Evaluation of Treatment Applications and Antibiotic Resistance Rates for Community Acquired Urinary Tract Infections in Turkey and a Review of the Literature

Objective: Increased extended-spectrum beta lactamase (ESBL) production is associated with higher rates of community-acquired strains in urinary tract infections (UTI) leading to an increase in the resistance rates, duration of treatment and costs. We aimed to investigate the resistance rates of ESBL-positive urine culture strains in our clinic, reviewed the literature and analysed antibiotics used in UTI treatment in outpatients in Turkiye. Materials and Methods: 2913 patients who were admitted to the outpatient clinics of Maltepe University Faculty of Medicine and Başkent University Faculty of Medicine were evaluated retrospectively. Data on prescribed antibiotics in outpatients with the diagnosis of UTI from all cities of Turkiye were collected through the Turkish Ministry of Health, Turkish Medicines and Medical Devices Agency. Results: Out of 563 ESBL-positive (19.3%) urine culture isolates, 450 (79.9%) were Escherichia coli and 89 (15.8%) were Klebsiella sp. Resistance rates were as follows: 98.8% to cefuroxime, 67.6% to ciprofloxacin, 12.5% to fosfomycin, 8.7% to amikacin, 1.4% to meropenem and 15% to nitrofurantoin. The most commonly prescribed antibiotics were ciprofloxacin (22.25%), fosfomycin (21.10%) and nitrofurantoin (12.82%). Conclusion: Our study suggests that the antibiotic resistance rates of most antibiotics prescribed for UTI in Turkiye are above the suggested rate of 10-20% to be used as empirical therapy. Updating and dissemination of guidelines for UTI in the light of antibiotic prescribing and resistance surveillance studies will contribute to the rational use of antibiotics in Turkiye.

Türkiye’de Toplum Kaynaklı İdrar Yolu Enfeksiyonlarında Tedavi Uygulamalarının ve Antibiyotik Direnç Oranlarının Değerlendirilmesi ve Literatür Eşliğinde Gözden Geçirilmesi

Amaç: Artan geniş spektrumlu beta laktamaz (ESBL) üretimi, idrar yolu enfeksiyonlarında (İYE) toplum kaynaklı suşların daha yüksek oranlarıyla ilişkilidir, bu da direnç oranlarında, tedavi süresinde ve maliyette bir artışa yol açar. Kliniğimizdeki ESBL pozitif idrar kültürü suşlarının direnç oranlarını araştırmayı, literatürü gözden geçirmeyi ve Türkiye’de ayaktan hastalarda İYE tedavisinde kullanılan antibiyotikleri analiz etmeyi amaçladık. Gereç ve Yöntem: Maltepe Üniversitesi Tıp Fakültesi ve Başkent Üniversitesi Tıp Fakültesi poliklinikler’ine başvuran 2913 hasta retrospektif olarak incelendi. Türkiye’nin tüm illerinden idrar yolu enfeksiyonu tanısı alan ayaktan hastalarda reçete edilen antibiyotik verileri TC Sağlık Bakanlığı, Türkiye İlaç ve Tıbbi Cihaz Kurumu Reçeteleme Bilgileri ile toplandı. Bulgular: Beş yüz altmış üç ESBL pozitif (%19,3) idrar kültürü izolatından 450 (%79,9) Escherichia coli ve 89 (%15,8) Klebsiella sp. Direnç oranları sefuroksime %98,8, siprofloksasine %67,6, fosfomisine %12,5, amikasine %8,7, meropeneme %1,4 ve nitrofurantoine %15 idi. En sık reçete edilen antibiyotikler siprofloksasin (%22,25), fosfomisin (%21,10) ve nitrofurantoindir (%12,82). Sonuç: Çalışmamız, Türkiye’de İYE için reçete edilen çoğu antibiyotiğin antibiyotik direnç oranlarının ampirik tedavi olarak kullanılmak üzere önerilen %10-20 oranının üzerinde olduğunu göstermektedir. Antibiyotik reçeteleme ve direnç sürveyans çalışmaları ışığında İYE kılavuzlarının güncellenmesi ve yaygınlaştırılması, Türkiye’de antibiyotiklerin akılcı kullanımına katkıda bulunacaktır.

Kaynakça

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