RESUMO
The first imported case of XDR typhoid fever in Taiwan contracted with a bacterial strain, which was most closely related to the blaCTX-M-15-carrying strains linked to Pakistan. Meropenem, in combination with an antimicrobial with intracellular activity against Salmonella, should be used for the treatment of XDR typhoid fever.
Assuntos
Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Doenças Transmissíveis Importadas/microbiologia , Farmacorresistência Bacteriana Múltipla , Salmonella typhi/efeitos dos fármacos , Salmonella typhi/patogenicidade , Febre Tifoide/tratamento farmacológico , Febre Tifoide/microbiologia , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Paquistão , Salmonella typhi/classificação , Salmonella typhi/genética , Sorogrupo , Taiwan , Doença Relacionada a Viagens , Febre Tifoide/diagnóstico , Adulto JovemRESUMO
We aimed to describe the molecular epidemiological characteristics and clinical treatment outcome of typhoid fever in Ningbo, China during 2005-2014. Eighty-eight Salmonella Typhi isolates were obtained from 307 hospitalized patients. Three prevalent pulsed-field gel electrophoresis (PFGE) patterns of 54 isolates from 3 outbreaks were identified. Overall, there were 64 (72.7%) isolates from clustered cases and 24 (27.3%) isolates from sporadic cases. Resistance to nalidixic acid (NAL) (n = 47; 53.4%) and ampicillin (AMP) (n = 40; 45.4%) and rare resistance to tetracycline (TET) (n = 2; 2.3%) and gentamicin (GEN) (n = 2; 2.3%) were observed. No isolates resistant to cefotaxime (CTX), chloramphenicol (CL), ciprofloxacin (CIP), and trimethoprim-sulfamethoxazole (SXT) were found. The occurrence of reduced sensitivity to CIP was 52.3% (n = 46). The medians of fever clearance time in cases with and without complications were 7 (interquartile range (IQR): 4-10) and 5 (IQR: 3-7) days (P = 0.001), respectively, when patients were treated with CIP or levofloxacin (LEV) and/or third-generation cephalosporins (CEP). Rates of serious complications were at low levels: peritonitis (2.3%), intestinal hemorrhage (6.8%), and intestinal perforation (1.1%). The present study revealed a long-term clustering trend with respect to PFGE patterns, occasional outbreaks, and the rapid spread of AMP resistance and decreased CIP susceptibility among S. Typhi isolates in recent years.
Assuntos
Antibacterianos/uso terapêutico , Surtos de Doenças , Eletroforese em Gel de Campo Pulsado , Tipagem Molecular , Salmonella typhi/classificação , Febre Tifoide/tratamento farmacológico , Febre Tifoide/epidemiologia , Adolescente , Adulto , Idoso , Criança , China/epidemiologia , Análise por Conglomerados , Transmissão de Doença Infecciosa , Farmacorresistência Bacteriana , Feminino , Genótipo , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Epidemiologia Molecular , Salmonella typhi/genética , Salmonella typhi/isolamento & purificação , Resultado do Tratamento , Febre Tifoide/microbiologia , Febre Tifoide/transmissão , Adulto JovemRESUMO
The interplay between bacterial antimicrobial susceptibility, phylogenetics and patient outcome is poorly understood. During a typhoid clinical treatment trial in Nepal, we observed several treatment failures and isolated highly fluoroquinolone-resistant Salmonella Typhi (S. Typhi). Seventy-eight S. Typhi isolates were genome sequenced and clinical observations, treatment failures and fever clearance times (FCTs) were stratified by lineage. Most fluoroquinolone-resistant S. Typhi belonged to a specific H58 subclade. Treatment failure with S. Typhi-H58 was significantly less frequent with ceftriaxone (3/31; 9.7%) than gatifloxacin (15/34; 44.1%)(Hazard Ratio 0.19, p=0.002). Further, for gatifloxacin-treated patients, those infected with fluoroquinolone-resistant organisms had significantly higher median FCTs (8.2 days) than those infected with susceptible (2.96) or intermediately resistant organisms (4.01)(pS. Typhi clade internationally, but there are no data regarding disease outcome with this organism. We report an emergent new subclade of S. Typhi-H58 that is associated with fluoroquinolone treatment failure.
Assuntos
Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Ciprofloxacina/farmacologia , Fluoroquinolonas/uso terapêutico , Genótipo , Salmonella typhi/efeitos dos fármacos , Febre Tifoide/tratamento farmacológico , Técnicas de Tipagem Bacteriana , Ceftriaxona/uso terapêutico , Gatifloxacina , Humanos , Nepal , Salmonella typhi/classificação , Salmonella typhi/isolamento & purificação , Análise de Sequência de DNA , Falha de Tratamento , Febre Tifoide/microbiologiaRESUMO
The turnaround time (TAT) for Salmonella enterica serovar Typhi identification and reporting of the antibiotic susceptibility profile was determined for 391 cases of typhoid fever, using the lysis direct plating or lysis centrifugation method of blood culture along with rapid antimicrobial susceptibility testing. The TAT was more rapid (TAT for 90% of the patients [TAT(90)] = 30 h; TAT(100) = 67 h) than was possible with conventional methodologies and was equivalent to that reported previously using more advanced, costly technologies that are largely unavailable in developing countries. Antibiotic susceptibility profiles, determined by the rapid antimicrobial susceptibility testing method, of randomly selected 60 S. enterica serovar Typhi isolates were identical to those determined by overnight conventional testing. Preliminary assessment of the impact of the reduced TAT on physician practices revealed that initial empirical therapy was prescribed at the time of presentation in most cases (87 of 108 [81%]) despite awareness that the final report would be available on the following day. Patients treated empirically with first-line antibiotics and shown subsequently to be infected with a multidrug-resistant strain benefited most (8 cases), since therapy was changed appropriately on the following day. In an additional 21 cases, therapy with an appropriate antibiotic was initiated after culture results were available. Thus, in approximately one-fourth (29 of 108 [27%]) of the cases, a change in management to an agent active for treatment of the isolate was made after receipt of the test results. However, in no case was therapy changed from a second-line to a first-line agent, even if the isolate was reported on the day after presentation to be sensitive to first-line therapy (33 cases). Ways in which to utilize rapid-TAT result reporting in order to positively influence physicians' prescribing in Bangladesh are the subject of ongoing research.
Assuntos
Antibacterianos/farmacologia , Sangue/microbiologia , Salmonella typhi/classificação , Salmonella typhi/efeitos dos fármacos , Febre Tifoide/microbiologia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Centrifugação , Criança , Meios de Cultura , Farmacorresistência Bacteriana Múltipla , Hemólise , Humanos , Testes de Sensibilidade Microbiana/métodos , Fatores de Tempo , Febre Tifoide/tratamento farmacológicoRESUMO
Alcoholic extract of black tea (Camelia sinensis) was assayed for its antibacterial activity against Salmonella serotypes causing enteric fever viz., Salmonella typhi and Salmonella paratyphi A. While all strains of S. paratyphi A tested were found sensitive, only 42.19% of S. typhi strains were inhibited by this extract. Further minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of black tea extract against S. paratyphi A was less compared with that against S. typhi.
Assuntos
Camellia sinensis , Fitoterapia , Extratos Vegetais/farmacologia , Salmonella typhi/efeitos dos fármacos , Febre Tifoide/tratamento farmacológico , Febre Tifoide/microbiologia , Feminino , Humanos , Índia , Masculino , Testes de Sensibilidade Microbiana , Salmonella typhi/classificação , Sensibilidade e Especificidade , SorotipagemRESUMO
Nalidixic acid-resistant Salmonella typhi (NARST) was first isolated in Viet Nam in 1993. Analysis of the quinolone resistance-determining region of gyrA in 20 NARST isolates by polymerase chain reaction and single-stranded conformational polymorphism yielded two novel patterns: pattern II corresponding to a point mutation at nucleotide 87 Asp-->Gly (n = 17), and pattern III corresponding to a point mutation at nucleotide 83 Ser-->Phe (n = 3). In trials of short-course ofloxacin therapy for uncomplicated typhoid, 117 (78%) of 150 patients were infected with multidrug-resistant S. typhi, 18 (15%) of which were NARST. The median time to fever clearance was 156 hours (range, 30-366 hours) for patients infected with NARST and 84 hours (range, 12-378 hours) for those infected with nalidixic acid-susceptible strains (P < .001). Six (33.3%) of 18 NARST infections required retreatment, whereas 1 (0.8%) of 132 infections due to susceptible strains required retreatment (relative risk = 44; 95% confidence interval = 5.6-345; P < .0001). We recommend that short courses of quinolones not be used in patients infected with NARST.