Resistance patterns in Turkey.

Resistance to antimicrobial agents in Gram-positive and Gram-negative bacteria is common in Turkey. In this review, resistance to several antimicrobial agents in this country is discussed for bacteria which have gained clinical importance in recent years. Among Gram-positives, staphylococci are of major importance because of their high level of resistance to many agents in the hospital and the community. Methicillin resistance in different hospitals ranges from 13% to 37%. High-level resistance to gentamicin occur in enterococci and resistance to glycopeptides have not been reported in these isolates. S. pneumoniae resistance to penicillin have been observed in Turkey as 47% in Hacettepe University and most of the resistant isolates were from children with severe underlying diseases. In reports from other hospitals, the level of resistance was lower because of a different patient population. In Gram-negative bacilli, aminoglycoside resistance is a significant problem in the treatment of severe infections in our country. The most common mechanism of resistance in our isolates is the plasmid-mediated enzymatic modification of these agents. Extended-broad spectrum beta-lactamases have been detected in Klebsiella spp. and Salmonella spp. in Turkey. In a Pseudomonas strain, an extended-spectrum variant of OXA-10 was identified. Some isolates were also shown to produce plasmid mediated PER-1 enzymes. Due to resistance problems encountered in many hospitals, restriction control measures have been started in some hospitals in order to limit the antibiotic use and our hope is the country-wide application of these precautions as soon as possible.