氟喹诺酮敏感性降低的沙门氏菌所致肠热症患者对环丙沙星的临床反应欠佳：病例系列
Suboptimal clinical response to ciprofloxacin in patients with enteric fever due to Salmonella spp. with reduced fluoroquinolone susceptibility: a case series.
作者信息
Slinger Robert, Desjardins Marc, McCarthy Anne E, Ramotar Karam, Jessamine Peter, Guibord Christiane, Toye Baldwin
机构信息
Division of Infectious Disease, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, Canada.
出版信息
BMC Infect Dis. 2004 Sep 20;4:36. doi: 10.1186/1471-2334-4-36.
BACKGROUND
Salmonella spp. with reduced susceptibility to fluoroquinolones have higher than usual MICs to these agents but are still considered "susceptible" by NCCLS criteria. Delayed treatment response to fluoroquinolones has been noted, especially in cases of enteric fever due to such strains. We reviewed the ciprofloxacin susceptibility and clinical outcome of our recent enteric fever cases.
METHODS
Salmonella enterica Serotype Typhi (S. Typhi) and Serotype Paratyphi (S. Paratyphi) blood culture isolates (1998-2002) were tested against nalidixic acid by disk diffusion (DD) and agar dilution (AD) and to ciprofloxacin by AD using NCCLS methods and interpretive criteria. Reduced fluoroquinolone susceptibility was defined as a ciprofloxacin MIC of 0.125-1.0 mg/L. The clinical records of patients treated with ciprofloxacin for isolates with reduced fluoroquinolone susceptibility were reviewed.
RESULTS
Seven of 21 (33%) S. Typhi and S. Paratyphi isolates had reduced susceptibility to fluoroquinolones (MIC range 0.125-0.5 mg/L). All 7 were nalidixic acid resistant by DD (no zone) and by AD (MIC 128- >512 mg/L). The other 14 isolates were nalidixic acid susceptible and fully susceptible to ciprofloxacin (MIC range 0.015-0.03 mg/L). Five of the 7 cases were treated initially with oral ciprofloxacin. One patient remained febrile on IV ciprofloxacin until cefotaxime was added, with fever recurrence when cefotaxime was discontinued. Two continued on oral or IV ciprofloxacin alone but had prolonged fevers of 9-10 days duration, one was switched to IV beta-lactam therapy after remaining febrile for 3 days on oral/IV ciprofloxacin and one was treated successfully with oral ciprofloxacin. Four of the 5 required hospitalization.
CONCLUSIONS
Our cases provide further evidence that reduced fluoroquinolone susceptibility of S. Typhi and S. Paratyphi is clinically significant. Laboratories should test extra-intestinal Salmonella spp. for reduced fluoroquinolone susceptibility.
背景
对氟喹诺酮类药物敏感性降低的沙门氏菌对这些药物的最低抑菌浓度（MIC）高于正常水平，但根据美国国家临床实验室标准化委员会（NCCLS）标准仍被视为“敏感”。已注意到对氟喹诺酮类药物的治疗反应延迟，尤其是在由此类菌株引起的肠热症病例中。我们回顾了近期肠热症病例的环丙沙星敏感性和临床结果。
方法
采用NCCLS方法和解释标准，通过纸片扩散法（DD）和琼脂稀释法（AD）对肠炎沙门氏菌伤寒血清型（伤寒沙门氏菌）和副伤寒血清型（副伤寒沙门氏菌）的血培养分离株（1998 - 2002年）进行萘啶酸检测，并通过AD法进行环丙沙星检测。氟喹诺酮类药物敏感性降低定义为环丙沙星MIC为0.125 - 1.0mg/L。回顾了用环丙沙星治疗氟喹诺酮类药物敏感性降低的分离株患者的临床记录。
结果
21株伤寒沙门氏菌和副伤寒沙门氏菌分离株中有7株（33%）对氟喹诺酮类药物的敏感性降低（MIC范围为0.125 - 0.5mg/L）。所有7株通过DD法（无抑菌圈）和AD法（MIC为128 - >512mg/L）对萘啶酸耐药。其他14株分离株对萘啶酸敏感且对环丙沙星完全敏感（MIC范围为0.015 - 0.03mg/L）。7例患者中有5例最初接受口服环丙沙星治疗。1例患者在静脉用环丙沙星治疗时仍发热，直至加用头孢噻肟，停用头孢噻肟后发热复发。2例继续单独口服或静脉用环丙沙星治疗，但发热持续9 - 10天，1例在口服/静脉用环丙沙星治疗3天后仍发热，随后改用静脉用β - 内酰胺类治疗，1例口服环丙沙星治疗成功。5例中有4例需要住院治疗。
结论
我们的病例进一步证明伤寒沙门氏菌和副伤寒沙门氏菌对氟喹诺酮类药物敏感性降低具有临床意义。实验室应检测肠外沙门氏菌对氟喹诺酮类药物敏感性降低的情况。
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