Türkiye’de ulusal antimikrobiyal direnç surveyans sisteminin ilk sonuçları

Year 2018, Volume: 75 Issue: 4, 323 - 458, 01.12.2018

Nilay Çöplü

Abstract

Amaç: Antimikrobiyal direnç ile mücadele için bazı önlemler alınmalıdır, mevcut durumun saptanması da bunlardan biridir. Türkiye’de ulusal antimikrobiyal direnç surveyans sistemi bu hedefle kurulmuştur. Ampirik tedaviyi desteklemek, antimikrobiyal kullanım politikaları oluşturmak, rehber kitaplara veri sağlamak, alınmış olan önlemlerin etkinliğini değerlendirmek için başlangıç bilgilerini sağlamak amaçlanmıştır. Yöntem: Elli beş hastaneden, kan ve beyin omurilik sıvısından izole edilen Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae ve Pseudomonas aeruginosa izolatlarının direnç verileri toplanmıştır. Antimikrobiyaller ve test yöntemleri uluslararası surveyans sitemleri ile uyumlu olacak şekilde seçilmiştir. Toplanan veriler WHONET programı ile analiz edilmiştir. Bulgular: S. aureus n=1437 ; metisilin direnci %31,5, rifampin, linezolid ve vankomisin direnci sırası ile %65,3; %2,3 ve %0,0, bulunmuştur. E. faecalis n=760 ampisilin direnci %9,7, linezolid, vankomisin, teikoplanin direnci %1’in altında, yüksek düzey YD aminoglikozid %30 civarında bulunmuştur. E. faecium n=756 ampisilin direnci %88,1; linezolid ve teikoplanin %1’den az, vankomisin %17, YD aminoglikozid %50 civarında bulunmuştur. S. pneumoniae n=128 nonmenenjit sınır değerler için eritromisin %32 dışında tüm antimikrobiyaller için direnç %5,2’den düşüktür, menejit sınır değerler için direnç %14,3-44,8’a yükselmiştir. E. coli 2280 ve K. pneumoniae 1307 için genişlemiş spektrumlu beta-laktamaz GSBL direnci sırası ile %51,6 ve %54,0 bulunmuştur. P. aeruginosa 825 direnci %8,4 amikacin ve %36,4 piperacillin arasında değişmektedir. Sonuç:Direnç Türkiye’ye yakın coğrafyadaki ülkelerden yüksek bulunmuş ve zaman içinde artış göstermiş olup bununla mücadele için politikalar geliştirmek gerektiğine işaret etmektedir. Ayrıca, alınan önlemlerin yararlılığını izlemek için de sonuçlar değerli olacaktır.

Keywords

Antimikrobiyal direnç, surveyans, Türkiye

The first results of national antimicrobial resistance surveillance system in Turkey

Abstract

Objective: In order to combat with antimicrobial resistance, some measures should be taken and determination of the current status is one of them. National antimicrobial resistance surveillance system NAMRSS was established for this purpose in Turkey. It was targeted to be useful for guidence of ampirical therapy, create antimicrobial usage policies, provide data to the guidebooks, and supply initial information to evaluate the efficasy of the measures taken. Methods: Data of resistance was collected from 55 hospital, from blood and cerebrospinal fluid isolates, which were S. aureus, E. faecalis and E. faecium, S. pneumoniae, E. coli, K. pneumoniae and P. aeruginosa. The antimicrobials and test methods were chosen in accordance with international surveillance systems. The collected data was analysed by WHONET software. Results: S. aureus 1437 ; meticillin resistance was 31.5%, rifampin, linezolid and vancomycin resistance were 65.3%, 2.3%, and 0.0%, respectively. E. faecalis n=760 resistance of ampicillin was 9.7%, linezolid, vancomycin, teicoplanin were lower than 1%, high level HL aminoglycoside was around 30%. E. faecium n=756 resistance of ampicillin was 88,1%, linezolid, teicoplanin were lower than 1%, vancomycin 17%, HL aminoglycoside was around 50%. S. pneumoniae n=128 with non-meningitis breakpoints; resistance were lower than 5.2% for all antimicrobials other than erythromycin 32% , with meningitis breakpoints: resistance increased to 14,3-44,8%. E. coli 2280 and K. pneumoniae 1307 , extended spectrum beta-lactamase ESBL was 51.6% and 54.0%, respectively. P. aeruginosa 825 resistance were changed in between 8.4% amikacin and 36.4% piperacillin . Conclusion: The resistance was higher among the countries in close geographical region and increased in time, indicating the need for developing policies to combat with it. Besides, the results will also be valuable to monitor the usefulness of the measures taken.

Keywords

Drug resistance, microbial, surveillance, Turkey

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