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Objective: In this retrospective study, we aimed to determine the distribution according to the species of Gram-negative bacteria in isolates obtained from urine cultures of hospitalized patients with urinary tract infections and to detect their antimicrobial susceptibility pattern for contribute to empirical treatment approach to urinary tract infections in our hospital. Methods: Between the dates of January 2006 and September 2011, a total of 3,548 Gram-negative isolates obtained from urine cultures of hospitalized patients with urinary tract infection were identified by conventional methods and the BD PhoenixTM 100 (Becton Dickinson, MD, USA) fully automated microbiology system. Antimicrobial susceptibility testing of isolates was performed by KirbyBauer’s disk diffusion method according to the Clinical and Laboratory Standarts Institute (CLSI) criteria. In addition, extended-spectrum beta-lactamase (ESBL) production of predominant urinary pathogenic bacteria was detected by the double-disk synergy method. Results: In this study, a significantly higher incidence of urinary tract infection was observed in females compared with males; 2,245 (63.3%) and 1,303 (36.7%), respectively. Escherichia coli was the predominant pathogenic bacterium and accounted for OZET Amac: Bu retrospektif calismada; hastanemizde yatan hastalarda gelisen uriner sistem enfeksiyonlarinin ampirik tedavi yaklasimina katkida bulunabilmek icin uriner sistem enfeksiyonu gelisen yatan hastalarin idrar kulturlerinden izole edilen Gram-negatif bakterilerin tur dagilimini ve antimikrobik duyarlilik paternlerini belirlemeyi amacladik. Yontemler: Ocak 2006 ve Eylul 2011 tarihleri arasinda, uriner sistem enfeksiyonu gelisen yatan hastalarin idrar kulturlerinden elde edilen toplam 3.548 Gramnegatif izolatin identifikasyonu geleneksel yontemler ve BD PhoenixTM 100 (Becton Dickinson, MD, ABD) tam otomatik mikrobiyoloji sistemi tarafindan yapilmistir. Izolatlarin antimikrobiyal duyarlilik testi Kirby-Bauer disk difuzyon yontemi ile Clinical and Laboratory Standarts Institute (CLSI) kriterlerine gore calisilmistir. Ayrica, baskin uropatojen bakterilerin genislemis spektrumlu beta-laktamaz (GSBL) uretimi cift-disk sinerji yontemi ile arastirilmistir. Bulgular: Bu calismada, erkeklere gore kadinlarda onemli olcude daha yuksek uriner sistem enfeksiyonu insidansi gozlenmistir, sirasiyla; 1.303 (%36,7) ve 2.245 (%63,3). Escherichia coli’nin baskin patojen bakteri oldugu belirlendi ve uriner sistem enfeksiyonu gelisen 1 Dicle Universitesi, Tip Fakultesi, Tibbi Mikrobiyoloji Anabilim Dali, DIYARBAKIR 2 Dicle Universitesi, Tip Fakultesi, Enfeksiyon Hastaliklari Anabilim Dali, DIYARBAKIR Gelis Tarihi / Received : Kabul Tarihi / Accepted : Iletisim / Corresponding Author : Alicem TEKIN Dicle Universitesi, Tip Fakultesi, Tibbi Mikrobiyoloji Anabilim Dali, DIYARBAKIR Tel : +90 412 248 80 01-4331 E-posta / E-mail : alicemtekin@gmail.com 03.12.2011 24.08.2012 DOI ID : 10.5505/TurkHijyen.2012.93823 Turk Hijyen ve Deneysel Biyoloji Dergisi Dal T, Tekin A, Tekin R, Deveci O, Can Ş, Ozekinci T, Dayan S. Yatan hastalarin idrar orneklerinden izole edilen Gram-negatif bakterilerin tur dagilimi ve antibiyotik duyarliliklari. Turk Hij Den Biyol Derg, 2012; 69(4): 193-200. Cilt 69  Sayi 4  2012 Turk Hij Den Biyol Derg 194 Urinary tract infections (UTIs) are one of the most common infections both community-acquired and hospital-acquired (nosocomial) in our country, as all over the world. UTIs are approximately 2540% of nosocomial infections worldwide. However this rate varies according the region, hospital and clinic those microorganisms isolated from UTIs (1, 2). Most patients with nosocomial UTIs have either had genitourinary or urological manipulation or permanent urethral catheterization. Most catheterassociated UTIs derive from the patient’s own colonic flora. The distribution according to the species of pathogenic bacterium that caused UTIs and their antimicrobial susceptibility pattern varies according to the regions. Gram-negative bacteria especially Escherichia coli and Klebsiella pneumoniae are the most frequent urinary pathogenic microorganisms isolated from UTIs in hospitalized patients (3-6). Over the past years antimicrobial drug resistance of the causative urinary pathogenic bacteria have increased rapidly in nosocomial infections. Today, because of the rapidly increasing antimicrobial drug INTRODUCTION toplam 3.548 yatan hastanin 2.341 (%65,8)’inde sorumlu etken oldugu bulundu. Ayrica, 679 (%19,1)’unda Klebsiella pneumoniae, 177 (%5)’sinde Acinetobacter spp., 176 (%5)’sinda Enterobacter spp., 142 (%4)’sinde Pseudomonas aeruginosa ve 38 (%1,1)’inde diger Gramnegatif bakterilerin sorumlu etken oldugu saptandi. Idrar kulturlerinden izole edilen Gram-negatif bakterilerin antimikrobik duyarlilik oranlari seftazidim, trimetoprimsulfametoksazol, siprofloksasin, piperasilin-tazobaktam, sefoperazon-sulbaktam, amikasin, imipenem ve meropenem icin sirasiyla; %34,5, %38, %42, %50, %70, %87, %90 ve %92 olarak tespit edilmistir. Ayrica, GSBL ureten E. coli ve K. pneumoniae oranlari da sirasiyla; %38 ve %36 olarak bulunmustur. Sonuc: Bu calisma ve diger calismalarin sonuclari yakin gelecekte, sefalosporinler, karbapenemler ve florokinolonlar gibi genis spektrumlu antibiyotiklere karsi yuksek duzeyde direnc gelisiminin mumkun oldugunu ve tedavi seceneklerimizin her zamankinden daha sinirli hale gelebilecegini gostermektedir. Seftazidim, siprofloksasin ve trimetoprim-sulfametoksazole karsi gelisen yuksek duzey direnc nedeniyle, uriner sistem enfeksiyonlarinin ampirik tedavisi icin bu antibiyotiklerin kullanilmamasini oneririz. Anahtar Sozcukler: Uriner sistem enfeksiyonu, antimikrobik duyarlilik, Gram-negatif bakteriler, Escherichia coli, GSBL 2,341 (65.8%) of 3,548 hospitalized patients with urinary tract infections. In addition, Klebsiella pneumoniae accounted for 679 (19.1%), Acinetobacter spp. for 177 (5%), Enterobacter spp. for 176 (5%), Pseudomonas aeruginosa for 142 (4%), and other Gram-negative bacteria for 38 (1.1%). Antimicrobial susceptibility rates of Gram-negative bacteria isolated from urine cultures for ceftazidime, trimethoprim-sulfamethoxazole, ciprofloxacin, piperacillin-tazobactam, cefoperazonesulbactam, amikacin, imipenem, meropenem were detected as 34.5%, 38%, 42%, 50%, 70%, 87%, 90%, and 92%, respectively. In addition, the rates of ESBLproducing Escherichia coli and Klebsiella pneumoniae were detected as 38% and 36%, respectively. Conclusion: The present study and the other studies show that in the near future it is possible our therapeutic options may become more limited than ever due to the development of high-level resistance against broad-spectrum antibiotics such as cephalosporins, carbapenems and fluoroquinolones. Due to the highlevel resistance to ceftazidime, ciprofloxacin and trimethoprim-sulfamethoxazole, we recommend that these antibiotics should not be used for the empirical treatment of urinary tract infections.

türk hijyen ve deneysel biyoloji dergisi/türk hijiyen ve deneysel biyoloji dergisi

The distribution according to the species of Gram-negative bacteria isolated from hospitalized patients's urine specimens and their antimicrobial susceptibility