Akademik Veri Yönetim Sistemi
Turk Hijyen ve Deneysel Biyoloji Dergisi, cilt.75, sa.1, ss.29-36, 2018 (Scopus)
© 2018, Refik Saydam National Public Health Agency (RSNPHA).Objective: Infections of the urinary tract are included among the most common infections globally, and the most frequently seen pathogen is Escherichia coli. Nitrofurantoin, trimethoprim-sulfamethoxasole and fosfomycin are recommended as the first choice antibiotics for urinary system infections according to the guideline prepared by Infectious Diseases Society of America (IDSA). Ciprofloxacin is recommended in case of treatment failure. The aim of the study was to investigate the in vitro efficacy of nitrofurantoin, fosfomycin, trimethoprim sulfamethoxazole and ciprofloxacin on isolates obtained as the agent of UTI. Additionally it was aimed to compare MIC results with disk diffusion (DD) results evaluated according to Clinical and Laboratory Standards Institute (CLSI) for want of FOS DD zone diameter limits in EUCAST. Methods: 302 E. coli isolates obtained from urine specimens of outpatients who applied with UTI complaint between May 2014 and September 2014. The antibiotic susceptibility of isolates were determined according to the recommendations of European Committee on Antimicrobial Susceptibility Testing (EUCAST) using the disc diffusion method for nitrofurantoin, trimethoprim sulfamethoxazole and ciprofloxacin and minimum inhibitor concentration (MIC) was determined with broth microdilution method forfosfomycin. Results: The susceptibility rates tested with disc diffusion method for nitrofurantoin, trimethoprim sulfamethoxazole and ciprofloxacin were 1.66%, 45.36% and 42.38%, respectively. The entire portion of test isolates were found susceptible against fosfomycin based on the MIC values. The rate of resistance of the isolates against both ciprofloxacin and trimethoprim sulfamethoxazole was found to be 29.14%. The MIC50/ MIC90 values against fosfomycin were found 2 μg/ml and / 8 μg/ml respectively. Fosfomycin MIC values of isolates were detected as consistent with EUCAST epidemiologic cutoff (ECOFF) data. The Pearson correlation analysis was carried out for zone diameters measured for fosfomycin as a result of disc diffusion test and MIC values showed a weak reverse correlation (r=-0,5238, p=0,00). Conclusion: We have the opinion that ciprofloxacin and trimethoprim sulfamethoxazole are not suitable choices for empirical treatment for our country based on this evaluation and fosfomycin can be the antibiotic that could be preferred in empirical treatment since its MIC values have not increased much yet. The data of the antibiotic consumption surveillance carried out on the outpatients in our country together with the results of the present study clearly show the relationship between the use of antibiotics and development of resistance. Accordingly, we want to emphasize the importance of starting therapy according to the results of cultures and antibiotics susceptibility results based on the UTI treatment protocols.