Trends in the Composite Antimicrobial Resistance Index of Healthcare-Associated Infections in Türkiye: A National Surveillance Study, 2015–2024
This national surveillance study reveals that Türkiye's Composite Antimicrobial Resistance Index for healthcare-associated infections remained stable between 2015 and 2020 before undergoing a sharp, sustained increase starting in 2021, reaching approximately 65–70% by 2024 and highlighting a structural shift in resistance patterns likely linked to the COVID-19 pandemic.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine a world where the tiny, invisible warriors we rely on to fight sickness—antibiotics—are slowly losing their superpowers. This is the story of antimicrobial resistance (AMR), a global challenge where bacteria evolve to shrug off the medicines designed to kill them. When these super-bacteria cause infections inside hospitals (known as healthcare-associated infections), it's like a fortress under siege, leading to longer stays, higher costs, and more danger for patients. To track this battle, scientists use a special tool called a "Composite Index." Think of this index as a single "resistance score" or a weather vane that measures how strong the storm of drug-resistant bacteria is across a whole country, rather than just looking at one specific germ. If the score goes up, the storm is getting worse; if it stays flat, the situation is stable. Everyone cares because if we don't understand these trends, we might run out of effective medicines to treat common infections.
Now, let's zoom in on a ten-year story from Türkiye, a country that has been keeping a very close eye on this storm. Researchers acted like detectives, sifting through a massive mountain of data collected from 2015 to 2024 by a national surveillance network called INFLINE. They were looking at six specific types of bacteria that are known troublemakers in hospitals: Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterococcus species. Their goal was to see if the "resistance score" was changing over time and, crucially, if the global COVID-19 pandemic had any impact on it.
For the first half of the story, from 2015 to 2020, the plot was surprisingly calm. The resistance score hovered steadily between 46.0% and 50.4%. It was like a car cruising on a flat highway; the speed didn't change much, and there was no statistical evidence of the situation getting better or worse. The researchers calculated that during these years, the resistance level was essentially holding its ground.
However, the story took a dramatic turn in 2021. Just as the world was navigating the peak of the pandemic, the resistance score suddenly jumped. In a single year, the Composite AMR Index leaped from 49.3% to 63.4%. That is a massive 14.1 percentage-point increase, the biggest single-year jump the researchers had ever seen in their data. It was as if the car hit a sudden, steep hill and accelerated rapidly. By 2024, the score had climbed even higher, reaching 67.1%. The researchers also checked a "Standardized" version of the score (which adjusts for changes in which bacteria were most common) to make sure the jump wasn't just a variation in the numbers. That score also rose sharply, hitting 70.6% by 2024.
The study suggests that this wasn't just a temporary glitch. The data points to a "structural break" in 2021, meaning the pandemic era fundamentally shifted the baseline of how much drug resistance exists in Turkish hospitals. Before 2021, the trend was flat; after 2021, the trend was a steep, sustained climb. The researchers suggest that factors like the intense pressure on hospitals during the pandemic, the heavy use of broad-spectrum antibiotics for critically ill patients, and changes in infection control practices likely contributed to this surge.
In short, the paper finds that Türkiye's battle against drug-resistant bacteria was stable for five years, but then the COVID-19 pandemic appears to have triggered a sharp and lasting escalation. By 2024, the resistance burden was about 20 percentage points higher than it was before the pandemic. The authors conclude that this new, higher level of resistance is likely here to stay unless there is a renewed, strong effort to improve infection control and manage how antibiotics are used. They emphasize that while the data clearly shows this jump, the exact reasons for every part of the rise are complex, but the trend itself is a clear signal that the fight against super-bacteria needs to be stepped up immediately.
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