Original article High prevalence of CTX-M-15 and first report of CTX-M-3, CTX-M-22, CTX-M-28 and plasmid-mediated AmpC beta-lactamase producing Enterobacteriaceae causing urinary tract infections in Bosnia and Herzegovina in hospital and community settings Amir Ibrahimagi c a, * , Branka Bedeni c b, c , Farah Kamberovi c d , Selma Uzunovi c a, e a Department for Laboratory Diagnostics, Cantonal Public Health Institute Zenica, fra Ivana Jukica 2, 72 000 Zenica, Bosnia and Herzegovina b School of Medicine, University of Zagreb, Salata 3, 10 000 Zagreb, Croatia c Clinical Department of Clinical and Molecular Microbiology, University Hospital Center Zagreb, Ki spaticeva 12, 10 000 Zagreb, Croatia d Microbiology Department, Biotechnical faculty, University of Ljubljana, Vecna pot 111,1000 Ljubljana, Slovenia e Faculty for Health Care, University “VITEZ” Travnik, Skolska 23, 72 270 Travnik, Bosnia and Herzegovina article info Article history: Received 8 October 2014 Received in revised form 5 December 2014 Accepted 3 January 2015 Available online 9 January 2015 Keywords: ESBL bla CMY-2 bla DHA-1 Antibiotic resistance abstract Aim: To investigate molecular epidemiology of extended-spectrum b-lactamase/ESBL and plasmid- mediated AmpC b-lactamase/pAmpC producing Gram-negative bacteria causing urinary tract in- fections (UTIs) in Zenica-Doboj Canton, Bosnia and Herzegovina, in the period Decembar 2009eMay 2010. Methods: Antibiotic susceptibility was determined by disc diffusion and broth microdilution according to CLSI guidelines. Double-disk synergy test was performed in order to screen for ESBLs/pAmpC beta- lactamases. PCR was used to detect bla ESBL /bla ampC /bla carb genes. Genetic relatedness of the strains was determined by pulsed-field-gel-electrophoresis (PFGE). Results: Among 85 patients with UTIs caused by ESBL producing isolates, 44 (51.8%) were from in- patients and 41 (48.2%) from outpatients. Klebsiella spp. was the most frequently isolated from in- patients, in 28 (63.6%) cases. Among outpatients, Klebsiella spp./Escherichia coli were the most frequently isolated, in 19 (46.3%)/16 (39.0%) cases. Twenty-one (75.0%) from hospital and nine (47.4%) from outpatient Klebsiella spp. isolates were positive for bla TEM, whereas 27 (96.4%) from in-patients and 6 (31.6%) from outpatient were bla CTX-M positive (18 hospital and five outpatient isolates were encoding bla CTX-M-15 ). One Klebsiella oxytoca and one Enterobacter cloacae inpatient isolates were positive for bla CTX-M-28 . One Klebsiella pneumoniae outpatient isolate were positive for bla CTX-M-22 and one E. coli for bla CTX-M-3 . One hospital Proteus mirabilis strain was positive for bla CMY-2 and two Klebsiella spp. strains for bla DHA-1, whereas two E. coli, one K. oxytoca and one Proteus vulgaris outpatient strains were positive for bla CMY-2 . Conclusion: Identification of bla CTX-M-3 , bla CTX-M-22 and bla CTX-M-28 among Enterobacteriaceae is uncom- mon. In this study we report the emergency of CMY-2 and DHA-1 plasmid-mediated beta-lactamases. © 2015, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. 1. Introduction Extended-spectrum b-lactamase (ESBL) producing gram- negative bacteria have been increasingly reported as causes of urinary tract infections (UTI) [1,2]. ESBLs production is the major resistance mechanism to oxymino-cephalosporins and aztreonam in Gram-negative bacteria [1]. ESBLs were predominantly derived from plasmid-mediated or SHV b-lactamases and have arisen * Corresponding author. Tel.: þ387 32 443 580; fax: þ387 32 443 530. E-mail addresses: ibrahimagic.amir@gmail.com (A. Ibrahimagic), branka. bedenic@zg.htnet.hr (B. Bedenic), farah_kamb@hotmail.com (F. Kamberovic), selma_kamb@yahoo.com (S. Uzunovic). Contents lists available at ScienceDirect Journal of Infection and Chemotherapy journal homepage: http://www.elsevier.com/locate/jic http://dx.doi.org/10.1016/j.jiac.2015.01.003 1341-321X/© 2015, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. J Infect Chemother 21 (2015) 363e369