Surveillance of Antimicrobial Resistance in Gram-Negative Isolates from Intensive Care Units in Turkey: Analysis of Data from the Last 5 Years

Abstract

A multicenter antimicrobial surveillance program was established in Turkey in 1995 to monitor the predominant Gram-negative pathogens from intensive care units (ICUs) and antimicrobial resistance patterns of these isolates. Sixteen hospitals participated in the study and a total of 1479 isolates from 1,100 patients were collected. The isolates were tested for their susceptibility against 13 antibiotics by E-test method. Minimum inhibitory concentrations (MICs) for each isolate were determined for imipenem, ceftazidime, ceftazidime-clavulanate, cefoperazone-sulbactam, ceftriaxone, cefepime, cefuroxime, piperacillin-tazobactam, ticarcillin-clavulanate, gentamicin, amikacin and ciprofloxacin. The most common isolates were Pseudomonas spp. (28.2%), Escherichia coli (19.2%) and Klebsiella spp. (19.1%). We found very high resistance rates to all major antibiotics that are used to treat serious infections. Although imipenem is the most active agent, it had an overall susceptibility rate of 68%. Half of the tested Klebsiella spp. strains were found to produce ESBL. This is a very high rate when compared with the literature. Cross-resistance among species was also investigated. 52% of ciprofloxacin-resistant strains were also resistant to imipenem, 80% to ceftazidime, 97% to ceftriaxone, 86% to amikacin and 19% of imipenem-resistant strains were susceptible to ceftazidime and 18% to amikacin. When susceptibilities of the years 1995 and 1999 were compared, the most interesting finding was the decrease in resistance to 3rd generation cephalosporins. In conclusion, this national clinical isolate database shows that resistance rates are high, the change over years is not predictable and continuous surveillance is necessary to monitor antimicrobial resistance and to guide antibacterial therapy.

Extended-spectrum beta-lactamases in ceftazidime-resistant <i>Escherichia coli </i>and <i>Klebsiella pneumoniae </i>isolates in Turkish hospitals

“…17 The prevalence of ESBL-producing Klebsiella and E. coli was found high in different studies in Turkey. 19 In a threeyear study, the rates of production of ESBLs were found to be 20.9% for E. coli and 50% for K. pneumoniae, using ceftazidime and ceftazidime/clavulanic acid E-test strips, at a Turkish university hospital. In this study, ESBL production increased each year (21.7%, 22.1% and 45.5%).…”

Epidemiology and risk factors for ESBL-producing Klebsiella pneumoniae: a case control study

“…Many countries have a remarkable ESBLproducing K. pneumoniae problem despite many preventive efforts. Turkey has a special situation for ESBL-producing Gram negatives because of exaggerated antibiotic use and insufficient infection control measures [4,5,15]. Revealing risk factors is an important issue for management and control of hospital-acquired infections.…”

“…Klebsiella pneumoniae (K. pneumoniae) are the most commonly implicated organisms harboring a diversity of ESBL genotypes [2,3]. In Turkey, a much higher figure was quoted from different hospitals for K. pneumoniae isolates, among which the percentage of ESBL production was about forty percent [4,5]. In recent years, the importance of such ESBL-mediated infections has been increasingly recognized [6][7][8].…”

The safety of cefepime in the treatment of infection

“…Instead, the majority of Stenotrophomonas maltophilia has been found to be resistant to cefepime [14,26] . Highly variable activity has been observed against Acinetobacter spp., as well as against anaerobes, including Bacteroides spp.…”

“…The spectrum of activity of cefepime encompasses a broad range of Grampositive and Gram-negative bacteria, resulting, in comparative studies, in similar or superior activity to that shown by other cephalosporins or carbapenems [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] .…”