Marina Bubonja-Šonje

Listeriosis in pregnancy: case report and retrospective study.

Background: Listeria monocytogenes usually causes mild maternal illness, but can be devastating to the fetus. Case: Listeriosis in a pregnant patient successfully treated with empiric antibiotic therapy is described. After induced delivery, despite severe placental infection, a healthy infant was born. Additionally, archived placental specimens with similar pathological manifestation were evaluated for evidence of L. monocytogenes. Conclusion: It is important to emphasize the value of associating maternal data and clinical and laboratory findings of the newborn with the pathologic placental findings to get better results in the etiologic diagnosis of the listeriosis.

Epidemic spread of OXA-48 beta-lactamase in Croatia

Purpose. A dramatic increase in OXA‐48 &bgr;‐lactamase was observed recently not only in large hospital centres, but also in smaller suburban hospital centres in geographic areas bordering Croatia. The aim of the study was to analyse the epidemiology, the mechanisms of antibiotic resistance and the routes of spread of OXA‐48 carbapenemase in Croatia. Methods. Carbapenemase and other &bgr;‐lactamase and fluoroquinolone resistance genes were detected by PCR and sequencing. Whole‐genome sequencing (WGS) was performed on five representative isolates. The isolates were genotyped by PFGE. Results. Forty‐eight isolates positive for OXA‐48, collected from seven hospital centres in Croatia from May 2016 to May 2017, were analysed (40 Klebsiella pneumoniae, 5 Enterobacter cloacae, 2 Escherichia coli and one Citrobacter freundii). Thirty‐three isolates were ESBL positive and harboured group 1 CTX‐M 1 &bgr;‐lactamases. In addition to the &bgr;‐lactam resistance genes detected by PCR (blaSHV‐1, blaOXA‐48 and blaOXA‐1), WGS of five representative isolates revealed the presence of genes encoding aminoglycoside resistance, aadA2 and aph3‐Ia, fluoroquinolone resistance determinants aac(6)Ib‐c, oqxA and oqxB, the sulfonamide resistance gene sul1, and fosA (fosfomycin resistance). IncL plasmid was found in all isolates. Two K. pneumoniae isolates belonged to ST16, two E. cloacae to ST66 and E. coli to ST354. K. pneumoniae isolates were allocated to five clusters by PFGE which occured in different hospitals, indicating epidemic spread. Conclusions. The OXA‐48‐positive organisms found in this study showed wide variability in antibiotic susceptibility, &bgr;‐lactamase content and PFGE banding patterns. This study revealed a switch from the predominance of VIM‐1 in 2012–2013 to that of OXA‐48 in the 2015 to 2017.

Salmonella enterica arthritis in a rheumatoid arthritis patient under anti-tumor necrosis factor therapy

Anti-tumour necrosis factor (TNF) monoclonal antibodies have become an invaluable treatment against chronic inflammatory diseases such as rheumatoid arthritis (RA). However, due to increased risk of opportunistic infections, patients receiving anti-TNF therapy should be closely monitored for serious infections. Here, we describe a case of acute Salmonella_enteritidis infection of a joint arthroplasty that previously was functioning well, in a patient receiving infliximab treatment for RA. After prolonged antimicrobial chemotherapy and interrupted infliximab treatment, reimplantation of a new prosthesis was successfully performed two years after Salmonella septic arthritis. Therefore, because of the possibility of extraintestinal salmonellosis, screening for fecal colonization could be advisable in patients undergoing anti-TNF treatment. Moreover we emphasize the importance of appropriate counselling of these patients concerning food hygiene.