title: Results from the Survey of Antibiotic Resistance (SOAR) 2011-13 in Turkey.
abstract: OBJECTIVE
  Data are presented from the Survey of Antibiotic Resistance (SOAR) for respiratory tract infection pathogens collected in 2011-13 from Turkey.
  
  
  METHODS
  MICs were determined using Etest(®). Susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) interpretive criteria.
  
  
  RESULTS
  Rates of antibiotic susceptibility were very low among 333 isolates of Streptococcus pneumoniae tested: penicillin 38% using CLSI (oral) and EUCAST breakpoints; erythromycin 51% using CLSI and EUCAST criteria; and cefuroxime 64.6% using CLSI and PK/PD and 46.9% using EUCAST. Of the isolates, >90% were susceptible to amoxicillin/clavulanic acid, ceftriaxone (except using EUCAST criteria: 76%), levofloxacin and high-dose intravenous penicillin. Among 339 Haemophilus influenzae isolates, 6.8% were β-lactamase positive while 9.1% were β-lactamase negative but ampicillin resistant (BLNAR) by CLSI (14.7% by EUCAST) criteria. Amoxicillin/clavulanic acid susceptibility was ∼90% by CLSI (with or without BLNAR adjustment, EUCAST and high-dose PK/PD) but lower, at 82.9%, by EUCAST with BLNAR adjustment. Levofloxacin susceptibility was 96% using all three breakpoints. Dramatic differences in rates of susceptibility, depending on the breakpoints used, were seen for cefaclor [94% by CLSI (86.4% BLNAR adjusted), 23% by PK/PD] and cefuroxime [97% by CLSI (89.1% BLNAR adjusted), 85% by PK/PD, 15% by EUCAST (13.0% BLNAR adjusted)]. Streptococcus pyogenes (n = 222) and Moraxella catarrhalis (n = 40) isolates remained highly susceptible to amoxicillin/clavulanic acid, cephalosporins and levofloxacin, with only erythromycin susceptibility dropping below 95% for S. pyogenes.
  
  
  CONCLUSIONS
  Overall, amoxicillin/clavulanic acid and levofloxacin were the most active antibiotics based on all three breakpoints against these pathogens. Although susceptibility was not universally low in Turkey, high resistance rates were found in S. pneumoniae and, when using PK/PD and EUCAST breakpoints, in other respiratory pathogens.
authors.affiliation: Marmara University Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Soyletir
authors.affiliation: Marmara University Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Altinkanat
authors.affiliation: Hacettepe University Medical Faculty, Department of Medical Microbiology, Ankara, Turkey.
authors.forename: D
authors.initials: D
authors.lastname: Gur
authors.affiliation: Hacettepe University Medical Faculty, Department of Medical Microbiology, Ankara, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Altun
authors.affiliation: Ege University Medical Faculty, Department of Medical Microbiology, Izmir, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Tunger
authors.affiliation: Ege University Medical Faculty, Department of Medical Microbiology, Izmir, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Aydemir
authors.affiliation: Istanbul University, Istanbul Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Kayacan
authors.affiliation: Istanbul University, Istanbul Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey.
authors.forename: Z
authors.initials: Z
authors.lastname: Aktas
authors.affiliation: Ondokuz Mayıs University Medical Faculty, Department of Medical Microbiology, Samsun, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Gunaydin
authors.affiliation: Ondokuz Mayıs University Medical Faculty, Department of Medical Microbiology, Samsun, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Karadag
authors.affiliation: GlaxoSmithKline Turkey, Buyukdere Cad. 1. Levent Plaza, No. 173, B Blok, 34394, Istanbul, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Gorur
authors.affiliation: IHMA Europe Sàrl, 9A route de la Corniche, Epalinges 1066, Switzerland.
authors.forename: I
authors.initials: I
authors.lastname: Morrissey
authors.affiliation: GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK didem.x.torumkuney@gsk.com.
authors.forename: D
authors.initials: D
authors.lastname: Torumkuney
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001419:Bacteria / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018942:Macrolides / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000382:microbiology*; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D047090:beta-Lactams