Evaluating the prevalence of plasmid- mediated quinolone resistant and ESBL- production in Uropathogenic Escherichia coli and the commensal gut microbiota in pregnant women: A comparative analysis

2020 ◽  
Author(s):  
Samane Mohebi ◽  
Soudeh Kholdi ◽  
Mahtab Hadadi ◽  
zahra hashemizadeh
Keyword(s):  
Gut Microbiota ◽  
Pregnant Women ◽  
Resistance Rate ◽  
Diffusion Method ◽  
Fecal Flora ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Commensal Flora ◽  
Fluoroquinolone Antibiotics ◽  
Tract Infections

Abstract Background: ß-lactam and fluoroquinolone antibiotics are frequently prescribed for urinary tract infections (UTIs). This study aimed to determine the prevalence of plasmid-mediated quinolone resistance (PMQR) and extended spectrum β-lactamases (ESBLs) in E. coli from UTIs in comparison with the E. coli isolates from gut microbiota (fecal flora).Methods: A total of 54 E. coli urine isolates and 54 E. coli fecal flora isolates were collected from pregnant women (same host) from April to September 2018. Antimicrobial susceptibility testing was determined by disk diffusion method. ESBLs were detected via double-disk test (DDST). ESBL and PMQR-encoding genes were identified, using PCR.Results: The highest resistance rate was found against nalidixic acid (42 isolates in urinary and 41 in fecal flora isolates) and the lowest resistance rate belonged to levofloxacin (23 isolates) and ofloxacin (25 isolates) in urinary and fecal flora isolates. The most prevalent PMQR genes were qnrS (29 isolates in urinary and 34 in fecal flora isolates) followed by qnrB, aac (6′)- Ib-cr and qnrA in urinary and fecal flora isolates. There was a significant association between qnrS gene and blaTEM in urinary and fecal flora isolates.Conclusions: Resistance to quinolones antibiotics was highest among fecal flora isolates, especially qnrS among other determinants of the qnr gene. In addition, it seems that high load of PMQR genes in commensal flora has a potential to spread to pathogenic organisms.

scholarly journals Prevalence of Resistance to Quinolone and Fluoroquinolone Antibiotics and Screening of qnr Genes Among Escherichia coli Isolates From Urinary Tract Infection

2017 ◽  
Vol 5 (4) ◽  
pp. 100-105 ◽  
Author(s):  
Mohadese Amiri ◽  
Maziar Jajarmi ◽  
Reza Ghanbarpour
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Nalidixic Acid ◽  
Diffusion Method ◽  
Biochemical Tests ◽  
Phylogenetic Groups ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Fluoroquinolone Antibiotics ◽  
Tract Infections

Background: Antibiotic resistance (AR) is an important challenge in prevention, treatment and control of infectious diseases and is a public health threat for human. Escherichia coli strains are the major causes of urinary tract infections (UTIs). Objective: This research aimed to determine prevalence of resistance to quinolone and fluoroquinolone antibiotics and screen qnr genes among E. coli isolates from UTIs. Materials and Methods: A total of 105 E. coli isolates were obtained from UTI cases in Bojnord city (northeast of Iran) and confirmed by biochemical tests. All strains were studied to determine their resistance to 3 antibiotics including ciprofloxacin, nalidixic acid, and levofloxacin via disk diffusion method. Moreover, the frequency of qnrA, qnrB and qnrS genes and phylogroups was studied by conventional Polymerase chain reaction (PCR). Results: In this study, prevalence of phenotypic AR to ciprofloxacin, nalidixic acid and levofloxacin was 47.6%, 44.8% and 38.1%, respectively. Three isolates were positive for qnrS and 1 isolate was positive for qnrA. Seven phylogenetic groups were also identified as follows: 18% A0, 6.7% A1, 7.6% B1, 1.9% B22, 23.8% B23, 15.3% D1 and 26.7% D2. Conclusion: Prevalence of qnr genes was very low; thus, other types of qnr and plasmid-mediated quinolone resistance genes were probably responsible for the resistance. Phenotypic AR to the 3 antibiotics was found in approximately half of E. coli strains. It is strongly recommended that antibiogram tests should be done before prescribing the ciprofloxacin, nalidixic acid and levofloxacin for UTIs.

Prevalence of SHV-extended spectrum β-lactamase producing carbapenem –resistantKlebsiellapneumoniae among patients with lower respiratory tractinfections in Babylon Province-Iraq.

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Fatima Moeen Abbas
Keyword(s):  
Resistance Rate ◽  
Combination Method ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
Carbapenem Resistant ◽  
Extended Spectrum ◽  
Pcr Method ◽  
Polymerase Chain ◽  
Tract Infections ◽  
Positive Results

This study was carried out to screen the prevalence of Klebsiella pneumoniae isolated from patients with lower respiratory tract infections in Babylon province.From December,2015 to the end of March,2016,a total of 100 sputum samples were collected from patients visited or hospitalized Merjan Teaching Hospital and Al- Hashimya General Hospital. Fifteenth (65%) isolates were identified as Klebsiellapneumoniae. All bacterial isolates were evaluated for extended spectrum β-lactamase (ESBL) production phenotypically using disk combination method. Eleven (73.3%) isolates were detected as ESBL-producers. Kirby-Bauer disk diffusion method was employed to determine resistance profile of ESBLs-positive isolates. Higher rates of resistance were observed for ampicillin and piperacillin antibiotics with (81.8%) and (72.7%) resistance rate, respectively, while the lowest rate was noticed for imipenem antibiotic (14.28%). Carbapenem-resistant isolates were investigated for blaSHV gene by Polymerase Chain Reaction (PCR) method, 2 (100%) isolates gave positive results.

scholarly journals Antibiotic Resistance of Uropathogens Isolated from Patients Hospitalized in District Hospital in Central Poland in 2020

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 447
Author(s):  
Barbara Kot ◽  
Agata Grużewska ◽  
Piotr Szweda ◽  
Jolanta Wicha ◽  
Urszula Parulska
Keyword(s):  
Antibiotic Resistance ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
Beta Lactamases ◽  
E Coli ◽  
Central Poland ◽  
Resistance Patterns ◽  
Extended Spectrum Beta Lactamases ◽  
Tract Infections

The aim of this study was to determine antibiotic resistance patterns and the prevalence of uropathogenes causing urinary tract infections (UTIs) in patients hospitalized in January–June 2020 in central Poland. Antimicrobial susceptibility testing was performed using the disk-diffusion method. Escherichia coli (52.2%), Klebsiella pneumoniae (13.7%), Enterococcus faecalis (9.3%), E. faecium (6.2%), and Proteus mirabilis (4,3%) were most commonly isolated from urine samples. E. coli was significantly more frequent in women (58.6%) (p = 0.0089) and in the age group 0–18, while K. pneumoniae was more frequent in men (24.4%) (p = 0.0119) and in individuals aged 40–60 and >60. Gram-negative species showed resistance to ampicillin. K. pneumoniae were resistant to amoxicillin plus clavulanic acid (75.0%), piperacillin plus tazobactam (76.2%), cefotaxime (76.2%), cefuroxime (81.0%), ciprofloxacin (81.0%), and trimethoprim plus sulphamethoxazole (81.0%). Carbapenems were effective against all E. coli and P. mirabilis. Some K. pneumoniae (13.6%) produced metallo-β-lactamases (MBLs). E. coli (22.6%), K. pneumoniae (81.8%), and all E. faecium were multidrug-resistant (MDR). Some E. coli (26.2%), K. pneumoniae (63.6%), and P. mirabilis (14.3%) isolates produced extended-spectrum beta-lactamases (ESBL). Vancomycin-resistant E. faecium was also found. This study showed that the possibilities of UTIs therapy using available antibiotics become limited due to the increasing number of antibiotic-resistant uropathogens.

scholarly journals Detection of plasmid-mediated qnr genes among the quinolone-resistant Escherichia coli isolates in Iran

2014 ◽  
Vol 8 (07) ◽  
pp. 818-822 ◽  
Author(s):  
Farzaneh Firoozeh ◽  
Mohammad Zibaei ◽  
Younes Soleimani-Asl
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Quinolone Resistance ◽  
Diffusion Method ◽  
Chain Reaction ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Polymerase Chain ◽  
Tract Infections

Introduction: Plasmid-mediated quinolone resistance, which complicates treatment, has been increasingly identified in Escherichia coli isolates worldwide. The purpose of this study was to identify the plasmid-mediated qnrA and qnrB genes among the quinolone-resistant Escherichia coli isolated from urinary tract infections in Iran. Methodology: A total of 140 Escherichia coli isolates were collected between March and October 2012 from urinary tract infections in Khorram Abad, Iran. All isolates were tested for quinoloe resistance using the disk diffusion method. Also, all quinolone-resistant isolates were screened for the presence of the qnrA and qnrB genes by polymerase chain reaction. Minimum inhibitory concentrations (MICs) of ciprofloxacin for the qnr-positive isolates were determined. Results: One hundred sixteen (82.8%) of 140 Escherichia coli isolates were nalidixic acid-resistant; among them, 14 (12.1%) and 9 (7.8%) were qnrA and qnrB-positive, respectively. Two quinolone-resistant isolates harbored both qnrA and qnrB. Among 63 ciprofloxacin-resistant isolates, 14 (22.2%) and 9 (14.3%) were found to carry qnrA and qnrB genes, respectively. The ciprofloxacin MIC range was 0.25–512 μg/mL for 23 qnr-positive Escherichia coli isolates, 18 of which had MICs values of 4–512 μg/mL. Conclusion: Our study shows that the frequency of plasmid-mediated quinolone resistance genes among E. coli isolates in Iran is high.

scholarly journals Drug resistance, serotypes, and phylogenetic groups among uropathogenic Escherichia coli including O25-ST131 in Mexico City

2011 ◽  
Vol 5 (12) ◽  
pp. 840-849 ◽  
Author(s):  
José Molina-López ◽  
Gerardo Aparicio-Ozores ◽  
Rosa María Ribas-Aparicio ◽  
Sandra Gavilanes-Parra ◽  
María Elena Chávez-Berrocal ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Multidrug Resistance ◽  
Mexico City ◽  
Uropathogenic Escherichia Coli ◽  
Diffusion Method ◽  
Phylogenetic Groups ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Pcr Multiplex ◽  
Tract Infections

Introduction: The increasing prevalence of uropathogenic Escherichia coli (UPEC) strains resistant to multiple antibiotics complicates the treatment of urinary tract infections (UTIs). This study aimed to analyze the antimicrobial resistance, serotypes, and phylogenetic groups among strains of E. coli isolated from outpatients with UTIs in Mexico City. Methodology: A total of 119 E. coli isolates were recovered from urine samples from outpatients with clinical diagnosis of uncomplicated UTIs from 2004 to 2007. The serotype was assessed by agglutination in microtiter plates; susceptibility to antimicrobials was determined by the disk diffusion method. Clone O25-ST131 and phylogenetic groups of E. coli strains were tested by methods based on PCR multiplex. Results: The predominant serotype was O25:H4 (21.2%). Resistance to antibiotics was ampicillin (83.7%); piperacillin (53.8%); the fluoroquinolone group (55.5-60.6%), and trimethoprim/sulfamethoxazole (TMP/SMX) (56.4%). Additionally, 36 (30.2%) isolates were multidrug-resistant and 13 of these 36 strains were identified as E. coli O25-ST131 clone by an allele-specific PCR-based assay. Phylogenetic analysis showed that 15 of 17 isolates with serotype O25:H4 belonged to group B2. Conclusions: This is the first report that establishes the presence in Mexico of the O25-ST131 clonal group of E. coli, which has been associated with multidrug-resistance and with high virulence potential. The spread of this clone in Mexico should be monitored closely. We found a correlation between serotype O25:H4 and multidrug resistance in UPEC strains. Our results indicate that the use of ampicillin, fluoroquinolones, and TMP/SMX should be reviewed when selecting empirical therapy for UTIs.

scholarly journals Prevalence of Urinary Tract Infections in Children and Changes in Sensitivity to Antibiotics of E. coli Strains

2019 ◽  
Vol 70 (11) ◽  
pp. 3788-3792
Author(s):  
Adrian Hasegan ◽  
Maria Totan ◽  
Elisabeta Antonescu ◽  
Adrian Gheorghe Bumbu ◽  
Carmen Pantis ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Disk Diffusion ◽  
Diffusion Method ◽  
Sensitivity Testing ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Positive Urine ◽  
Tract Infections

Urinary tract infections (UTIs) are the most common bacterial pathologies in children, but they are difficult to spot. The diagnosis relies on urine culture in order to measure the prevalence of the infection, to identify the etiology and the sensitivity of the germs to different antibiotics. Escherichia coli (E. coli) strains are the most common uro-pathogen germs. The change in sensitivity to antibiotic of these uro-pathogen bacteria should be closely monitored because the physicians should be informed about the evolution of the antibiotic resistance of E coli, for a more effective treatment in their fight against diseases. The study aimed to determine the prevalence of UTIs and the evolution of antimicrobial sensitivity for E. coli. This retrospective study was performed over a period of 4 years, 2013-2016, and included all the patients admitted in the Children�s Hospital, aged 0-18 years, with the suspicion of UTIs; also, the standard culture techniques for urine samples, the modified Kirby-Bauer disk diffusion method for the antibiotic sensitivity testing, and the disk diffusion method to confirm the ESBL production by the clinical isolates of E. coli in urine were used. The statistical analysis was performed using the proportions of sensitive, resistant and intermediates. Descriptive statistics like the total, mean and percentage were performed using the Statistical Package for the Social Sciences (SPSS), version 15.0 and Microsoft Excel. From 15389 urine cultures processed in 4 years, 1530 were positive (9.9 %). Among these positive urine cultures, 1056 (69 %) were positive for E. coli. Testing the E. coli to a range of antibiotics, according to CLSI standard, a high resistance to Ampicillin (69-96%), Amoxicillin/Clavulanic acid (32-70%), Trimethoprim/Sulfamethoxazole (36-42%) was observed and low levels of resistance to Ceftazidime, Cefuroxime, Cefpodoxime, Gentamycin, Nalidixic acid. Among E. Coli strains, 9-9.6 % were ESBL positive. Despite the low number of positive urine cultures in a paediatric population, it is very important to perform the urine culture in order to correctly identify the etiology of UTIs, recommend the right antibiotic, and avoid the wrong use of the antibiotics in children.

scholarly journals Occurrence of urinary tract infection among children attending Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal

2013 ◽  
Vol 2 (3) ◽  
pp. 82-86 ◽  
Author(s):  
G Gautam ◽  
S Regmi ◽  
NT Magar ◽  
B Subedi ◽  
T Sharma ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Teaching Hospital ◽  
College Teaching ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Medical College ◽  
Tract Infections

INTRODUCTION: Urinary tract infection (UTI) is considered as the most common bacterial infectious disease seen among the pediatric patients. Most commonly, members of Enterobacteriaceae, particularly uropathogenic strains of E. coli and Enterobacter spp. are the primary causative pathogens of UTI in the different part of the world. Emergence of antimicrobial resistance rates among pathogens recovered from urinary tract infections is an increasing problem in the specific region. MATERIALS AND METHODS: Prevalence and anti microbial susceptibility pattern of the bacterial uropathogens isolated from the children attending Gandaki Medical College Teaching Hospital and Reserch Center (GMC) Nepal. A total of 155 children aged upto 15 years were included in this study. Urine cultures were carried out and the isolates were identified by Gram staining and conventional biochemical methods. Antimicrobial susceptibility testing was performed by disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI). RESULTS: In the present study 21.3 % of the sample size, showed significant bacterial growth. E. coli was the most frequently occurring pathogen (39.40%), followed by Proteus spp. 21.2%, Citrobacter spp. and Streptococcus faecalis (12.1%) Klebsiella spp. (9.1%), and Staphylococcus aureus and Enterobacter (3.0%). Susceptibility rate of E. coli were 69.2% to Gentamycin and Amikacin, 53.8% to Norfloxacin, 38.4% to Nalidixic acid and Norfloxacin. CONCLUSIONS: Pediatric urine culture isolates were becoming increasingly resistant to commonly used antibiotics. Finally, we suggest that empirical antibiotic selection should be based on knowledge of the local prevalence of bacterial organisms and antibiotic sensitivities rather than on universal guidelines. DOI: http://dx.doi.org/10.3126/ijim.v2i3.8665   Int J Infect Microbiol 2013;2(3):82-86

scholarly journals Distribution and Antimicrobial Susceptibilities of Members of Enterobacterales Isolated from Blood Cultures in a University Hospital

2021 ◽  
Author(s):  
Hasan Cenk Mirza ◽  
Banu Sancak
Keyword(s):  
Resistance Rate ◽  
Blood Cultures ◽  
University Hospital ◽  
Automated System ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
E Coli ◽  
Antimicrobial Susceptibilities ◽  
Resistance Rates ◽  
Epidemiological Information

Objective: Members of Enterobacterales can cause various diseases in humans. The objective of this study was to determine the genus/species distribution and antimicrobial susceptibilities of Enterobacterales isolated from blood cultures in Central Laboratory of Hacettepe University Hospital. Method: Enterobacterales isolated from blood between July-2014 and April-2018 were included in the study. MALDI-TOF MS was used for the identification of isolates. Antimicrobial susceptibilities were determined with automated system (VITEK 2 Compact for the isolates between 2014 and 2018; BD Phoenix for the isolates in 2018) and disk diffusion method. Results of antimicrobial susceptibility testing were interpreted according to EUCAST breakpoints. Results: In total, 1765 isolates belonging to the order Enterobacterales were isolated from blood cultures. The most common microorganisms were Escherichia coli (47.6%), Klebsiella (34.1%), Enterobacter (6%), Proteus (4.4%) and Serratia spp. (3.5%), respectively. The remaining isolates included Salmonella, Citrobacter, M. morganii, Pantoea, Raoultella and Providencia spp. The lowest resistance rates among E. coli, Klebsiella and Enterobacter spp. isolates were observed against meropenem and amikacin. However, 21.1% of Klebsiella isolates were resistant to meropenem. The most active antimicrobials against Proteus isolates were piperacillintazobactam and meropenem. Resistance was not observed against piperacillin-tazobactam and meropenem among Proteus isolates. The most active antimicrobial against Serratia isolates was trimethoprim/ sulfamethoxazole with a resistance rate of 0%. Resistance was not noted against ampicillin and trimethoprim/ sulfamethoxazole among Salmonella isolates, whereas 26.1% of isolates were resistant to ciprofloxacin. All Citrobacter isolates were susceptible to meropenem, amikacin and cefepime. Conclusion: Findings of our study may guide the selection of proper antimicrobials for the treatment of bacteremia caused by Enterobacterales. Furthermore, this study provides important epidemiological information regarding the distribution of members of Enterobacterales causing bacteremia.

scholarly journals THE CURRENT STATE OF ANTIBIOTIC RESISTANCE AND THE COMPOSITION OF PATHOGENS OF URINARY TRACT INFECTIONS IN PREGNANT WOMEN

2018 ◽  
Vol 6 (2) ◽  
pp. 13-20 ◽  
Author(s):  
K. L. Lokshin ◽  
V. N. Shirshov ◽  
A. S. Popko ◽  
Yu. L. Demidko ◽  
N. D. Luchenkova
Keyword(s):  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Pregnant Women ◽  
Urinary Tract Infections ◽  
Asymptomatic Bacteriuria ◽  
Resistance Rate ◽  
Acute Cystitis ◽  
E Coli ◽  
Tract Infections

Introduction.The main treatment component of asymptomatic bacteriuria, acute cystitis and pyelonephritis in pregnant women is antibiotic therapy, which in many patients is prescribed empirically. For successful selection of the drug, it is necessary to know both the structure of pathogens and the current profile of their antibiotic resistance.Purpose of research.The study of species composition and resistance to antibiotics of bacteria that cause urinary tract infections (UTIs) in pregnant women in the Moscow RegionMaterials and methods.The study included 104 pregnant women with uncomplicated UTIs who were observed and treated at the Lapino Clinical Hospital between 2016 and 2017. The material for bacteriological studies was the midstream portion of urine or urine collected by a catheter.Results.90 patients had asymptomatic bacteriuria, 10 had acute cystitis, and 4 had acute gestational pyelonephritis. The structure of the pathogens of UTI is presented: E. coli, Enterococcus faecalis, Klebsiella pneumoniae, Proteus spp., Staphylococcus spp., Streptococcus spp., Enterobacter cloacae. The most frequently detected pathogens were E. coli (67.3%) and E. faecalis (50%). Resistance rate of E.coli strains more than 20% was detected to ampicillin (36.4%), amoxicillin / clavulanate (23.2%), trimethoprim / sulfamethoxazole (27.4%), nalidixic acid (20.7%), cephalosporins 2 and 3 generation (respectively, 25.7% and 24.3%). Resistance rate more than 20% in Enterobacteriaceae family strains was detected to trimethoprim/sulfamethoxazole (24.4%), nalidixic acid (20.7%), cephalosporins 2 generations (21.7%). Antibiotic resistance of E.coli and other Enterobacteriaceae family taxons less than 10% was noted only with respect to carbapenems (0%) and fosfomycin (1.5% and 3.5%, respectively).Conclusions.It is expedient to use the obtained data on the composition and sensitivity profile of uropathogens in UTIs in pregnant women when choosing starting empirical antibiotic therapy. Disclosure: The study did not have sponsorship. The authors have declared no conflicts of interest.

Mecillinam: Old Molecule, New Option

2018 ◽  
Vol 13 (03) ◽  
pp. 229-233
Author(s):  
Mevliye Yetik ◽  
Fulya Bayındır Bilman
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Susceptibility Testing ◽  
Diffusion Method ◽  
First Line ◽  
Disk Diffusion Method ◽  
In Vitro Susceptibility ◽  
E Coli ◽  
Tract Infections

Background Mecillinam is a β-lactam antibiotic that is increasingly being used for the treatment of uncomplicated urinary tract infections. Nevertheless, the international guidelines still recommend nitrofurantoin, fosfomycin trometamol, and pivmecillinam as first-line agents in the treatment of such infections. Aim The objective of this study was to determine the in vitro efficacy of mecillinam against Escherichia coli and Klebsiella pneumoniae strains isolated from children with urinary tract infections. Materials Methods We investigated E. coli and K. pneumoniae isolates, obtained within the period from January 2016 to October 2017, from urine samples of patients aged 0 to 16 years. Antibiotics susceptibility testing was conducted through the disk diffusion method based on the guidelines provided by EUCAST (European Committee on Antimicrobial Susceptibility Testing). Extended-spectrum β-lactamase (ESBL)-positivity was detected by the double-disk synergy test. Isolates with mecillinam inhibition-zone diameter breakpoints lower than < 15 mm were considered to be resistant according to EUCAST criteria. Results A total of 450 isolates were assessed in the study, 135 of which were ESBL-producing E.coli, 230 were non-ESBL-producing E. coli, 35 were ESBL-producing K. pneumoniae, and 50 were non-ESBL-producing K. pneumoniae isolates. Mecillinam susceptibility was observed in most of the non-ESBL-producing and ESBL-producing E. coli isolates (230/230, 100% and 115/135, 85.1%, respectively). The rates of susceptibility of the non-ESBL-producing and ESBL-producing K. pneumoniae isolates were 37/50 (74%) and 24/35 (68.6%), respectively. Conclusion The in vitro susceptibility results obtained support the usage of mecillinam as a first-line agent. The high susceptibility of non-ESBL-producing E. coli and K. pneumoniae isolates established in vitro brings the hope that this antibiotic could soon be used in clinical practice in Turkey.

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