, Andrea
Babić-Erceg1, Maja Šantak2, Irena Tabain1, Goran Tešović3, Gordana
Vojnović1, Ljiljana Milašinčić1, Snježana Artl1, Bernard Kaić1
1
2
Center for Research and Knowledge Transfer in Biotechnology, University
of Zagreb, Zagreb, Croatia
3
Croatia
In Croatia, measles vaccination was first introduced in the national childhood

vaccination schedule in 1968 and was replaced by the combined measles, mumps
and rubella (MMR) vaccine in 1976. Vaccine coverage rates for the first MMR dose
are more than 94% since 2004, and for the second dose more than 97%. In the pre-
vaccinal period, 5.000-20.000 cases of measles and rubella were notified each year
in Croatia. In the last two decades, less than 10 measles cases have been reported
annually, with the exception of three import-related outbreaks (2003/2004, 2008
and 2014/2015). In 2002, four subacute sclerosing panencephalitis cases were
notified. Regarding rubella, only sporadic cases were reported with an outbreak in
2007. There was no reported congenital rubella syndrome. A seroepidemiological
study conducted from 2005-2009 showed that 94.6% of the Croatian childbearing-
aged women are immune to rubella. However, vaccination coverage has been
decreasing since 2012.
The last measles outbreak started in December 2014, when measles was clinically
diagnosed in a 6-year old boy (probably imported from Berlin). His brother
developed symptoms 11 days later. Two additional family members with measles
represent first family cluster (4 patients). Until March 2015, 17 clusters (2-15 cases)
of measles were identified. Cases were mainly members of Roma community with
very low vaccination coverage (<50%) who had numerous contacts with family
members from Bosnia and Herzegovina as well as autochthonous cases among
members of Roma population. Sporadic cases in non-Roma community also
occurred. Six healthcare workers acquired infection at work. Viruses from 30 cases
were partially sequenced and all possessed identical or highly similar sequences
indicating that the outbreak was caused by a single strain belonging to genotype
D8. Similar to contemporaneous epidemiological data from other European
countries, strains detected in Croatia belong to genotypes D4 (epidemics in 2003
and 2008), B3 (single imported case in 2014) and D8 (epidemics in 2014/2015,
single case in 2016).
226
PO-55 Infekcijski endokarditis povezan s implantacijom elektrostimulatora srca

Josip Vincelj1, Sandra Jakšić Jurinjak1, Igor Rudež1, Vladimir Krajinović2,
Bruno Baršić2
1
Zavod za bolesti srca i krvnih žila, KB Dubrava, Zagreb, Hrvatska
2
Infective endocarditis related to pacemaker implantation

Josip Vincelj1, Sandra Jakšić Jurinjak1, Igor Rudež1, Vladimir Krajinović2,
Bruno Baršić2
1
Department of Heart Disease and Blood Vessels, Clinical Hospital Dubrava,
Zagreb, Croatia
2
Croatia
PO-56 Novi predikcijski model za ranu dijagnostiku ozbiljne bakterijske infekcije

u dojenčadi mlađe od 90 dana
Matea Vujević1, Benjamin Benzon1, Joško Markić2
1
Sveučilište u Splitu, Medicinski fakultet, Split, Hrvatska
2
Klinički bolnički centar Split, Klinika za dječje bolesti, Split, Hrvatska
Cilj istraživanja: Usporediti učinkovitost različitih biomarkera i demografskih

pokazatelja u ranoj dijagnostici ozbiljne bakterijske infekcije (OBI) dojenčadi do 90
dana starosti. Izgraditi predikcijski model pomoću kojeg se može učinkovitije nego
pojedinačnim biomarkerima dijagnosticirati OBI.
Metode: Febrilna dojenčad mlađa od 90 dana hospitalizirana u dvogodišnjem
periodu na Klinici za pedijatriju Kliničkog bolničkog centra Split pod sumnjom na
OBI uključena je u ovo istraživanje. Istraživanje je provedeno retrospektivnom
kohortnom analizom podataka iz medicinske dokumentacije.
Rezultati: Od ukupno 181 uključenih ispitanika, OBI je potvrđena u njih 70. Najčešća
dijagnoza bila je infekcija mokraćnog sustava (68.6%), zatim pneumonija (12.9%),
sepsa (11.4%), gastroenterokolitis (5.7%) i meningitis (1.4%). Muški spol se pokazao
kao rizični čimbenik za razvoj OBI u ovoj populaciji (p=0.008). Kao nezavisni
prediktori ozbiljne bakterijske infekcije pokazali su se broj leukocita, apsolutni broj
neutrofila (ANC) i CRP, od kojih CRP ima najveću dijagnostičku vrijednost.
Predikcijski model za dijagnostiku OBI u kojeg su uključeni broj leukocita, CRP,
maksimalna izmjerena tjelesna temperatura i spol pokazao je osjetljivost 74.29% i
specifičnost 88.29%.
Zaključci: C-reaktivni protein (CRP) je superiorniji biomarker u dijagnostici ozbiljne
bakterijske infekcije od broja leukocita i apsolutnog broja neutrofila (ANC).
Predikcijski model pokazao se kao bolji u predviđanju ozbiljne bakterijske infekcije
nego pojedinačni biomarkeri. Iako je pokazao visoku osjetljivost i specifičnost,
njegovu pravu snagu potrebno je utvrditi validacijskom kohortom.
227
New prediction model for early diagnosis of serious bacterial infection in

infants < 90 days old
Matea Vujević1, Benjamin Benzon1, Joško Markić2
1
University of Split, School of Medicine, Split, Croatia
2
Department of Pediatrics, University Hospital Centre Split, Split, Croatia
Background: Due to non-specific clinical presentation in febrile infants, extensive

laboratory testing is often carried out to distinguish simple viral disease from
serious bacterial infection (SBI). Objective of this study was to compare efficacy of
different biomarkers and demographic characteristics in early diagnosis of SBI in
infants younger than 90 days. Also, we developed a prediction model with whom it
will be possible to diagnose SBI with more accuracy than with any of biomarkers
independently.
Methods: Febrile <90-day-old infants hospitalized in 2-year-period at Department
of Pediatrics, University Hospital Centre Split with suspicion of having SBI were
included in this study. Retrospective cohort analysis of data acquired from medical
records was performed.
Results: Out of 181 enrolled patients, SBI was confirmed in 70. The most common
diagnosis was urinary tract infection (68.6%), followed by pneumonia (12.9%),
sepsis (11.4%), gastroenterocolitis (5.7%) and meningitis (1.4%). Male gender was
shown to be a risk factor for SBI in this population (p=0.008). White blood cell
count (WBC), absolute neutrophil count (ANC) and C-reactive protein (CRP) were
confirmed as the independent predictors of SBI, with CRP as the best one.
Prediction model for diagnosing SBI has shown sensitivity of 74.29% and specificity
of 88.29%.
Conclusions: CRP is more superior biomarker in diagnostics of serious bacterial
infection comparing to WBC and ANC. Prediction model was shown to be better in
predicting SBI than independent biomarkers. Although it showed high sensitivity
and specificity, its true strength should be determined using validation cohort.
PO-57 Guillain-Barre sindrom udružen s infekcijom virusom gripe A: prikaz

bolesnice
Borislav Vuković, Dobrinka Petković, Ivana Vuković
Opća županijska bolnica Požega, Požega, Hrvatska
Guillain-Barre sindrom (GBS) je akutna monofazička imunološki posredovana bolest

perifernog živčanog sistema koja se najčešće javlja nakon bolesti probavnog ili
dišnog sustava. Može se javiti i nakon gripe ili rjeđe nakon cijepljenja protiv gripe.
Tipovi GBS uključuju akutnu inflamatornu demijelinizirajuću polineuropatiju (AIDP),
akutnu motornu aksonalnu neuropatiju (AMAN), akutnu motornu i senzornu
neuropatiju (AMSAN) i druge varijante kao što su Miller-Fischerov sindrom (MFS).
228
Prikazat ćemo bolesnicu s AIDP varijantom GBS nakon teške obostrane upale pluća i
ARDS uzrokovane virusom gripe A.
Bolesnica u dobi od 57 godina primljena je na interni odjel Opće županijske bolnice
Požega zbog ARDS uzrokovanog teškom obostranom upalom pluća tijekom
epidemije gripe. Nakon dva dana premještena je u jedinicu intenzivnog liječenja, a
potom na odjel neurologije. Tijek bolesti je bio kompliciran novonastalom
tetraplegijom uzrokovanom AIDP varijantom GBS. Liječena je imunoglobulinima
intravenski u dozi 0,4 g/ kg/ dnevno kroz pet dana i provodila je fizikalnu terapiju.
Dvije godine od početka bolesti, motorički deficit sva četiri ekstremiteta se
oporavio do nivoa pareze 4-5/5 st.
Prikazali smo slučaj bolesnice s AIDP varijantom GBS udružene s dokazanom
infekcijom inflenzom A. Kod sumnje ili dokaza GBS potrebno je provesti terapiju
imunoglobulinima intravenski ili plazmaferezu.
Acute inflammatory demyelinating polyneuropathy associated with

influenza A infection: Case report
Borislav Vuković, Dobrinka Petković, Ivana Vuković
Introduction/Objectives: Guillain-Barre syndrome (GBS) is an acute monophasic

immune mediated disease of the peripheral nervous system that usually occurs
after diseases of the digestive or respiratory system. It can occur after influenza or
rarely after vaccination against influenza. The spectrum of GBS includes acute
inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal
neuropathy (AMAN), acute motor sensory axonal neuropathy (AMSAN), and some
other variant like Miller-Fisher syndrome (MFS).
Participants, Materials/Methods: Patient with AIDP variant of GBS after severe
bilateral pneumonia and ARDS due the influenza A virus is presented.
Results: 57-year-old female was admitted to County General Hospital Požega,
Department of Internal Medicine, because of ARDS due to severe bilateral
pneumonia during influenza epidemic. After two days she was transmitted to the
Intensive Care Unit and than to the Department of Neurology. The course of the
disease was complicated with the onset of quadriplegia caused by AIDP variant of
GBS. She was treated with intravenous immunoglobulin (IVIG) 0.4 g/kg/day for five
days and she completed the physical therapy treatment. Two years after the onset
of the disease, motor deficit of all the limbs recovered to the level of paralysis 4-
5/5 degree.
Conclusions: We reported a case of AIDP variant of GBS associated with proven
influenza A infection. Once the diagnosis of GBS is suspected or established, the
treatment with intravenous immuneglobulin or plasma exchange (PE) is indicated.
229
PO-58 Utjecaj Herpes simplex virusa 2 na ishod trudnoće

Robert Vulić
Specijalistička ginekološka ordinacija dr.med. Robert Vulić, Split, Hrvatska
Uvod: Genitalni herpes predstavlja opasnu opstetrično-neonatološku bolest.

Transmisija se može dogoditi intrauterino, perinatalno i postnatalno. Infekcija se
može prezentirati kao primarna, neprimarna prva epizoda i rekurentna epizoda.
Primarna maternalna infekcija HSV-om ima veći rizik za razvoj komplikacija nego
rekurentna epizoda. Visok titar majčinih neutralizirajučih protutijela povezan je s
nižim rizikom za nastanak neonatalne infekcije. Seroprevalencija među trudnicama
varira između 7 i 33%. Transplacentarno stečena infekcija HSV-om prije 20. tjedna
trudnoće u značajnom postotku uzrokuje spontani pobačaj ili multiple
malformacije.
U ovom radu prikazat će se ishodi trudnoće s neprepoznatom primarnom i
rekurentnom infekcijom HSV-om u iste trudnice.
Metode: Pregled kliničkog praćenja trudnoća i poroda trudnice s rekurentnom
infekcijom HSV-om te analiza dostupne literature.
Rezultati: Prva trudnoća tada 30 godišnjakinje, koja je u ranoj fazi trudnoće prvi put
preboljela genitalni herpes, završila je medicinski indiciranim pobačajem u 23.
tjednu trudnoće radi multiplih malformacija ploda. Bez obzira na strah pacijentice
od neizvjesnosti budućih trudnoća, detaljno savjetovanje je ohrabrilo na trudnoće
koje su usljedile nakon 3 i 5 godina. Intenzivno su nadzirane klinički i serološki u
suradnji s infektologom. S obzirom na HSV IgM + i prodromalne simptome na kraju
druge trudnoće ista se u interesu djeteta, dovršila carskim rezom. U trećoj trudnoći
pacijentica je bila seronegativna na infekciju HSV-om. Od poroda 9/2015. godine,
pacijentica je u tri navrata razvila klinički manifestnu infekciju HSV-om genitalnog
područja.
Zaključak: Odluka da se trudnoća dovrši preventivnim carskim rezom radi
sprječavanja vertikalnog prijenosa kod trudnice koja je imala simptome genitalnog
herpesa, rezultirala je rođenjem zdravog djeteta.
Smjernice preporučuju takav način poroda i u onih koje imaju prodromalne
simptome s genitalnim herpesom u anamnezi. Trudnicama koje u anamnezi imaju
rekurirajuči genitalni herpes, od 37. tjedna trudnoće treba ordinirati antivirusnu
profilaksu.
Ovakve kompleksne trudnoće neminovno zahtijevaju suradnju ginekologa,
infektologa i mikrobiologa.
230
The impact of the Herpes simplex virus 2 on the outcome of pregnancy

Robert Vulić
Special gynecology office dr.med. Robert Vulić, Split, Hrvatska
Introduction: Genital herpes is a dangerous obstetrical-neonatal disease.

Transmission can occure intrauterineal, perinatal and postnatal. The infection can
be presented as a primary, non-primary first episode and recurrent episode.
Primary maternal HSV infection has higher risk of complications than recurrent
episodes. A high titer of maternal neutralizing antibodies is associated with a lower
risk of neonatal infection. Seroprevalence among pregnant women varies between
7 and 33%. Transplacentarily acquired HSV infection before 20th week of
pregnancy causes an inncreasing percentage of miscarriages or multiple
malformations.
Tthis paper will present the outcome of pregnancy with unrecognized primary and
recurrent HSV infection at the same pregnant women.
Methods: Reviewing of clinical monitored pregnancy and childbirth with a
recurrent HSV infection present and analysis of available literature.
Results: The first pregnancy of a 30 year old, at the time who had a genital herpes
in the early stage of her pregnancy ended by medically indicated abortion after 23
weeks of pregnancy because of multiple fetal malformations. Given the patient's
fear of the uncertainty of future pregnancies, detailed advicing encouraged the
pregnancy that followed after 3 and 5 years. The pregnancies were intensively
monitored clinically and serologically, in collaboration with Infectologist.
Considering the HSV IgM + and prodromal symptoms at the end of the second
pregnancy it was completed by Caesarean section given the child's best interes. In
the third pregnancy, the patient was seronegative to HSV infection. From birth,
9/2015., the patient three times has developed clinically manifested herpes
infection of the genital area.
Conclusion: The decision to complete the pregnancy by Caesarean section to
prevent vertical transmission at the pregnant woman who had symptoms of genital
herpes, has resulted in a birth of a healthy child.
The guidelines recommend such a manner of childbirth also in those who have
prodromal symptoms with genital herpes in history. Pregnant women with a
history of recurrent genital herpes, from 37 weeks of pregnancy should be
administered antiviral prophylaxis.
These complex pregnancyies necessarily require cooperation between
gynecologist, infectologist and microbiologist.
231
PO-59 Rana kongenitalna citomegalovirusna infekcija – prikaz slučaja

Maja Vrdoljak, Leo Markovinović, Goran Tešović, Ivica Knezović
Uvod: Citomegalovirusna (CMV) infekcija jedna je od najčešćih kongenitalnih

infekcija koja može ostaviti značajne neurološke posljedice. Samo oko 10%
inficirane novorođenčadi ima simptomatsku infekciju koja se manifestira
petehijama, ikterusom, hepatosplenomegalijom, kao i zastojem u rastu,
mikrocefalijom, gubitkom sluha, hipotonijom, korioretinitisom ili pneumonitisom.
Prikaz slučaja: Prikazujemo 1-mjesečno muško dojenče hospitalizirano prvog dana
bolesti koja se manifestirala vodenastim stolicama i odbijanjem dojenja. Dojenče je
prethodno bilo zdravo, rođeno u terminu, vaginalno, od zdrave majke, porođajne
mase 2950 g, duljine 50 cm, Apgar ocjene 10 nakon 1. i 5. minute. Trudnoća se
komplicirala razvojem placentalnog hematoma u prvom trimestru. Redovitim
ultrazvučnim pregledima nisu nađene značajnije malformacije fetusa, osim blaže
proširenog pijelona desnog bubrega.
Kod prijema dojenče je bilo bistre svijesti i živahne motorike, bez patoloških
odstupanja u somatskom i neurološkom statusu. Rezultati rutinskih laboratorijskih
nalaza bili su unutar referentnih vrijednosti. S obzirom na anamnestičke podatke o
odbijanju dojenja i pojačanoj pospanosti, napravljen je ultrazvuk mozga koji je
pokazao značajno proširenu lijevu lateralnu komoru. Stoga je učinjen probir na
uzročnike iz TORCH spektra, s nalazom od gotovo 3 milijuna kopija CMV DNA u
mililitru uzorka urina. U serumu su bila pozitivna anti-CMV protutijela razreda IgM i
IgG. Cerebrospinalni likvor bio je urednog nalaza, uključujući negativnu CMV DNA.
Magnetska rezonanca (MR) mozga pokazala je brojne abnormalnosti: redukciju
bijele tvari lijeve hemisfere s istostranom ventrikulomegalijom, polimikrogirijom i
periventrikularnim kalcifikacijama.
Dojenče je liječeno 2 tjedna parenteralnim ganciklovirom, zatim peroralnim
valganciklovirom do ukupno 6 mjeseci terapije. Kontrolni radiološki nalazi mozga
bili su stacionarni. Dojenče je uključeno u multidisciplinarno praćenje s
pohađanjem neurorazvojnih vježbi. Unatoč poduzetom liječenju, na kontrolnim
pregledima zamijećena je desnostrana hemipareza i dektektiran lijevostrani gubitak
sluha od 40%.
Zaključak: Naš bolesnik imao je opsežne morfološke promjene mozga kao
posljedice kongenitalne CMV infekcije. Budući da takve promjene koreliraju s
lošijim neurorazvojnim ishodom, potrebno je daljnje multidisciplinarno praćenje.
232
Early congenital cytomegalovirus infection - a case report

Maja Vrdoljak, Leo Markovinović, Goran Tešović, Ivica Knezović
University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb,
Croatia
Background: Cytomegalovirus (CMV) infection is one of the most common

congenital infections leading to many neurodevelopmental disabilities. Only 10 %
of infected newborns have symptomatic disease which may manifest with
petechiae, jaundice, hepatosplenomegaly as well as growth restriction,
microcephaly, hearing loss, hypotonia, chorioretinitis and pneumonitis Case
presentation: We report a 1- month-old male infant with 24-hour history of
diarrhea and poor suck. He was previously healthy, born at term by vaginal delivery
to a healthy mother, with birth weight 2950 g, length 50 cm, Apgar score 10 at 1
and 5 minutes . The pregnancy was complicated by placental hematoma in the first
trimester. No fetal abnormalities, except mild dilatation of the right renal pelvis,
were detected by ultrasound during pregnancy.
On admission infant was alert and active, without pathological findings in physical
and neurological examination. The results of routine laboratory tests were within
reference values. Because of the history of poor suck and reduced activity, cranial
ultrasound was performed revealing enlarged left lateral ventricle. Screening for
the infections from TORCH spectrum was made, showing almost 3 million CMV
DNA copies per milliliter of urine sample. Anti-CMV antibodies, both IgM and IgG,
were positive in serum. The results od cerebrospinal fluid analysis were normal,
including negative CMV DNA. Magnetic resonance imaging (MRI) of the brain
revealed numerous abnormalities: white matter reduction of the left cerebral
hemisphere with ventriculomegaly, polymicrogyria and periventricular
calcifications. The infant was treated 2 weeks with parenteral ganciclovir, followed
by oral valganciclovir, 6 months in total. Control radiographic findings of brain were
stationary. The infant was included in multidisciplinary monitoring. At a follow up
right-sided hemipharesis and left-sided 40 % hearing loss were reported.
Conclusions: Our patient had extensive brain radiographic findings as a result of
congenital CMV infection. Considering that abnormalities on cranial imaging
correlate with poor long-term neurodevelopmental outcome, further
multidisciplinary monitoring is necessary.
233
ZAHVALJUJEMO SPONZORIMA KOJI SU POMAGALI ORGANIZACIJU KONGRESA

WE GRATEFULLY ACKNOWLEDGE THE SUPPORT OF OUR SPONZORS AND SUPPORTERS
ZLATNI SPONZOR / GOLD SPONSOR
BRONČANI SPONZORI / BRONZE SPONSORS
234
OSTALI SPONZORI / OTHER SPONZORS
235
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11.

HRVATSKI KONGRES KLINIČKE MIKROBIOLOGIJE

11th CROATIAN CONGRESS OF CLINICAL MICROBIOLOGY

under the auspices of

Hrvatsko društvo za kliničku mikrobiologiju

Hrvatsko društvo za infektivne bolesti

Poreč, Hrvatska / Croatia

Maja Abram, Rijeka Maja Sabolić, Zagreb

ZNANSTVENI ODBOR / SCIENTIFIC BOARD

Josip Begovac, Zagreb Vesna Mađarić, Koprivnica

ADMINISTRATIVNI TAJNIK / ADMINISTRATIVE SECRETARY

PRIPREMA KNJIGE SAŽETAKA / ABSTRACT BOOK PREPARATION

Autori su odgovorni za stručnu i jezičnu ispravnost objavljenog sažetka.

PL-1 ESCMID 2016

PL-2 Carbapenem resistant enterobacteriaceae, a worldwide overview

PL-3 Recent advances in the treatment of parasitic diseases

Most parasitic diseases of humans occur in low-income tropical countries. There is

PL-4 Clostridium difficile infection: a collatera

Clostridium difficile (CD) is a Gram-positive, anaerobic, spore-forming, toxin

PL-5 Clinical presentation and diagnostics of autoimmune encephalitis

RACIONALNA PRIMJENA ANTIBIOTIKA

O-1 Dvadeset godina praćenja rezistencije na antibiotike

U Hrvatskoj je sustavno praćenje rezistencije bakterija na antibiotike započelo

Twenty years of antibiotic resistance surveillance

In Croatia continuous antibiotic resistance surveillance at national level started in

O-2 Potrošnja antibiotika u Hrvatskoj

Antibiotici pripadaju skupini lijekova neophodnih za uspješno i učinkovito liječenje

godine se koriste podaci od Hrvatskog zavoda za zdravstveno osiguranje (HZZO).

Antibiotic Consumption in Croatia

Antibiotics belong to a group of medicines necessary for a successful and effective

O-5 Treatment for MDR gram-negative bacteria

O-6 Akcijski plan za kontrolu virusnih hepatitisa

Action plans to control viral hepatitis

O-7 Molekularna dijagnostika u eri liječenja hepatitisa C bez interferona

Metode molekularne dijagnostike, posebice lančana reakcija polimerazom u

Molecular diagnostics of hepatitis C infection in the „interferon free“ era

O-8 Liječenje bolesnika s ekstrahepatalnim manifestacijama kroničnog

Treatment of extrahepatic manifestations of HCV infection

purpura and autoimmune hemolytic anemia. Leukocytoclastic vasculitis is

O-9 Smjernice za dijagnostiku i liječenje hepatitisa E

Guidelines for diagnostics and treatment of hepatitis E

transaminases had positive anti-HEV antibodies as a sign of acute or previous

O-10 Hepatitis C u Splitsko-dalmatinskoj županiji – epidemiologija i liječenje

Od početka 1993. do 1. rujna 2016. godine u Splitsko-dalmatinskoj (SD) županiji

Hepatitis C in Split-Dalmatian County - epidemiology and treatment

INFEKCIJE U TRUDNICA I NOVOROĐENČADI

O-11 Infekcije uzrokovane citomegalovirusom

Konatalna citomegalovirusna (CMV) infekcija najčešća je vertikalno prenosiva

Congenital cytomegalovirus infection

Congenital cytomegalovirus (CMV) infection is the commonest mother-to-child

O-12 Liječenje i prevencija HIV-infekcije kod trudnica i novorođenčadi

Treatment and prevention of HIV-infection in pregnant women and

O-13 Javnozdravstveni značaj infekcija u trudnica

Spolno prenosive infekcije u trudnica mogu uzrokovati brojne nepovoljne

The public health significance of infections in pregnant women

Sexually transmitted infections among pregnant women can cause numerous

O-14 Seroprevalencija TORCH infekcija uzrokovanih virusima u žena

Najznačajniji uzročnici infekcija u trudnoći obuhvaćeni su kraticom TORCH koja uz

Seroprevalence of TORCH infections caused by viruses in childbearing-

O-15 Laboratorijska dijagnostika infekcije parazitom Toxoplasma gondii u

Širom svijeta prošireni jednostanični organizam Toxoplasma gondii uzročnik je

Laboratory diagnosis of Toxoplasma gondii infection in pregnant women

Globally pervasive single-celled organism Toxoplasma gondii is the causative agent