Antibiotic Resistance Patterns of Escherichia coli Strains Isolated from Urine Cultures in Turkey: A Meta-Analysis

Abstract

Escherichia coli is the most frequently isolated microorganism from both community-acquired and nosocomial urinary tract infections in Turkey. A large number of studies concerning antibiotic susceptibility of E.coli have been published from different centers throughout the country. The aim of this study was to evaluate the antibiotic resistance patterns of E.coli strains isolated from urine cultures by a meta-analysis in published medical literature between the years of 1996-2012 in Turkey. The study was planned and conducted in accordance with the declaration of PRISMA and describes the methods of literature search, the determining criteria for inclusion and evaluation of articles, data collection and statistical analysis. To find the published series Google Scholar and PubMed international databases were used to access published manuscripts evaluated according to the determined criteria for acceptance and rejection. For each study, general data and antibiotic resistance rates were collected as a common unit. Publications considered as lacking in appropriate content was eliminated from the study. Statistical analysis of the data obtained were 95% confidence intervals, and p≤ 0.05 value was considered as significant difference. A total of 228 articles were found to be published during 1996-2012 period, while 101 of them were included in the meta-analysis according to the eligibility criteria. The analyses indicated that nitrofurantoin and piperacillin resistance rates have been decreased, whereas ciprofloxacin, cefepime, co-trimoxazole and extended-spectrum beta-lactamase (ESBL) positivity rates have been increased during the study period. The increases in the rates of ciprofloxacin and cefepime resistance and and ESBL production were statistically-significant (p< 0.05). A significant reduction in resistance rates for ampicilin, amoxicillin-clavulanate, and amikacin was noted in pediatric patients between 2002-2012. Ceftriaxone, imipenem, gentamicin and amikacin resistance were not homogenous between the geographical regions, and statistically significant differences were observed for amoxicillin-clavulanate, cefuroxime and ciprofloxacin resistance rates (p< 0.05). Antibiotic resistance rates, except for imipenem, in bacterial strains, isolated from hospitalized patients were found significantly higher in strains obtained from outpatients. The differences between those groups were significant in terms of ampicilin, amoxicillin-clavulanate, cefuroxime, ceftriaxone, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, amikacin and cefepime resistances (p< 0.05). It has been noted that antibiotic resistance patterns of E.coli strains isolated from urine cultures between 1996-2012 demonstrated significant variability, and many studies were based only on laboratory data. The results of this meta-analysis demonstrated that the resistance rates in commonly-used antibiotics for empirical therapy were high. In conclusion, information obtained by systematic evaluation of national data will be valuable for the determin...

Antibiotic Resistance Trends and The ESBL Prevalence of Escherichia coli and Klebsiella spp Urinary Isolates in In-and Outpatients in a Tertiary Care Hospital in Istanbul, 2004 - 2012

“…In 2012, the overall prevalence in our study among inpatients and outpatients was 44.7% and 22.8%, respectively. The lower rates were reported in outpatients from Turkey (16,17,20). Although in Netherlands, the prevalence of ESBL-producing E. coli in outpatients is lower than our country, there was a significant increasing from 2004 (0.1%) to 2009 (1%) (18).…”

“…In both inpatients and outpatients, roughly 70% of ESBL producing E. coli were resistant to both trimethoprimsulfamethoxazole and fluoroquinolones. Several studies have been shown fluoroquinolones and trimethoprimsulfamethoxazole to be highly active against E. coli (24-28) in contrast to dramatically decreasing susceptibility rates among ESBL-producers (20,21,25,29). Fluoroquinolone resistance was reported 85% in ESBL producing E. coli isolates in a study in Nepal in 2012 (29) and in 2010 Italian study reported this rate to be even higher (85% -90%) in ESBL-producing E. coli isolates (30).…”

Isolation rates and antibiotic susceptibilities of different Enterobacteriaceae species as urinary tract infection agents in Turkey: a systematic review

“…According to that study, resistance rates of cotrimoxazole and ciprofloxacin were approximately 50% and 55% in outpatients and inpatients, respectively. Again in that study, the resistance rate of ceftriaxone was found to be 25% in inpatients (26).…”

Investigation of Fosfomycin Trometamol Susceptibility in Escherichia coli Strains Isolated from Urinary Tract Infections

“…Üriner sistem enfeksiyonu tedavisinde sıklıkla kullanılan antibiyotiklere direnç oranları bölgesel olarak değişmekle birlikte, E. coli suşlarında 1996-2012 yılları arasın-da siprofloksasin, sefepim, kotrimaksazol ve GSBL oranlarında artış istatistiki olarak anlamlı (3) . Çalışmamızda da GSBL pozitifliği %27.9 olarak saptanmış ve Baykan ve ark.…”