Background Vancomycin is associated with disruption of the indigenous microbiota, potentially predisposing patients to overgrowth of endogenous pathogens. Our objective was to determine whether high-dose oral vancomycin is associated with cultures growing gram-negative organisms in adult patients with Clostridioides difficile infection (CDI). Methods This is a retrospective cohort study of 632 adult patients with CDI from January 2015 to December 2017. The primary outcome was prevalence of cultures growing gram-negative organisms within 6 months after onset of the first episode of CDI. A multivariate logistic regression analysis was used to determine predictors of the outcome. Results One hundred fifty-three patients (24.2%) had cultures growing gram-negative organisms after onset of CDI, where urine (97, 63.4%) and blood (27, 17.7%) were the most common sources. The most commonly isolated gram-negative organisms were Escherichia coli (49, 32.0%) and Klebsiella species (34, 22.2%). A total of 38 (38/100, 38.0%) and 48 (48/199, 24.1%) of the patients who received high- and standard-dose oral vancomycin, respectively, had gram-negative organism growth on culture (odds ratio [OR], 2.22, 95% confidence interval [CI], 1.41–3.5; P = 0.02). The multivariate analysis showed that high-dose oral vancomycin (OR, 2.21; 95% CI, 1.29–3.79; P = 0.004) and recent use of antibiotic therapy within 3 months (OR, 2.11; 95% CI, 1.27–3.52; P = 0.004) were associated with positive cultures growing gram-negative organisms. Conclusions High-dose oral vancomycin therapy for CDI was associated with increased risk of gram-negative organisms probably throughout disruption of the indigenous microbiota.

Introduction: Chickenpox is very contagious childhood disease, which occurs due to varicella-zoster virus (VZV) primary infection. Disease in healthy children resolves usually without complications, but risk of complication is much higher in adults and immunocompromised hosts. The goal of this study was to determine different clinical and epidemiological characteristics, laboratory features, clinical course, and outcome of chickenpox in children and adults. Material and methods: The descriptive study was conducted at the Department of Infectious Diseases, Clinical Center in Sarajevo, Bosnia-Herzegovina. The study included 120 patients chosen randomly. We compared their clinical and epidemiological characteristics, laboratory investigations, complications and the outcome of the disease. Results: Age of patients was in range from one to 48 years. Male patients prevailed in both groups (65% in adults, 52% in children). Hospitalization rate was 10.7/100,000 inhabitants. Positive contact with chickenpox was confirmed in 80% adults and 82% children. Dominating symptoms were fever, rash and muscle aches. Levels of C-reactive protein, erythrocyte sedimentation rates (ESR) and fibrinogen levels were elevated in both groups, while thrombocytopenia was presented in 33% of adults and 3% of children. Adults had complications in 83.3% and their hospitalization rate was longer compared to children (11.5 days vs. 9.5 days, p<0.001). Conclusions: Chickenpox is a potentially severe illness in adult patients. Introduction of active immunization in BosniaHerzegovina should be considered to prevent severe forms of chickenpox. J Microbiol Infect Dis 2012; 2(2): 64-67

SUMMARY CONFLICT OF INTEREST: none declared. Introduction Varicella or chickenpox is highly contagious, childhood infectious disease caused by primary infection with varicella – zoster virus from the herpes family of viruses. Usually it has a mild clinical course, rarely with described complication, mostly affecting respiratory tract and rarely the central nervous system. Case report The case present 8 year old boy hospitalized eighth day of disease with clinical pictures of varicella complication. Upon receipt tachydyspnea, high fever, tachycardia, hypotensive with positive findings on lung auscultation in the sense of pneumonia. Extremely high values of non-specific inflammatory parameters are implied on bacterial infection which is treated using triple antimicrobial therapy and antiviral. A detailed clinical, laboratory and radiological evaluation is determined of clinical disease complication under a picture of MODS that required prolonged multidisciplinary treatment in ICU. Conclusion The disease had a favorable clinical outcome in terms of training completely without consequences but, with the detected congenital absence lower lobe of right lung and transposition of the brachiocephalic trunk.

SUMMARY CONFLICT OF INTEREST: none declared. Introduction Staphylococcal bacteremia/sepsis is one of the most serious bacterial infections around the world. In individuals with pre-existing diseases, there is always an increased risk of infections occurring due to impaired immune system, a variety of drug therapy, exposure to a diagnostic and therapeutic procedure and frequent hospitalizations. Objectives To analyze the prevalence of comorbidity in a patient with the staphylococcal bacteremia/sepsis according to the diagnosis, the site of infection and according to the isolated agent. Patients and methods We analyzed the patients affected by the staphylococcal bacteremia/sepsis and treated in the Clinic for Infectious Diseases during a ten-year period. Results 87 patients were included, out of whom 20 (23%) with clinical signs of the bacteremia and 67 (77%) of sepsis. In the analyzed sample, in 36 (41.4%) were not registered comorbidity. Hospital infections are represented by the previous antibiotic, corticosteroid and chemo therapy, pressure ulcers, and different implants. In all comorbidity, the most common isolated bacteria was S. aureus primarily strain MSSA followed by MRSA strain which is more frequent in patients who were surgically treated (comorbidity–various implants). Conclusion The results suggest the importance of being mindful of the staphylococcal etiology of the bacteremia/sepsis in patients with comorbidities due to the selection of an adequate initial empirical therapy and reducing the risks of the septic shock.

OBJECTIVE The purpose of this study was to determine the effectiveness of percutaneous catheter drainage (PCD) and to compare PCD with percutaneous needle aspiration in the management of liver abscess. SUBJECTS AND METHODS Sixty patients with pyogenic liver abscess were randomly assigned to two groups in a prospective study. Antibiotics were administered for 10 days, starting the day of the beginning of percutaneous treatment. One group was treated with sonographically guided PCD and the other group with repeated percutaneous needle aspiration. Percutaneous needle aspiration was attempted a maximum of three times. Lack of response to the third aspiration was considered failure of treatment; these patients were treated with PCD but were not included in the PCD group for analysis. Patient demographics, duration of hospital stay, treatment outcome, and complications were analyzed. RESULTS Percutaneous needle aspiration was successful in 20 (67%) of the 30 patients after one (n = 12), two (n = 7), or three (n = 1) aspirations. PCD was curative in all 30 patients after one (n = 24) or two (n = 6) procedures. All abscesses 50 mm or less in longest diameter were successfully managed, 10 by percutaneous needle aspiration and 12 by PCD. None of patients in the percutaneous needle aspiration group with multiloculated abscesses (n = 5) was successfully treated. Hospital stay did not differ significantly between the groups. There were no complications related to the procedure. CONCLUSION PCD is more effective than percutaneous needle aspiration in the management of liver abscess. Percutaneous needle aspiration can be used as a valid alternative for simple abscesses 50 mm in diameter or smaller.