Bir Üçüncü Basamak Hastanede İdrar Kültürlerinden İzole Edilen Üropatojenlerin Antimikrobiyal Direnç Trendleri: Altı Yıllık Retrospektif Analiz (2019-2024)

Öz

Amaç: Bu çalışma, Orta Anadolu'daki bir üçüncü basamak merkezde 2019-2024 yılları arasında idrar kültürü izolatlarında üropatojen dağılımını ve antimikrobiyal direnç trendlerini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Toplam 16.220 idrar kültürü izolatı retrospektif olarak incelendi. Bakteri tanımlaması VITEK® 2 sistemi ile, antimikrobiyal duyarlılık testi VITEK® 2 AST kartları ve/veya Kirby-Bauer disk difüzyon 
yöntemiyle gerçekleştirildi. Sonuçlar EUCAST sınır değerlerine göre yorumlandı. İstatistiksel analizlerde Pearson ki-kare ve trend ki-kare testi kullanıldı. Anlamlılık eşiği p<0,05 olarak belirlendi.
Bulgular: Tüm izolatlarda kadın hastalar %63,0-67,3 oranında baskındı. Gram-negatif bakteriler yıllık %68,0-83,4 oranıyla predominant olarak izlendi. COVID-19 pandemisiyle örtüşen 2020-2021 döneminde yoğun bakım kaynaklı izolatlar belirgin şekilde arttı (sırasıyla %32,1 ve %30,1). Escherichia coli en sık izole edilen üropatojen oldu; siprofloksasin direnci 2019'daki %51,2'den 2024'te %34,8'e gerilerken ertapenem direnci %1,0'dan %3,1'e  yükseldi. Klebsiella pneumoniae'de en endişe verici direnç artışı gözlemlendi: ertapenem direnci 2022'de %43,0'a, kolistin direnci %63,6'ya, seftazidim direnci 2024'te %96,8'e ulaştı. Acinetobacter baumannii çalışma boyunca neredeyse pandirençli profil sergiledi. Vankomisin dirençli Enterococcus faecium oranları 2020'deki %50,0'dan 2024'te %20,7'ye anlamlı biçimde geriledi (p<0,001); linezolid aktivitesini korudu (%0,0-3,7 direnç).
Sonuç: Bu çalışma, özellikle karbapenem dirençli K. pneumoniae ve A. baumannii açısından giderek zorlaşan bir direnç tablosunu ortaya koymaktadır. Kuruma özgü antibiyogramların yıllık güncellenmesi, son çare ajanlara yönelik sistematik duyarlılık testlerinin uygulanması ve antimikrobiyal yönetim programlarının güçlendirilmesi acil gerekliliklerdir. 
 

Anahtar Kelimeler

• Antimikrobiyal Direnç
• Üropatojen
• Sürveyansı

Etik Beyan

Bu çalışma, Kırşehir Ahi Evran Üniversitesi Sağlık Bilimleri Bilimsel Araştırmalar Etik Kurulu tarafından onaylanmıştır (No: 2024-09/76, Tarih: 30.04.2024).

ANTIMICROBIAL RESISTANCE TRENDS AMONG UROPATHOGENS ISOLATED FROM URINE CULTURES AT A TERTIARY CARE HOSPITAL: A SIX-YEAR RETROSPECTIVE ANALYSIS (2019-2024)

Öz

Objective: This study aimed to evaluate the distribution of uropathogens and temporal trends in antimicrobial resistance among urine culture isolates from a tertiary care center in central Türkiye over a six-year period (2019-2024).
Material and Methods: A total of 16,220 urine culture isolates were retrospectively analyzed. Bacterial identification was performed using the VITEK® 2 system, and antimicrobial susceptibility testing was conducted using VITEK® 2 AST cards and/or Kirby-Bauer disk diffusion. Results were interpreted according to EUCAST breakpoints. In the statistical analyses, the Pearson chi-square test and the trend chi-square test were used. The significance level was set at p<0.05.
Results: Female patients constituted 63.0-67.3% of all isolates. Gram-negative bacteria predominated (68.0-83.4% annually). ICU-derived isolates peaked during 2020-2021 (32.1% and 30.1%, respectively), coinciding with the COVID-19 pandemic. Escherichia coli was the most frequently isolated uropathogen; ciprofloxacin resistance declined from 51.2% (2019) to 34.8% (2024), while ertapenem resistance increased from 1.0% to 3.1%. Klebsiella pneumoniae showed the most alarming resistance escalation, with ertapenem resistance reaching 43.0% in 2022, colistin resistance peaking at 63.6% in 2022, and ceftazidime resistance reaching 96.8% in 2024. Acinetobacter baumannii demonstrated near-pandrug-resistant profiles throughout the study period. Vancomycin-resistant Enterococcus faecium rates declined significantly from 50.0% (2020) to 20.7% (2024) (p<0.001), while linezolid remained active (0.0-3.7% resistance).
Conclusion: This study documents a progressively challenging resistance landscape, particularly for carbapenem-resistant K. pneumoniae and A. baumannii. Annual updating of institution-specific antibiograms, systematic testing of last-resort agents, and reinforced antimicrobial stewardship programs are urgently needed.

Anahtar Kelimeler

• Antimicrobial Resistance
• Uropathogen
• Surveillance

Etik Beyan

This study was approved by the Ethics Committee of Kırşehir Ahi Evran University (Approval No: 2024-09/76, Date: 30.04.2024).

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