Pooled Analysis of Resistance Patterns of Escherichia coli Strains Isolated From Urine Cultures in Turkey: Comparison of 1997–2001 and 2002–2007 Periods
Makaleler > Tam Makale · 2008
Yazarlar: Meltem TAŞBAKAN, Hüsnü PULLUKÇU, O.R. Sipahi, Tansu YAMAZHAN, Bilgin ARDA, S. Ulusoy
International Journal of Infectious Diseases, Uluslararası, Wos, 2008, cilt 12, ss e112-e113
DOI: 10.1016/j.ijid.2008.05.282
Özet
Objectives: Urinary tract infections (UTI) are one of the most common infectious diseases diagnosed in outpatients and also constitutes the most common nosocomial infection in many hospitals. Escsherichia coli remains the principal causative pathogen of UTIs both in outpatients and inpatients. In this study it was aimed to compare the resistance patterns of E. coli strains reported to be isolated from urine cultures in published medical literature from Turkey in the 1997–2001 and 2002-September 2007 periods. Method: To find out the published series three national databases (Ulakbim Turkish Medical Literature database, http://www.turkishmedline.com, http://medline.pleksus.com.tr) and two international databases (Pubmed and Science Citation Index (SCI)) were searched. Keywords for national databases were [“idrar yolu infeksiyonu” or “idrar yolu enfeksiyonu” or “urinary tract infection” or “üriner sistem infeksiyonu” or “üriner sistem enfeksiyonu”]. Keywords for Index Medicus and SCI-expanded were [“urinary tract infection” and Turkey]. Articles i)published before 1997 ii)resistance data of outpatient and inpatient strains were not analysed seperately iii)antibiotic susceptibility data were not given, were excluded. All studies used Kirby-Bauer disc diffusion test by using NCCLS/CLSI criteria for determination of antimicrobial resistance. Resistance data of inpatient and outpatient strains were compared by Chi-square test. A p value less than 0.05 was considered significant. Results: Data for 25577 E.coli strains were obtained from 53 articles (28 articles from 1997–2001 period, 25 from 2002–2007 period). Of these starins 18106 were isolated from outpatients whereas 7471 from inpatients. The resistance rates and comparisons of 1997–2001 and 2002–2007 periods are shown in Table 1. Conclusions: Trimethoprim sulphametoxazole resistance is very high and it cannot be recommended in the empirical treatment any more. Nitrofurantoin may be a cheap and reasonable option in uncomplicated UTI. Aminoglycosides and third-generation cephalosporins may be good choices in the treatment of complicated UTI. Carbapenems may be conserved for extended-spectrum beta lactamase producing strains. ESBL rate in the outpatient strains is alarming. Policies to constrain resistance such as antibiotic stewardship or restriction programmes should be implemented immediately.