Replogle M L, Fleming D W, Cieslak P R
School of Medicine, Oregon Health Sciences University, and Portland, OR, USA.
Clin Infect Dis. 2000 Mar;30(3):515-9. doi: 10.1086/313715.
Ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ) are currently considered acceptable empirical therapy for shigellosis in developed countries. However, there are few recently reported studies on antimicrobial resistance among shigellae isolated in the United States. We examined the epidemiology of shigellosis and the antimicrobial susceptibility of Shigella species isolated in Oregon from July 1995 through June 1998. Of 430 isolates, 410 were identified to the species level: Shigella sonnei accounted for 55% of isolates, and Shigella flexneri, for 40%. The overall annual incidence of shigellosis was 4.4 cases per 100,000 population. Children aged <5 years (annual incidence, 19.6 cases per 100,000 population) and Hispanics (annual incidence, 28.4 cases per 100,000 population) were at highest risk. Of 369 isolates tested, 59% were resistant to TMP-SMZ, 63% were resistant to ampicillin, 1% were resistant to cefixime, and 0.3% were resistant to nalidixic acid; none of the isolates were resistant to ciprofloxacin. Thirteen percent of the isolates had multidrug resistance to ampicillin, chloramphenicol, streptomycin, sulfisoxazole, and tetracycline. Infections due to multidrug-resistant shigellae are endemic in Oregon. Neither ampicillin nor TMP-SMZ should be considered appropriate empirical therapy for shigellosis any longer; when antibiotics are indicated, a quinolone or cefixime should be used.
在发达国家，氨苄西林和甲氧苄啶-磺胺甲恶唑（TMP-SMZ）目前被认为是治疗志贺菌病可接受的经验性疗法。然而，最近在美国分离出的志贺菌中，关于抗菌药物耐药性的报道研究很少。我们研究了1995年7月至1998年6月在俄勒冈州分离出的志贺菌病的流行病学情况以及志贺菌属的抗菌药物敏感性。在430株分离菌株中，410株被鉴定到种水平：宋内志贺菌占分离菌株的55%，福氏志贺菌占40%。志贺菌病的总体年发病率为每10万人口4.4例。年龄＜5岁的儿童（年发病率为每10万人口19.6例）和西班牙裔（年发病率为每10万人口28.4例）风险最高。在369株测试的分离菌株中，59%对TMP-SMZ耐药，63%对氨苄西林耐药，1%对头孢克肟耐药，0.3%对萘啶酸耐药；没有分离菌株对环丙沙星耐药。13%的分离菌株对氨苄西林、氯霉素、链霉素、磺胺异恶唑和四环素具有多重耐药性。耐多药志贺菌引起的感染在俄勒冈州呈地方性流行。氨苄西林和TMP-SMZ都不应再被视为治疗志贺菌病合适的经验性疗法；当需要使用抗生素时，应使用喹诺酮类药物或头孢克肟。
