Koksal Iftihar, Yilmaz Gurdal, Unal Serhat, Zarakolu Pinar, Korten Volkan, Mulazimoglu Lutfiye, Tabak Fehmi, Mete Birgul, Oguz Vildan Avkan, Gulay Zeynep, Alp Emine, Badal Robert, Lob Sibylle
Karadeniz Technical University, Trabzon, Turkey.
Hacettepe University, Ankara, Turkey.
J Antimicrob Chemother. 2017 May 1;72(5):1364-1372. doi: 10.1093/jac/dkw574.
To describe the epidemiology and susceptibility of pathogens (including ESBL producers) from hospital-acquired (HA) versus community-acquired (CA) urinary tract infections (UTIs) and ICU- versus non-ICU-associated intra-abdominal infections (IAIs) in Turkey as a part of the SMART study.
: For this report, Gram-negative pathogens (363 from UTIs and 458 from IAIs) were collected in 2011 and 2012 at six hospitals in Turkey. HA versus CA UTIs and ICU- versus non-ICU-associated IAIs were compared for the species isolated, percentage of ESBL-positive isolates by species and susceptibility for overall and individual Gram-negative species.
: Escherichia coli was the most common pathogen identified in HA (40.2%) and CA (73.9%) UTIs and ICU-associated (25.8%) and non-ICU-associated (43.3%) IAIs. The rate of ESBL-positive E. coli was significantly higher in HA than in CA UTIs (50.5% versus 38.2%, P < 0.001) and in non-ICU-associated than in ICU-associated IAIs (52.5% versus 29.2%, P = 0.029). Of the drugs studied, only amikacin was active against ≥90% of pathogens in UTIs, while ertapenem, imipenem and amikacin were active against ≥90% of E. coli ; and imipenem, amikacin and cefoxitin were active against ≥90% of Klebsiella pneumoniae in IAIs.
Our findings demonstrated that E. coli continues to be the principal pathogen of UTIs and IAIs in Turkey. Along with a high rate of ESBL-positive isolates, high antimicrobial resistance among Gram-negative bacilli from either UTIs or IAIs was noted particularly in the case of HA UTIs and ICU-associated IAIs, with a higher likelihood of carbapenem- or amikacin-based therapy to provide the broadest activity against bacterial pathogens.
作为全球抗微生物耐药性和毒性监测（SMART）研究的一部分，描述土耳其医院获得性（HA）与社区获得性（CA）尿路感染（UTI）以及重症监护病房（ICU）相关与非ICU相关腹腔内感染（IAI）的病原体（包括产超广谱β-内酰胺酶菌）的流行病学和药敏情况。
在本报告中，2011年和2012年在土耳其的6家医院收集了革兰阴性病原体（363株来自UTI，458株来自IAI）。比较了HA与CA UTI以及ICU相关与非ICU相关IAI中分离出的菌种、各菌种中产ESBL菌株的百分比以及总体和各革兰阴性菌种的药敏情况。
大肠杆菌是在HA（40.2%）和CA（73.9%）UTI以及ICU相关（25.8%）和非ICU相关（43.3%）IAI中鉴定出的最常见病原体。HA UTI中产ESBL大肠杆菌的比例显著高于CA UTI（50.5%对38.2%，P＜0.001），非ICU相关IAI中产ESBL大肠杆菌的比例高于ICU相关IAI（52.5%对29.2%，P = 0.029）。在所研究的药物中，只有阿米卡星对≥90%的UTI病原体有活性，而厄他培南、亚胺培南和阿米卡星对≥90%的大肠杆菌有活性；亚胺培南、阿米卡星和头孢西丁对≥90%的IAI中的肺炎克雷伯菌有活性。
我们的研究结果表明，在土耳其，大肠杆菌仍然是UTI和IAI的主要病原体。除了产ESBL菌株比例较高外，UTI或IAI中的革兰阴性杆菌耐药性也很高，尤其是HA UTI和ICU相关IAI，基于碳青霉烯类或阿米卡星的治疗更有可能对细菌病原体具有最广泛的活性。
