A pooled analysis of the resistance patterns of Escherichia coli strains isolated from urine cultures in Turkey: a comparison of the periods 1997-2001 and 2002-2007

Authors: MELTEM IŞIKGÖZ TAŞBAKAN, HÜSNÜ PULLUKÇU, OĞUZ REŞAT SİPAHİ, TANSU YAMAZHAN, BİLGİN ARDA, SERCAN ULUSOY

Abstract: To compare the resistance patterns of Escherichia coli strains reported to be isolated from urine cultures in published medical literature from Turkey in 1997-2001 and 2002-September 2007. Materials and methods: To find the published series, 3 national databases (Ulakbim Turkish Medical Literature database, http://www.turkishmedline.com, http://medline.pleksus.com.tr), and 2 international databases (Pubmed and Science Citation Index (SCI)) were searched. Results: Data for 25,577 E. coli strains were obtained from 53 articles (28 articles from 1997-2001, 25 from 2002-2007). Of these strains 18,106 were isolated from outpatients, whereas 7471 were from inpatients. When the strains isolated from outpatients were evaluated, there was a significant increase in the ciprofloxacin resistance, whereas there was a significant decrease in amikacin, netilmicin, and co-trimoxazole resistance (P < 0.05). When the data of hospitalized patients were analyzed, there was significant decrease in amikacin, gentamicin, netilmicin, co-trimoxazole, and amoxicillin/clavulanate resistance, whereas a significant increase was observed in nitrofurantoin resistance (P < 0.05). The ESBL rate increased in both the inpatients and outpatients (P < 0.05). Conclusion: When looked at from Turkey's perspective, our data suggest that aminoglycosides and third-generation cephalosporins may be good choices in the treatment of inpatients. Fosfomycin/tromethamine, nitrofurantoin, and oral third-generation cephalosporins may be reasonable alternatives in the empirical treatment of uncomplicated outpatient cases. Policies to constrain resistance in both the community, and hospitals, such as antibiotic stewardship or restriction programs, should be implemented immediately.

Keywords: E. coli, Turkey, urinary tract infections

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