title: Epidemiology and susceptibility of pathogens from SMART 2011-12 Turkey: evaluation of hospital-acquired versus community-acquired urinary tract infections and ICU- versus non-ICU-associated intra-abdominal infections.
abstract: To describe the epidemiology and susceptibility of pathogens (including ESBL producers) from hospital-acquired (HA) versus community-acquired (CA) urinary tract infections (UTIs) and ICU- versus non-ICU-associated intra-abdominal infections (IAIs) in Turkey as a part of the SMART study.
  
  
  
  : For this report, Gram-negative pathogens (363 from UTIs and 458 from IAIs) were collected in 2011 and 2012 at six hospitals in Turkey. HA versus CA UTIs and ICU- versus non-ICU-associated IAIs were compared for the species isolated, percentage of ESBL-positive isolates by species and susceptibility for overall and individual Gram-negative species.
  
  
  
  : Escherichia coli was the most common pathogen identified in HA (40.2%) and CA (73.9%) UTIs and ICU-associated (25.8%) and non-ICU-associated (43.3%) IAIs. The rate of ESBL-positive E. coli was significantly higher in HA than in CA UTIs (50.5% versus 38.2%, P  <   0.001) and in non-ICU-associated than in ICU-associated IAIs (52.5% versus 29.2%, P  = 0.029). Of the drugs studied, only amikacin was active against ≥90% of pathogens in UTIs, while ertapenem, imipenem and amikacin were active against ≥90% of E. coli ; and imipenem, amikacin and cefoxitin were active against ≥90% of Klebsiella pneumoniae in IAIs.
  
  
  
  Our findings demonstrated that E. coli continues to be the principal pathogen of UTIs and IAIs in Turkey. Along with a high rate of ESBL-positive isolates, high antimicrobial resistance among Gram-negative bacilli from either UTIs or IAIs was noted particularly in the case of HA UTIs and ICU-associated IAIs, with a higher likelihood of carbapenem- or amikacin-based therapy to provide the broadest activity against bacterial pathogens.
authors.affiliation: Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Iftihar
authors.initials: I
authors.lastname: Koksal
authors.affiliation: Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Gurdal
authors.initials: G
authors.lastname: Yilmaz
authors.affiliation: Hacettepe University, Ankara, Turkey.
authors.forename: Serhat
authors.initials: S
authors.lastname: Unal
authors.affiliation: Hacettepe University, Ankara, Turkey.
authors.forename: Pinar
authors.initials: P
authors.lastname: Zarakolu
authors.affiliation: Marmara University, Istanbul, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Korten
authors.affiliation: Marmara University, Istanbul, Turkey.
authors.forename: Lutfiye
authors.initials: L
authors.lastname: Mulazimoglu
authors.affiliation: Istanbul University, Istanbul, Turkey.
authors.forename: Fehmi
authors.initials: F
authors.lastname: Tabak
authors.affiliation: Istanbul University, Istanbul, Turkey.
authors.forename: Birgul
authors.initials: B
authors.lastname: Mete
authors.affiliation: Dokuz Eylul University, Izmir, Turkey.
authors.forename: Vildan Avkan
authors.initials: VA
authors.lastname: Oguz
authors.affiliation: Dokuz Eylul University, Izmir, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Gulay
authors.affiliation: Erciyes University, Kayseri, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Alp
authors.affiliation: International Health Management Associates, Inc., Schaumburg, IL, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Badal
authors.affiliation: International Health Management Associates, Inc., Schaumburg, IL, USA.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Lob
mesh_terms: D000583:Amikacin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology; D002440:Cefoxitin / Q000494:pharmacology; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity; D000077727:Ertapenem; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D007362:Intensive Care Units; D059413:Intraabdominal Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D008826:Microbial Sensitivity Tests; D014421:Turkey / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D047090:beta-Lactams; D002440:Cefoxitin; D015378:Imipenem; D000583:Amikacin; D000077727:Ertapenem