A survey of antibiotic resistance in Streptococcus pneumoniae and Haemophilus influenzae in Turkey, 2004 2005.
OBJECTIVE
To determine the prevalence of antimicrobial resistance among Streptococcus pneumoniae and Haemophilus influenzae isolated in Turkey as part of Survey Of Antibiotic Resistance, a surveillance programme in the Africa and Middle East region examining the antimicrobial susceptibility of key bacterial pathogens involved in community-acquired respiratory tract infections (CARTIs).


METHODS
Susceptibility was evaluated against a range of antimicrobial agents using disc diffusion and Etest methods.


RESULTS
Six centres in five cities collected 301 S. pneumoniae and 379 H. influenzae isolates between October 2004 and November 2005. Among S. pneumoniae, the prevalence of isolates with intermediate susceptibility (MICs 0.12-1 mg/L) and resistance to penicillin (MICs >or=2 mg/L) was 24.6% and 7.6%, respectively; there was a wide variation between cities (2.4% to 36.9% intermediate and 0% to 23.8% resistant phenotypes). Macrolide-azalide resistance rates exceeded those of penicillin resistance in all cities. Overall, 5.0% of isolates were co-resistant to penicillin and erythromycin and 10.0% were multidrug-resistant (joint resistance to erythromycin, co-trimoxazole and tetracycline). Agents tested to which over 90% of countrywide S. pneumoniae isolates remained susceptible were amoxicillin/clavulanate (98.7%), chloramphenicol (94.7%) and cefprozil (90.6%). Overall, the percentage of H. influenzae isolates producing beta-lactamase was 5.5%, differing widely across the country with the highest prevalence of beta-lactamase production detected in Trabzon (14.0%) and no beta-lactamase-positive isolates found in Izmir. H. influenzae had the highest per cent susceptibility to amoxicillin/clavulanate (99.5%) and ofloxacin (99.2%) while >20% were resistant to co-trimoxazole.


CONCLUSIONS
Prevalence of penicillin and macrolide-azalide resistance among S. pneumoniae appears to be on the increase in Turkey while overall beta-lactamase production in H. influenzae remains relatively low. To adequately monitor the spread of drug-resistant phenotypes among these two important CARTI pathogens, ongoing collection of resistance surveillance data is required-where possible locally as resistance patterns can vary substantially between cities and institutions.
Sener
Burçin
B
Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Tunçkanat
Ferda
F
Ulusoy
Sercan
S
Tünger
Alper
A
Söyletir
Güner
G
Mülazimoğlu
Lütfiye
L
Gürler
Nezahat
N
Oksüz
Lütfiye
L
Köksal
Iftihar
I
Aydin
Kemalettin
K
Yalçin
Ata Nevzat
AN
Oğünç
Dilara
D
Acar
Asli
A
Sievers
Jörg
J
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003627:Data Interpretation, Statistical; D024881:Drug Resistance, Bacterial; D006193:Haemophilus influenzae / Q000187:drug effects*; D006306:Health Surveys; D006801:Humans; D008826:Microbial Sensitivity Tests; D011786:Quality Control; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D014421:Turkey / Q000453:epidemiology
D000900:Anti-Bacterial Agents