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Journal of Antimicrobial Chemotherapy (1999) 43, 373-378
© 1999 The British Society for Antimicrobial Chemotherapy

A surveillance study of antimicrobial resistance of Gram-negative bacteria isolated from intensive care units in eight hospitals in Turkey

Filiz Günserena, Latife Mamikoglua, Süheyla Öztürkb, Mine Yücesoyc, Kadir Biberogluc, Nuran Yulugc, Mehmet Doganayd, Bülent Sümerkand, Sesin Kocagöze, Serhat Ünale, Sila Çetinf, Semra Çalanguf,*, Iftihar Köksalg, Hakan Leblebiciogluh and Murat Günaydinh

a Akdeniz University Faculty of Medicine; b Ankara Numune Hospital; c Dokuz Eylül University Faculty of Medicine; d Erciyes University Faculty of Medicine; e Hacettepe University Faculty of Medicine; f Istanbul University Faculty of Medicine; g Karadeniz Technical University Faculty of Medicine; h Ondokuz Mayis University Faculty of Medicine,Turkey

This study was carried out with the participation of eight hospitals in Turkey to determine the frequency of Gram-negative bacteria isolated in intensive care units (ICU) and to compare their resistance rates to selected antibiotics. Aerobic Gram-negative bacteria isolated from ICUs during 1996 were studied. Antibiotic susceptibilities to imipenem, ceftazidime, ceftazidime– clavulanate, ceftriaxone, cefotaxime, cefepime, cefodizime, cefuroxime, piperacillin/tazobactam, amoxycillin–clavulanate, gentamicin, amikacin and ciprofloxacin were determined by Etest. A total of 748 isolates were obtained from 547 patients. The majority of organisms were isolated from the respiratory (38.8%) and urinary tracts (30.9%). Pseudomonas spp. were the most frequently isolated Gram-negative species (26.8%), followed by Klebsiellaspp. (26.2%). Escherichia coli, Acinetobacter spp. and Enterobacterspp. were the other commonly isolated organisms. High resistance rates were observed for all antibiotics studied. Imipenem appeared to be the most active agent against the majority of isolates. Although resistance rates exceeded 50%, ciprofloxacin, cefepime and amikacin were found to be relatively effective. Extended-spectrumß-lactamase (ESBL) production appeared to be a major mechanism of resistance to ß-lactam antibiotics. In contrast to ceftazidime- clavulanate, piperacillin/tazobactam showed poor activity against organisms thought to produce ESBL, suggesting the presence of an enzyme resistant to tazobactam action. This study has yielded high rates of resistance in aerobic Gram-negative isolates from ICUs in Turkey. High resistance rates to all the other antibacterials studied leave imipenem as the only reliable agent for the empirical treatment of ICU infections in Turkey.

* Corresponding author. University of Istanbul, Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Çapa 34390, Istanbul, Turkey. Tel: +90-212-213-5800; Fax: +90-212-213-5828.


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