Nilay ÇÖPLÜ, Ufuk HASDEMIR, Dilber AKTAŞ, Zeynep GÜLAY, Nezahat GÜRLER, Şöhret AYDEMIR, Ayşegül GÖZALAN, Mete EYIGÖR, Deniz GÜR, Gülçin BAYRAMOĞLU, Hüsniye ŞIMŞEK, Duygu PERÇIN

Türkiye’de ulusal antimikrobiyal direnç surveyans sisteminin ilk sonuçları

Amaç: Antimikrobiyal direnç ile mücadele için bazı önlemler alınmalıdır, mevcut durumun saptanması da bunlardan biridir. Türkiye’de ulusal antimikrobiyal direnç surveyans sistemi bu hedefle kurulmuştur. Ampirik tedaviyi desteklemek, antimikrobiyal kullanım politikaları oluşturmak, rehber kitaplara veri sağlamak, alınmış olan önlemlerin etkinliğini değerlendirmek için başlangıç bilgilerini sağlamak amaçlanmıştır. Yöntem: Elli beş hastaneden, kan ve beyin omurilik sıvısından izole edilen Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae ve Pseudomonas aeruginosa izolatlarının direnç verileri toplanmıştır. Antimikrobiyaller ve test yöntemleri uluslararası surveyans sitemleri ile uyumlu olacak şekilde seçilmiştir. Toplanan veriler WHONET programı ile analiz edilmiştir. Bulgular: S. aureus (n=1437); metisilin direnci %31,5, rifampin, linezolid ve vankomisin direnci sırası ile %65,3; %2,3 ve %0,0, bulunmuştur. E. faecalis (n=760) ampisilin direnci %9,7, linezolid, vankomisin, teikoplanin direnci %1’in altında, yüksek düzey (YD) aminoglikozid %30 civarında bulunmuştur. E. faecium (n=756) ampisilin direnci %88,1; linezolid ve teikoplanin %1’den az, vankomisin %17, YD aminoglikozid %50 civarında bulunmuştur. S. pneumoniae (n=128) nonmenenjit sınır değerler için eritromisin (%32) dışında tüm antimikrobiyaller için direnç %5,2’den düşüktür, menejit sınır değerler için direnç %14,3-44,8’a yükselmiştir. E. coli (2280) ve K. pneumoniae (1307) için genişlemiş spektrumlu beta-laktamaz (GSBL) direnci sırası ile %51,6 ve %54,0 bulunmuştur. P. aeruginosa (825) direnci %8,4 (amikacin) ve %36,4 (piperacillin) arasında değişmektedir. Sonuç:Direnç Türkiye’ye yakın coğrafyadaki ülkelerden yüksek bulunmuş ve zaman içinde artış göstermiş olup bununla mücadele için politikalar geliştirmek gerektiğine işaret etmektedir. Ayrıca, alınan önlemlerin yararlılığını izlemek için de sonuçlar değerli olacaktır.

The first results of national antimicrobial resistance surveillance system in Turkey

Objective: In order to combat with antimicrobialresistance, some measures should be taken anddetermination of the current status is one of them.National antimicrobial resistance surveillance system(NAMRSS) was established for this purpose in Turkey.It was targeted to be useful for guidence of ampiricaltherapy, create antimicrobial usage policies, providedata to the guidebooks, and supply initial information toevaluate the efficasy of the measures taken.Methods: Data of resistance was collected from 55hospital, from blood and cerebrospinal fluid isolates,which were S. aureus, E. faecalis and E. faecium,S. pneumoniae, E. coli, K. pneumoniae and P.aeruginosa. The antimicrobials and test methods werechosen in accordance with international surveillancesystems. The collected data was analysed by WHONETsoftware.Results: S. aureus (1437); meticillin resistance was31.5%, rifampin, linezolid and vancomycin resistancewere 65.3%, 2.3%, and 0.0%, respectively. E. faecalis(n=760) resistance of ampicillin was 9.7%, linezolid,vancomycin, teicoplanin were lower than 1%, highlevel (HL) aminoglycoside was around 30%. E. faecium(n=756) resistance of ampicillin was 88,1%, linezolid,teicoplanin were lower than 1%, vancomycin 17%, HLaminoglycoside was around 50%. S. pneumoniae (n=128)with non-meningitis breakpoints; resistance were lowerthan 5.2% for all antimicrobials other than erythromycin(32%), with meningitis breakpoints: resistance increasedto 14,3-44,8%. E. coli (2280) and K. pneumoniae (1307),extended spectrum beta-lactamase (ESBL) was 51.6%and 54.0%, respectively. P. aeruginosa (825) resistancewere changed in between 8.4% (amikacin) and 36.4%(piperacillin).Conclusion: The resistance was higher among thecountries in close geographical region and increasedin time, indicating the need for developing policies tocombat with it. Besides, the results will also be valuableto monitor the usefulness of the measures taken.

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