RESUMEN
We describe a ceftriaxone-resistant Salmonella Typhi bacteraemia in a pregnant woman returning from a family visit in Pakistan. Whole genome sequencing confirmed similarity to a Pakistani outbreak clone. Pregnancy and unawareness of this outbreak delayed appropriate antibiotic therapy. Concurrently, we detected faecal carriage of a carbapenemase-producing Escherichia coli. Awareness of the ongoing outbreak should affect empiric treatment of typhoid fever and hygiene precautions in travellers returning from Pakistan. Meropenem may be warranted in severe cases.
Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Ceftriaxona/farmacología , Meropenem/uso terapéutico , Salmonella typhi/genética , Salmonella typhi/aislamiento & purificación , Fiebre Tifoidea/diagnóstico , Fiebre Tifoidea/tratamiento farmacológico , Dolor Abdominal/etiología , Adulto , Pruebas de Aglutinación , Antibacterianos/farmacología , Bacteriemia/tratamiento farmacológico , Enterobacteriaceae Resistentes a los Carbapenémicos , Ceftriaxona/uso terapéutico , Dinamarca , Resistencia a Medicamentos , Escherichia coli/genética , Escherichia coli/aislamiento & purificación , Femenino , Fiebre/etiología , Humanos , Pruebas de Sensibilidad Microbiana , Pakistán , Plásmidos/análisis , Reacción en Cadena de la Polimerasa , Embarazo , Salmonella typhi/efectos de los fármacos , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Viaje , Fiebre Tifoidea/microbiología , Secuenciación Completa del GenomaRESUMEN
We describe a multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and azithromycin intermediate resistance in a heterosexual man in Denmark, 2017. Whole genome sequencing of the strain GK124 identified MSLT ST1903, NG-MAST ST1614 and all relevant resistance determinants including similar penA resistance mutations previously described in ceftriaxone-resistant gonococcal strains. Although treatment with ceftriaxone 0.5 g plus azithromycin 2 g was successful, increased awareness of spread of gonococcal strains threatening the recommended dual therapy is crucial.
Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Ceftriaxona/uso terapéutico , Gonorrea/tratamiento farmacológico , Neisseria gonorrhoeae/efectos de los fármacos , Administración Oral , Antibacterianos/administración & dosificación , Azitromicina/administración & dosificación , Ceftriaxona/administración & dosificación , Dinamarca , Gonorrea/microbiología , Humanos , Inyecciones Intramusculares , Masculino , Pruebas de Sensibilidad Microbiana , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/aislamiento & purificación , Técnicas de Amplificación de Ácido Nucleico , Resultado del Tratamiento , Uretritis/tratamiento farmacológico , Uretritis/microbiología , Adulto JovenRESUMEN
Antibiotic consumption during 1996 was measured in 15 large hospitals from 14 countries and 3000 consecutive Staphylococcus aureus samples were collected, allowing calculation of local resistance rates and typing of isolates. Antibiotic consumption data were converted to defined daily doses (DDD), and similar antibiotics were grouped if they belonged to the same therapeutic subgroup. Variations in hospital size were corrected by using DDD per 1000 bed-days. The total antibiotic consumption in the 15 hospitals varied between 296 DDD/1000 bed-days and 1108 DDD/1000 bed-days. Differences in the usage of therapeutical subgroups of antimicrobials varied significantly between hospitals. A positive correlation was found between S. aureus resistance to methicillin (MRSA) and consumption of beta-lactam combinations, between resistance to quinolones and consumption of beta-lactam combinations and carbapenems and resistance to aminoglycosides and consumption of beta-lactam combinations. The consumption of beta-lactamase-sensitive antibiotics was negatively correlated to resistance to methicillin, quinolones, and aminoglycosides. Usage of the different antimicrobial therapeutical subgroups was also correlated. Consumption of beta-lactamase-sensitive antibiotics (penicillin) was positively correlated to consumption of beta-lactamase-resistant penicillins and negatively correlated to consumption of carbapenems, quinolones, and glycopeptides, whereas consumption of cephalosporins was positively correlated to consumption of aminoglycosides, quinolones, and glycopeptides. In this study of hospitals with MRSA prevalence of between 0% and 63%, significant correlations were found between resistance and consumption of antimicrobials. These findings support the importance of antimicrobial consumption on resistance. An accompanying paper addresses the issue of antibiotic resistance and clonality of isolates.