Overview Of Antimicrobial Resistance And Epidemiology Of Türkiye With A One Health Approach

Yıl 2025, Cilt: 10 Sayı: 2, 65 - 75, 28.05.2025

Süheyla Kurum , Ahmet İlber Balcı , Ayşe Hilal Çuhadar , Eda Aydemir , Emre Erkal , Meltem Bulut , Egemen Ünal , Mehmet Enes Gökler

https://doi.org/10.70852/tmj.1530388

Öz

Since their discovery, antimicrobials have saved countless lives and formed the foundation of modern medicine. In addition, their use in veterinary medicine, agriculture, and livestock has provided great convenience. However, despite all these benefits, antimicrobial resistance (AMR), resulting from excessive and inappropriate use, threatens the global achievements made against diseases and thus public health. The World Health Organization (WHO) included AMR in its “Ten Threats to Global Health” list published in 2019 and encouraged the joint participation of all nations and stakeholders for effective action. This issue, which has become a global concern for many organizations, is also emerging as a growing problem in Türkiye. According to current AMR reports, Türkiye is one of the countries with the highest resistance rates in the WHO European Region. These findings highlight the urgency and importance of the fight against AMR. The misuse of antimicrobials in the food industry and veterinary medicine, as well as their environmental effects, should be considered priority issues, and policies should be shaped through intersectoral cooperation. In this review, AMR is evaluated through the One Health approach, and Türkiye’s AMR data obtained from reports are analyzed.

Anahtar Kelimeler

Antimicrobial Resistance , One Health , Surveillance

Tek Sağlık Yaklaşımıyla Türkiye'nin Antimikrobiyal Direnci ve Epidemiyolojisine Genel Bakış

Öz

Antimikrobiyaller keşfedilmeleriyle birlikte sayısız hayat kurtarmış ve modern tıbbın temelini oluşturmuştur. Ayrıca veterinerlik, tarım ve hayvancılıkta kullanımı büyük kolaylık sağlamıştır. Ancak tüm bu faydaların yanı sıra aşırı ve uygunsuz kullanım sonucu oluşan antimikrobiyal direnç (AMD); antimikrobiyaller ile hastalıklara karşı elde edilen küresel başarıları ve böylelikle toplum sağlığını tehdit etmektedir. Dünya Sağlık Örgütü (DSÖ), 2019 yılında yayınladığı “Küresel Sağlık İçin On Tehdit Listesi”ne AMD’yi dahil ederek, etkili mücadele için tüm ulusların ve paydaşların ortak katılımını teşvik etti. Dünya çapında birçok kuruluşun odak noktası haline gelen bu konu, Türkiye’de de giderek büyüyen bir sorun haline geldi. Güncel AMD raporlarına göre Türkiye, DSÖ- Avrupa Bölgesi’nde en yüksek direnç yüzdelerine sahip ülkelerden biridir. Bu sonuçlar mücadelenin aciliyetini ve önemini gösteriyor. Gıda endüstrisinde ve veteriner hekimliğinde antimikrobiyallerin yanlış kullanımı ve çevreye olan etkileri de öncelikli konular arasında ele alınmalı ve politikalar sektörler arası iş birliği yoluyla belirlenmelidir. Bu derlemede AMD, Tek Sağlık yaklaşımıyla değerlendirilmiş ve Türkiye’nin raporlardan elde edilen AMD verileri incelenmiştir.

Anahtar Kelimeler

Antimikrobiyal Direnç , Tek Sağlık , Sürveyans

Kaynakça

• Antituberculosis Drug Resistance Laboratory Surveillance Network (TULSA). (2024). https://hsgm.saglik.gov.tr/tr/surveyanslar/tulsa.html
• Aquilina, G., Azimonti, G., Bampidis, V., De, M., Bastos, L., Bories, G., Chesson, A., Cocconcelli, P. S., Flachowsky, G., Urgen Gropp, J. €, Kolar, B., Kouba, M., Lopez Puente, S., Lopez-Alonso, M., Mantovani, A., Mayo, B., Ramos, F., Rychen, G., Saarela, M., … Poulsen, H. D. (2016). Revision of the currently authorised maximum copper content in complete feed. EFSA Journal, 14(8), e04563. https://doi.org/10.2903/j.efsa.2016.4563
• Ayukekbong, J. A., Ntemgwa, M., & Atabe, A. N. (2017). The threat of antimicrobial resistance in developing countries: Causes and control strategies. Antimicrobial Resistance and Infection Control, 6(1), 1–8. https://doi.org/10.1186/S13756-017-0208-X/TABLES/2
• Babu Rajendran, N., Arieti, F., Mena-Benítez, C. A., Galia, L., Tebon, M., Alvarez, J., Gladstone, B. P., Collineau, L., De Angelis, G., Duro, R., Gaze, W., Göpel, S., Kanj, S. S., Käsbohrer, A., Limmathurotsakul, D., Lopez de Abechuco, E., Mazzolini, E., Mutters, N. T., Pezzani, M. D., … Wozniak, T. (2023). EPI-Net One Health reporting guideline for antimicrobial consumption and resistance surveillance data: a Delphi approach. The Lancet Regional Health - Europe, 26. https://doi.org/10.1016/j.lanepe.2022.100563
• Bangura, F. I., Leno, A., Hann, K., Timire, C., Nair, D., Bah, M. A., Gborie, S. R., Satyanarayana, S., Edwards, J. K., Davtyan, H., Kamara, S. M., Jalloh, A. T., Sellu-Sallu, D., Kanu, J. S., Johnson, R., & Nantima, N. (2022). An Update on the Surveillance of Livestock Diseases and Antimicrobial Use in Sierra Leone in 2021—An Operational Research Study. International Journal of Environmental Research and Public Health, 19(9). https://doi.org/10.3390/IJERPH19095294/S1
• Berman, T. S., Barnett-Itzhaki, Z., Berman, T., & Marom, E. (2023). Antimicrobial resistance in food-pro-ducing animals: towards implementing a one health based national action plan in Israel. Israel Journal of Health Policy Research, 12(1), 1–17. https://doi.org/10.1186/S13584-023-00562-Z/FIGURES/2
• Bosetti, D., & Neofytos, D. (2023). Invasive Aspergillosis and the Impact of Azole-resistance. Current Fungal Infection Reports, 17(2), 77–86. https://doi.org/10.1007/S12281-023-00459-Z
• Cao, D., Wang, F., Yu, S., Dong, S., Wu, R., Cui, N., Ren, J., Xu, T., Wang, S., Wang, M., Fang, H., & Yu, Y. (2021). Prevalence of Azole-Resistant Aspergillus fumigatus is Highly Associated with Azole Fungicide Residues in the Fields. Environmental Science & Technology, 55(5), 3041–3049. https://doi.org/10.1021/acs.est.0c03958
• Çırak, V. Y., Kar, S., & Girişgin, O. (2010). İvermektin ve pirantele karşı at strongylidae’lerinde antelmentik direnç araştırılması ve parascaris equorum’da makrosiklik lakton direnci. Türkiye Parazitoloji Dergisi, 34(1), 35–39.
• Dean, A. S., Tosas Auguet, O., Glaziou, P., Zignol, M., Ismail, N., Kasaeva, T., & Floyd, K. (2022). 25 years of surveillance of drug-resistant tuberculosis: achievements, challenges, and way forward. The Lancet. Infectious Diseases, 22(7), 191–196. https://doi.org/10.1016/S1473-3099(21)00808-2
• Drug-Resistant Infections: A Threat to Our Economic Future - Final Report. (2017, March). International Bank for Reconstruction and Development/The World Bank. https://www.worldbank.org/en/topic/health/publication/drug-resistant-infections-a-threat-to-our-economic-future
• ECDC, & WHO. (2023). Antimicrobial resistance surveillance in Europe 2023 : 2021 data. https://doi.org/https://data.europa.eu/doi/10.2900/63495
• Ener, B., Ergin, Ç., Gülmez, D., Aǧca, H., Tikveşli, M., Aksoy, S. A., Otkun, M., Siǧ, A. K., Öǧünç, D., Özhak, B., Topaç, T., Özdemir, A., Metin, D. Y., Polat, S. H., Öz, Y., Koç, N., Atalay, M. A., Erturan, Z., Birinci, A., … Arikan-Akdagli, S. (2022). Frequency of azole resistance in clinical and environmentalstrains of Aspergillus fumigatus in Turkey: a multicentre study. The Journal of Antimicrobial Chemotherapy, 77(7), 1894–1898. https://doi.org/10.1093/JAC/DKAC125
• Frost, I., Kapoor, G., Craig, J., Liu, D., & Laxminarayan, R. (2021). Status, challenges and gaps in antimic robial resistance surveillance around the world. Journal of Global Antimicrobial Resistance, 25, 222–226. https://doi.org/10.1016/j.jgar.2021.03.016
• GLASS-AMC Module. (2024). WHO. https://www.who.int/initiatives/glass/glass-amc-module Global Action Plan on Antimicrobial Resistance. (2015). https://iris.who.int/bitstream/handle/10665/193736/9789241509763_eng.pdf?sequence=1
• Global Antimicrobial Resistance and Use Surveillance System (GLASS). (2024). WHO. https://www.who.int/initiatives/glass
• Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report 2022. (2022). https://www.who.int/publications/book-orders.
• Global Tuberculosis Programme. (2024). WHO. https://www.who.int/teams/global-tuberculosis-programme/diagnosis-treatment/treatment-of-drug-resistant-tb/surveillance-of-drug-resistant-tb
• Global tuberculosis report. (2020). WHO. https://www.who.int/publications/i/item/9789240013131
• Hiçcan, Ö. (2017, March). AB Uzmanlık Tezi - Hayvan ve İnsan Sağlığı Konusunda Bütüncül Bir Yaklaşım Tek Sağlık. T.C. Tarım ve Orman Bakanlığı Avrupa Birliği ve Dış İlişkiler Genel Müdürlüğü. https://www.tarimorman.gov.tr/ABDGM/Link/37/Ab-Uzmanlik-Tezleri
• Humboldt-Dachroeden, S., & Mantovani, A. (2021b). Assessing Environmental Factors within the One Health Approach. Medicina, 57(3). https://doi.org/10.3390/MEDICINA57030240
• Johnson, A. P. (2015). Surveillance of antibiotic resistance. Philosophical Transactions of the Royal Society B: Biological Sciences, 370(1670). https://doi.org/10.1098/rstb.2014.0080
• Köse, M., Kozan, E., Sevimli, F. K., & Eser, M. (2007). The resistance of nematode parasites in sheep against anthelmintic drugs widely used in Western Turkey. Parasitology Research, 101(3), 563–567. https://doi.org/10.1007/S00436-007-0514-Y
• Malagón-Rojas, J. N., Parra Barrera, E. L., & Lagos, L. (2020). From environment to clinic: the role of pesticides in antimicrobial resistance. Revista Panamericana de Salud Pública, 44(1). https://doi.org/10.26633/RPSP.2020.44
• Morgan, D. J., Okeke, I. N., Laxminarayan, R., Perencevich, E. N., & Weisenberg, S. (2011). Non-presc-ription antimicrobial use worldwide: a systematic review. The Lancet. Infectious Diseases, 11(9), 692–701. https://doi.org/10.1016/S1473-3099(11)70054-8
• No time to Wait: Securing the future from drug-resistant infections. (2019). World Health Organization. https://www.who.int/publications/i/item/no-time-to-wait-securing-the-future-from-drug-resistant-infections
• OIE (2021) OIE List of Antimicrobial Agents of Veterinary Importance. https://www.woah.org/app/uploads/2021/06/a-oie-list-antimicrobials-june2021.pdf
• Önder, Z., Yıldırım, A., İnci, A., Düzlü, Ö., & Çiloğlu, A. (2015). Koyunlarda Haemonchus contortus’un Moleküler Prevalansı, Filogenetik Karakterizasyonu ve Benzimidazol Dirençliliği. Kafkas Universitesi Veteriner Fakultesi Dergisi, 22(1), 93–99. https://doi.org/10.9775/kvfd.2015.13960
• Picot, S., Beugnet, F., Leboucher, G., & Bienvenu, A.-L. (2022). Drug resistant parasites and fungi from a one-health perspective: A global concern that needs transdisciplinary stewardship programs. One Health, 14, 100368. https://doi.org/10.1016/j.onehlt.2021.100368
• Pulingam, T., Parumasivam, T., Gazzali, A. M., Sulaiman, A. M., Chee, J. Y., Lakshmanan, M., Chin, C. F., & Sudesh, K. (2022). Antimicrobial resistance: Prevalence, economic burden, mechanisms of resistance and strategies to overcome. European Journal of Pharmaceutical Sciences, 170, 106103. https://doi.org/10.1016/j.ejps.2021.106103
• Responsible and prudent use of anthelmintic chemicals to help control anthelmintic resistance in grazing livestock species. (2021). https://www.woah.org/app/uploads/2021/12/oie-anthelmintics-prudent-and-responsible-use-final-v4-web-opt.pdf
• Semenza, J. C., & Menne, B. (2009). Climate change and infectious diseases in Europe. The Lancet Infectious Diseases, 9(6), 365–375. https://doi.org/10.1016/S1473-3099(09)70104-5
• Surveillance and monitoring for antimicrobial use and resistance IACG discussion paper. (2018). https://cdn.who.int/media/docs/default-source/antimicrobial-resistance/iacg-surveillance-and-monitoring-for-amu-and-amr-110618.pdf?sfvrsn=8a07c166_4
• Tackling Drug-Resistant Infections Globally: final report and recommendations | AMR Review. (2016, May 19). Review on Antimicrobial Resistance. https://amr-review.org/
• Tang, K. L., Caffrey, N. P., Nóbrega, D. B., Cork, S. C., Ronksley, P. E., Barkema, H. W., Polachek, A. J., Ganshorn, H., Sharma, N., Kellner, J. D., & Ghali, W. A. (2017). Restricting the use of antibiotics in food-producing animals and its associations with antibiotic resistance in food-producing animals and human beings: a systematic review and meta-analysis. The Lancet Planetary Health, 1(8), e316–e327. htps://doi.org/10.1016/S2542-5196(17)30141-9
• Tinkler, S. H. (2020). Preventive chemotherapy and anthelmintic resistance of soil-transmitted helminths – Can we learn nothing from veterinary medicine? One Health, 9, 100106. https://doi.org/10.1016/J.ONEHLT.2019.100106
• Tuncer, İ. H. (2007). To Banned Usage of Hormones, Antibiotics, Anticoccidials and Drugs in Compound Animal Feed (A Review). Lalahan Hayvancılık Araştırma Enstitüsü Dergisi, 47(1), 1–9.
• Ulusal Antimikrobiyal Direnç Sürveyans Sistemi. (2024). https://hsgm.saglik.gov.tr/tr/surveyanslar/uamdss.html
• Wang, M., Liu, P., Xiong, W., Zhou, Q., Wangxiao, J., Zeng, Z., & Sun, Y. (2018). Fate of potential indicator antimicrobial resistance genes (ARGs) and bacterial community diversity in simulated manure-so-il microcosms. Ecotoxicology and Environmental Safety, 147, 817–823. https://doi.org/10.1016/j.ecoenv.2017.09.055
• WHO. (2018). WHO Report on Surveillance of Antibiotic Consumption. In Who. http://apps.who.int/iris%0Ahttps://apps.who.int/iris/bitstream/handle/10665/277359/9789241514880-eng.pdf
• WHO. (2023). Antimicrobial resistance. WHO Fact Sheets. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
• WHO (2020) Global tuberculosis report. https://www.who.int/publications/i/item/9789240013131
• WHO Advisory Group of the Critically Important Antimicrobials for Human Medicine (AG-CIA). (2019). https://www.who.int/groups/advisory-group-on-the-who-list-of-critically-important-antimicrobials
• WHO EMRO | Public health surveillance | Health topics. (2024). https://www.emro.who.int/health-topics/public-health-surveillance/index.html
• Wielinga, P. R., & Schlundt, J. (2012). Food Safety: At the Center of a One Health Approach for Combating Zoonoses. In One Health: The Human-Animal-Environment Interfaces in Emerging Infectious Diseases (Vol. 366, pp. 3–17). Nature Publishing Group. https://doi.org/10.1007/82_2012_238
• World Health Organization GLASS dashboard. (2022). https://worldhealthorg.shinyapps.io/glass-dashboard/_w_63b1b2bb/#!/home