XXXX resistance to six antibiotics by two breakpoint systems and resistance evolution in Bulgaria.

@entity1 @entity868 @entity115 @entity3284 @entity7646 @entity4581 @entity5553 @entity2887 @entity1534 @entity1215 @entity803
BACKGROUND: @entity1534 resistance to antibiotics is the main cause for eradication failures. METHODS: Antibiotic resistance in 299 @entity1534 strains from 233 untreated adults, 26 treated adults, and 40 untreated @entity1 was assessed by E tests and, for @entity868 , by breakpoint susceptibility testing and two breakpoint systems. RESULTS: Using EUCAST breakpoints (EBPs) and previous breakpoints (PBPs), overall resistance rates were: @entity115 4.0 and 0.6%, @entity868 33.8 and 33.8%, @entity4581 28.1 and 27.4%, @entity5553 19.4 and 19.4%, @entity803 3.7 and 1.5%, respectively, and @entity1215 8.3% (EBP). Multidrug resistance was detected in treated and untreated adults and an untreated @entity1 and included 17 (EBPs) and 15 strains (PBPs). Differences between susceptibility categories were found for @entity115 (3.5% of strains), @entity4581 (0.7%), and @entity803 (2.2%). Using PBPs, from 2005-2007 to 2010-2015, overall primary @entity4581 resistance continued to increase (17.9-25.6%) as noted in our previous study. However, in 2010-2015, overall primary @entity868 (24.0-31.5%) and @entity3284 (7.6-18.3%) resistance rates also increased. Primary resistance rates in @entity1 and adults were comparable. CONCLUSIONS: Briefly, differences in resistance rates by the two breakpoint systems affected the results for three antibiotics. National antibiotic consumption was linked to @entity7646 resistance in adults. Current primary @entity1534 resistance to three antibiotics increased in all untreated @entity1 and in the untreated adults, with the sharpest rise for the @entity2887 . The presence of fivefold @entity1534 resistance to @entity868 , @entity4581 , @entity803 , @entity5553 , and @entity115 according to EBPs is alarming.
