The authors have declared that no competing interests exist.
The morbidity and mortality associated with the multi drug resistant Gram negative bacterial infections pose a significant and growing challenge to clinical practitioners.
In this study, the antibiotic susceptibility profiles of 2452
The study included a total of 2452
In this study, high rates of resistance to carbapenems were noteworthy. Determination of hospital antimicrobial resistance rates will be useful in developing antibiotic use policies of each hospital, in the treatment of causative agents, in selecting antibiotics according to antimicrobial susceptibility.
The worldwide increase in the occurrence of antimicrobial resistance (AMR) and prevalence of infections with multidrug-resistant (MDR) Gram negative Enterobacteriaceae has become a global health problem. Antimicrobial resistance could be accelerated by the misuse of antibiotics in animals and humans, leading to restricted treatment options, poor clinical outcomes and increasing hospital costs
Therefore, surveillance programs are needed to establish antibiotic resistance policies, to determine treatment schemes for infections with multi drug resistance bacteria and to observe emerging new resistance phenotypes.
The aim of this study was determine the antibiotic susceptibility of
A total of 2452
The isolated strains included in the study were mostly isolated from blood; this was followed by bronchial lavage, wound, drainage and other clinical specimens. The distribution of isolated
|
|
|
---|---|---|
Blood | 894 | 36,5 |
Bronchial lavage fluid | 790 | 32,2 |
Wound | 211 | 8,6 |
Drainage | 148 | 6 |
Peritoneal fluid | 148 | 6 |
Tracheal aspirates | 95 | 3,9 |
Catheter | 64 | 2,6 |
Urine | 62 | 2,5 |
Other |
40 | 1,6 |
|
2452 | 100 |
plevral fluid, cerebrospinal fluid, throat samples
Of the isolates, 1616 (65,9 %) were obtained from intensive care units, 813 (33,2 %) from service and 23 (0,9 %) from polyclinic patients. The disribution of isolated strains according to clinics is given in
|
|
|
|
---|---|---|
Amoxicillin clavulonic acid | 2264 | 92,3 |
Amikacin | 1120 | 45,7 |
Ceftazidime | 2122 | 86,5 |
Ciprofloxacin | 1862 | 75,9 |
Ceftriaxone | 2220 | 90,5 |
Colistin | 822 | 33,5 |
Cefuroxime | 2252 | 91,8 |
Cefuroxime axetil | 2452 | 100 |
Cefazolin | 2293 | 93,5 |
Ertapenem | 1841 | 75 |
Cefepime | 241 | 87 |
Cefoxitin | 1744 | 71,1 |
Gentamicin | 1290 | 52,6 |
Meropenem | 1559 | 63,6 |
Trimethoprim- sulfamethoxazole | 1900 | 77,5 |
Tigecycline | 9 | 0,4 |
Piperacillin- tazobactam | 2133 | 87 |
The resistance rates that we found in our study have increased over the years, especially for critical broad-spectrum antibiotics. It may be due to the fact that the isolates included in the study were mostly obtained from intensive care patients (65,9 %) in order to detect high antibiotic resistance rates. Resistant nosocomial infections are the most common places are intensive care units (ICU). Empirically, missuse / overuse of broad-spectrum antibiotics leads to the selection of resistant strains. Prolonged hospitalization, invasive procedures, immune suppression of patients facilitate colonization of resistance organisms in these patients. Therefore, multidrug-resistant infections are more common in this patient group and treatment options are very limited
Resistance to carbapenems (imipenem / meropenem) in the 2018 CAESAR report was comparable to that in previous years for
Carbapenems are broad-spectrum antibiotics containing the carbapenem ring additional to beta-lactam ring. The carbapenem groups of these antibiotics are supposed to protect the beta-lactam ring from destructive enzymes produced by bacteria. These antibiotics break down the bacterial cell wall at the penicillin-binding protein via a beta-lactam ring
Carbapenem resistance in
In our study, the increase in resistance to carbapenems from broad-spectrum antibiotics over the years and the high rates detected were considered as worrying. 99.1% of the strains in our study were the samples of hospitalized patients and the majority of them were in the intensive care units (65, 9 %). The high number of carbapenem-resistant
Colistin resistance poses an important public health risk because it further limits treatment alternatives in patients with infections caused by health care associated, including carbapenem resistance
Aminoglycosides were found to be more effective than most antibiotics in our study. It can be considered as an alternative agent in combination therapy. The resistance of tigecycline was very low (0, 4 %). The resistance rates of tigecycline are consistent with the literature data Although it is accepted as a good treatment option for multi-drug resistant
Early detection of carbapenem-producing isolate is one of the most important measures to prevent hospital-acquired outbreaks. The establishment of institutional, regional, national and global surveillance programs should be aimed to prevent the spread of antibiotic resistance.
Antimicrobial resistance rates and distributions could vary between countries, regions and clinics. Wars, travels, health tourism, climate change, overuse of antibiotics in livestock facilitate the distribution of antibiotic resistance in the world and the emerge of new resistance phenotypes. Antibiotic resistance is a dynamic process that requires close monitoring and urgent measures should be taken. The one health approach should be kept in mind when countries take precautions.
The study was not supported by a financial institution.