Distribution of urinary Enterobacterales isolates and antibiotic resistance profiles: Three-year

Abstract

Objective: Urinary tract infections (UTIs) are one the most frequent human infections. Increasing trend of antimicrobial resistance (AMR) and difficult-to-treat resistance cases are of serious concern. This study aimed to investigate the order of Enterobacterales urinary isolates and AMR profiles for 3 years in a tertiary hospital. Material and Methods: Clinical urinary cultures of patients obtained from January 2017 to December 2019 in Balıkesir Atatürk City Hospital were included in the study. Isolated Enterobacterales strains and their antibiotic susceptibilities were retrospectively evaluated. Antimicrobial susceptibility tests were performed by conventional and automated methods according to guidelines of The European Committee on Antimicrobial Susceptibility Testing. Results: Among a total of 9297 urine isolates, 78.5% were members of order Enterobacterales (n=7300). The majority of strains were isolated from intensive care units (n=3979; 54.5%). Most of the patients were female (62.9%) and 52.4% of the patients had an indwelling urinary catheter (catheter-associated UTIs). The carbapenem resistance was 13.6% in Klebsiella spp., followed by Morganella spp. (7.5%). Extended-spectrum β-lactamases (ESBLs) were detected most frequently also in Klebsiella spp. (over 50%), followed by Escherichia coli (over 30%) and Enterobacter spp. (over 30%). E. coli and Klebsiella spp. showed significant change in resistance to ceftazidime, while Proteus and Morganella spp. showed a change in resistance to cefepime and fluoroquinolone, additionally. Alterations in Amoxicillin and Clavulanic acid and cefepime resistance of Enterobacter and other rare species were also significant. Conclusion: Antibiotic consumption is strongly related to AMR and Türkiye seems to have a serious struggle with both antibiotic consumption and AMR. Local and/or national antimicrobial policies are effective in Türkiye, but further measures are required