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    COMPARISON OF THE SUSCEPTIBILITY OF ESBL-POSITIVE AND ESBL-NEGATIVE ISOLATES OF E. COLI AND KLEBSIELLA PNEUMONIAE TO ANTIMICROBIAL AGENTS
    (Macedonian Association of Anatomists and Morphologists (MAAM), 2014)
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    The aim of this investigation was to compare the susceptibility between ESBL-positive and ESBL-negative isolates to different antimicrobial agents. Material and methods: A total of 1207 consecutive non-repeat isolates of E. coli and K. pneumoniae-Kp (E. coli-804, Kp-403) were obtained from different clinical specimens from patients hospitalized at the University Clinics in Skopje over a one year period. Conventional microbiological procedures for the isolation and detection of the strains were used. Susceptibility to beta-lactams and non-beta-lactams was determined by standard disk diffusion method and by automated method using Vitek (for determination of the MIC-minimal inhibitory concentration). A total of 251 isolates were selected (E. coli-126 and K. pneumoniae-125) using tests for phenotypic detection of the ESBL-production. A total of 233 randomly selected strains which were ESBL-negative by phenotypic tests (E.coli-130 and K.pneumoniae103) were used as a control strains for susceptibility testing. Results: Difference of the susceptibility to imipenem between ESBL-positive and ESBL-negative strains of E. coli and K. pneumoniae was not detected. Both groups of strains were 100% susceptible to imipenem. Considering the rest of the tested beta-lactams, as well as non-beta lactams and uroantiseptics, there was a difference in the susceptibility comparing both groups of strains of E. coli and K. pneumoniae. This was due to the fact that ESBL-negative strains were highly susceptible to all tested antimicrobial agents, unlike the ESBL-positive ones (except in cases of cotrimoxazole and nitrofurantoin, where the difference in susceptibility between ESBL-positive and ESBL-negative strains of E. coli was not statistically significant, because both groups of strains were susceptible to those antimicrobial agents).These data are important for recommending adequate treatment of infections with ESBL-producing bacteria.
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    The most common bacterial isolates from wound samples – a three-year study
    (INSTITUTE OF PUBLIC HEALTH OF REPUBLIC OF NORTH MACEDONIA, 2021)
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    Blerta Mehmeti
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    Aim: The aim of our study was to determine the most common bacteria isolated from wound samples and tо compare the frequency of the resistant bacteria isolated over a 3-year period. Material and methods: During a three years period (2017-2019) a total of 11 863 wound samples (wound swabs, punctuates, exudates, tissue, etc.) were obtained from the hospitalized patients in the University Clinics of the ,,Mother Theresa” campus, the City hospital ,,8th September” and the University Clinic for surgical diseases ,,St. Naum Ohridski” in Skopje. All samples were processed at the Institute of Microbiology and Parasitology, Faculty of Medicine, Skopje. They were examined by standard microbiology techniques. Identification and susceptibility of microorganisms were done by both standard methods and automatized Vitek 2 system. Results: Out of a total number of samples, which was 3 463 in 2017, 4 127 in 2018 and 4 273 in 2019, positive were 2 068 (60%), 2 302 (55.8%) and 2 387 (55.9%), respectively. From the total of aerobes/facultative anaerobes (2 758, 2 949 and 3 279 in three consecutive years, 2017, 2018 and 2019, respectively), Staphylococcus aureus was the most predominant isolate (19.5%, 16.6%, 16.9%) followed by Enterococcus spp (16%, 16%, 16.7%), Pseudomonas aeruginosa (12%, 13%, 12.7%) and E. coli (10%, 10.4%, 10.7%). Considering anaerobic bacteria, the percentage of Gram positive anaerobes (Peptostreptococcus) has decreased from 33% to 18% out of a total number of anaerobes, unlike Gram negative anaerobes in which the increasing percentage was mostly observed in bacteria of the genus Bacteroides (from 39% to 45%). The percentage of the resistant strains of MRSA, CNS-MR and VRE was almost the same in that period. In Gram-negatives the percentage of ESBL-positive isolates of E. coli and Enterobacter spp. increased consecutively from 2017 to 2019. The increase in the percentage of resistant strains was more noticeable in ESBL-positive isolates of Klebsiella pneumonia between 2017 and 2018, but in 2019 a percentage decrease can be observed. Considering carbapenem-resistant (CR) Enterobacterales, an increase in the resistance was noticeable in K. pneumonia. The increase in the percentage of resistant strains in Enterobacter spp. between 2017 and 2018, as well as the decrease between 2018 and 2019 was statistically significant. The percentage of CR-isolates of Pseudomonas aeruginosa was from 30% to 38% and for Acinetobacter spp. this percentage was from 81% to 85%. Conclusion: The knowledge of the most commonly isolated bacterial pathogens, especially the presence of resistant bacteria, is crucial and should be continuously monitored in order to understand, construct and update effective treatment algorithms and guidelines.
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    Item type:Publication,
    Microbiological analysis of wound samples
    (Medical Faculty, Ss. Cyril and Methodius University in Skopje, 2020)
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    Cvetanovska S
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    Incorporation of antimicrobial agents can be used to enhance the antibacterial effect of endodontic sealers
    (Elsevier, 2013-03)
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    J.W. Nicholson
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    Aim. The antibacterial activity of five endodontic sealers against three different microorganism strains alone and following incorporation of 2% benzalkonium chloride (BC) and 2% cetylpyridinium chloride (CPC) was evaluated. Methodology. The agar diffusion method was used to determine the inhibitory effect of the following endodontic sealers: RoekoSeal, Endomethasone N, N2, Apexit Plus and AH plus, on Streptococcus mutans – ATCC 25175, Lactobacillus casei – ATCC 4646 and Actinomyces viscosus – ATCC 19246. Bacterial strains were inoculated into BHIB, and incubated in an anaerobic atmosphere (37 ◦C). From the bacteria grown in the liquid medium, the density of the inoculum was setto be equivalentto McFarland 2 standard. In Shaedler agar, 350L ofthe bacterial suspension were equally spread. Specimens (4mm× 6mm) were prepared from each material without and with addition of 2% BC or 2% CPC. The inhibition zones were determined after 2 days, after 7 days and after 21 days of incubation. Results. The largest inhibition zones were shown at zero time in all cases, with progressively less inhibition at 7 and 21 days. Endomethasone N and N2 showed the most intense antimicrobial activity, while RoekoSeal showed the least antimicrobial effect. The most susceptible microorganism was A. viscosus. Greater antimicrobial effects were found following incorporation of BC or CPC, and generally, BC gave greater inhibition zones than CPC. Conclusions. Adding either BC or CPC has the potential to improve clinical outcomes with endodontic sealers, as these substances enhance the short-term antimicrobial effects of the sealers
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    FREQUENCY OF SURGICAL SITE INFECTIONS FOLLOWING SURGICAL TREATMENT OF ISOLATED FRACTURES: A RETROSPECTIVE STUDY
    (Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2024)
    Vejseli, Valentin
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    Brava, Edmond
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    Kacarska, Aleksandra
    Surgical site infections (SSIs) are a frequent and serious complication that occur after surgical treatment of isolated fractures, leading to increased morbidity, mortality, prolonged hospital stays, and higher healthcare costs. This study aimed to identify the frequency and risk factors associated with SSIs. Methods: This retrospective observational study included 51 patients who underwent open reduction and internal fixation (ORIF) surgery for isolated fractures and later developed bacterial infections. We analyzed factors such as the presence of comorbidity, patient age, gender, body region affected, and duration of the operation. We used multinomial logistic regression and chi-square tests as statistical analyses to examine the relationships between these factors and the types of pathogens as a cause of bacterial infection, classified as Gram-positive bacteria only, Gram-negative bacteria only, or both. Results: Our study found that in 18%, 56% and 26% of patients the cause of infection was Gram-positive, Gram-negative and both groups of bacteria, respectively. The factors that did not significantly predict the type of bacterial infection were: comorbidity presence, although the observed trends suggested further investigation was needed; duration of operation; and patient age. Gender analysis concluded a marginally significant association, with males less likely to have infections caused by Gram-positive bacteria. Additionally, the body region affected showed a marginally significant correlation with infection type, with the thigh region being more sensitive to infections caused by Gram-negatives. Our study highlights trends and marginal associations in SSIs post-ORIF surgery, suggesting the need of personalized infection control strategies.
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    Item type:Publication,
    Pneumococcal serotypes and their resistance to penicillin
    (Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, R Macedonia, 2014)
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    Phenotypic and genetic relationship of Acinetobacter Baumannii isolates
    (Македонска академија на науките и уметностите, Одделение за биолошки и медицински науки = Macedonian Academy of Sciences and Arts, Section of Biological and Medical Sciences, 2011)
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    G. Jankoska
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    The interest in Acinetobacter continues to rise. One of the main reasons is the emergence of multi-resistant strains, which cause outbreaks of infection involving several patients in a ward, in the intensive care unit and in different areas of the hospital. Many outbreaks of its infection or colonization in surgical, neonatal and burn intensive care units have been reported, but the epidemiology of these infections remains unclear. Aim: To investigate the relationship among the isolates of Acinetobacter baumannii, comparing some of their phenotypic and genetic features. Material and methods: A total of 20 Acinetobacter baumanni isolates were included in the study. 12 strains of Acinetobacter baumannii were obtained within a week in July 2010, from neonates hospitalized at the paediatric intensive care unit and on the neonatal ward. Three strains were isolated from neonates at the paediatric intensive care unit three months ago. All the Acinetobacter baumannii strains were isolated from tracheal aspirates obtained from neonates with infection of the lower respiratory tract. Five additional Acinetobacter baumannii strains were included in the study as controls. They were isolated from wound swabs taken from adult patients with wound infection, hospitalized at the University Traumatology Clinic. Susceptibility of the bacterial strains to 13 different antimicrobial agents was determined by the disk diffusion method (Kirby-Bauer). Additional testing of the susceptibility was performed by the VITEK 2 system. RAPD-PCR fingerprinting was carried out using the following primer (5' GAAACAGCTATGACCATG -3'). Results: All A. baumannii isolates were multi-drug resistant. Antibiotic susceptibility-testing by the disk-diffusion method and automated VITEK 2 system showed 3 and 2 antimicrobial susceptibility patterns, respectively. RAPD-PCR assay of A. baumannii strains revealed two different RAPD-fingerprints. All the strains of A. baumannii isolated within a week in July 2010 from tracheal aspirates taken from neonates in the paediatric intensive care unit and neonates in the paediatric ward revealed the same RAPD-fingerprint, as well as 3 strains of A. baumannii isolated from tracheal aspirates taken from neonates in the paediatric intensive care unit three months ago. 5 strains of A. baumannii isolated from wound swabs of patients hospitalized at the Traumatology Clinic revealed a different RAPD-fingerprint. Conclusion: All the strains of A. baumannii isolated from neonates in the paediatric intensive care unit and paediatric ward were multi-drug resistant. Investigating the resistance patterns in multi-resistant isolates of Acinetobacter is a useful method which can predict the strain relationship. This method could be completed by at least one molecular method, such as the RAPD-PCR technique, which has shown itself to be a convenient and more reliable in interpreting the strain relationship of the A. baumannii isolates. Good infection control procedures, including phenotypic and molecular typing of A. baumannii isolates, are essential for preventing outbreaks of multi-drug resistant A. baumannii infections in our hospitals.
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    Item type:Publication,
    Evaluation of Multiplex PCR in diagnosis of invasive infections with Candida species
    (Medical Facilty, Ss Cyril and Methodius University, Skopje, R Macedonia, 2016)
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    Adenoid Vegetations - Reservoir of Bacteria for Chronic Otitis Media with Effusion and Chronic Rhinosinusitis
    (Македонска академија на науките и уметностите, Одделение за медицински науки = Macedonian Academy of Sciences and Arts, Section of Medical Sciences, 2015)
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    Beti Zafirovska
    Introduction: Otitis media and rhinosinusitis are commonly encountered illnesses in pediatric population. Literature reports have documented the association between the occurrence of these two conditions and even their almost identical microbiological findings. Until recently, the key factor in the association of these two conditions was considered to be the hypertrophic adenoid tissue, but within the past few years there have been evidences in the literature about the presence of bacterial biofilms on the adenoids suggesting biofilms to be also responsible for both conditions, chronic otitis media with effusion and chronic rhinosinusitis. Aim: The aim of this study was to make a microbiological analysis of the adenoid tissue specimens taken from patients with chronic otitis media with effusion and chronic or recurrent rhinosinusitis and to determine their potential for biofilms formation. Methods: After the surgical intervention, adenoidectomy, microbiological evaluation and analysis of the adenoid tissue specimens taken from 20 patients were made. Having in mind the disease history, chronic otitis media with effusion was diagnosed in all 20 patients and chronic rhinosinusitis in 9 patients. Results: The results obtained from the microbiological analyses showed many potentially pathogenic bacteria in the adenoids that were almost identical with the most common organisms incorporated in the etiopathogenesis of both conditions, in chronic otitis media with effusion and in chronic rhinosinusitis. In 7 (35%) patients Haemophylus influenzae was isolated, in 6 (30%) Streptococcus pneumoniae, in 4 (20%) Moraxella catаrrhalis, in 2 (10%) patients Staphylococcus aureus and in 1 (5%) patient Streptococcus pyogenes - group A was isolated. One bacterium was isolated from all adenoid vegetations, except in one case when two bacteria (Haemophylus influenzae and Staphylococcus aureus) were concurrently isolated. Conclusion: Our results have shown that the key role in adenoid vegetations in chronic otitis media with effusion and chronic rhinosinusitis is not only the mechanism of rhinopharyngeal obstruction, but also the presence of bacterial strains with a large potential for formation of biofilms adhered to their surface, especially in cases with symptoms of chronic otitis media with effusion and chronic rhinosinusitis that were resistant to antibiotic therapy.
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    Item type:Publication,
    Phenotipic and genetic relationship of Acinetobacter baumannii isolates
    (Macedonian Academy of Sciences and Arts, 2011)
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    Jankoska, G
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    Mircevska, Gordana
    The interest in Acinetobacter continues to rise. One of the main reasons is the emergence of multi-resistant strains, which cause outbreaks of infection involving several patients in a ward, in the intensive care unit and in different areas of the hospital. Many outbreaks of its infection or colonization in surgical, neonatal and burn intensive care units have been reported, but the epidemiology of these infections remains unclear. Aim: To investigate the relationship among the isolates of Acinetobacter baumannii, comparing some of their phenotypic and genetic features. Material and methods: A total of 20 Acinetobacter baumanni isolates were included in the study. 12 strains of Acinetobacter baumannii were obtained within a week in July 2010, from neonates hospitalized at the paediatric intensive care unit and on the neonatal ward. Three strains were isolated from neonates at the paediatric intensive care unit three months ago. All the Acinetobacter baumannii strains were isolated from tracheal aspirates obtained from neonates with infection of the lower respiratory tract. Five additional Acinetobacter baumannii strains were included in the study as controls. They were isolated from wound swabs taken from adult patients with wound infection, hospitalized at the University Traumatology Clinic. Susceptibility of the bacterial strains to 13 different antimicrobial agents was determined by the disk diffusion method (Kirby-Bauer). Additional testing of the susceptibility was performed by the VITEK 2 system. RAPD-PCR fingerprinting was carried out using the following primer (5' GAAACAGCTATGACCATG -3'). Results: All A. baumannii isolates were multi-drug resistant. Antibiotic susceptibility-testing by the disk-diffusion method and automated VITEK 2 system showed 3 and 2 antimicrobial susceptibility patterns, respectively. RAPD-PCR assay of A. baumannii strains revealed two different RAPD-fingerprints. All the strains of A. baumannii isolated within a week in July 2010 from tracheal aspirates taken from neonates in the paediatric intensive care unit and neonates in the paediatric ward revealed the same RAPD-fingerprint, as well as 3 strains of A. baumannii isolated from tracheal aspirates taken from neonates in the paediatric intensive care unit three months ago. 5 strains of A. baumannii isolated from wound swabs of patients hospitalized at the Traumatology Clinic revealed a different RAPD-fingerprint. Conclusion: All the strains of A. baumannii isolated from neonates in the paediatric intensive care unit and paediatric ward were multi-drug resistant. Investigating the resistance patterns in multi-resistant isolates of Acinetobacter is a useful method which can predict the strain relationship. This method could be completed by at least one molecular method, such as the RAPD-PCR technique, which has shown itself to be a convenient and more reliable in interpreting the strain relationship of the A. baumannii isolates. Good infection control procedures, including phenotypic and molecular typing of A. baumannii isolates, are essential for preventing outbreaks of multi-drug resistant A. baumannii infections in our hospitals.