title: A survey of antibiotic resistance in Streptococcus pneumoniae and Haemophilus influenzae in Turkey, 2004 2005.
abstract: 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.
authors.affiliation: Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Burçin
authors.initials: B
authors.lastname: Sener
authors.forename: Ferda
authors.initials: F
authors.lastname: Tunçkanat
authors.forename: Sercan
authors.initials: S
authors.lastname: Ulusoy
authors.forename: Alper
authors.initials: A
authors.lastname: Tünger
authors.forename: Güner
authors.initials: G
authors.lastname: Söyletir
authors.forename: Lütfiye
authors.initials: L
authors.lastname: Mülazimoğlu
authors.forename: Nezahat
authors.initials: N
authors.lastname: Gürler
authors.forename: Lütfiye
authors.initials: L
authors.lastname: Oksüz
authors.forename: Iftihar
authors.initials: I
authors.lastname: Köksal
authors.forename: Kemalettin
authors.initials: K
authors.lastname: Aydin
authors.forename: Ata Nevzat
authors.initials: AN
authors.lastname: Yalçin
authors.forename: Dilara
authors.initials: D
authors.lastname: Oğünç
authors.forename: Asli
authors.initials: A
authors.lastname: Acar
authors.forename: Jörg
authors.initials: J
authors.lastname: Sievers
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents