Epidemiology and susceptibility of pathogens from SMART 2011-12 Turkey: Evaluation of hospital-acquired versus community-acquired urinary tract infections and ICU- versus non-ICU-associated intra-abdominal infections

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Koksal I., Yilmaz G., Unal S., Zarakolu P., Korten V., Mulazimoglu L., ...Daha Fazla

Journal of Antimicrobial Chemotherapy, cilt.72, sa.5, ss.1364-1372, 2017 (SCI-Expanded, Scopus)

Özet

Objectives: 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-ICUassociated intra-abdominal infections (IAIs) in Turkey as a part of the SMART study. Methods: 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. Results: Escherichia coli was the most common pathogen identified in HA (40.2%) and CA (73.9%) UTIs and ICUassociated (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. Conclusions: 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.