Malla S, Kansakar P, Serichantalergs O, Rahman M, Basnet S
National Public Health Laboratory, Teku, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2005 Jan-Mar;44(157):18-22.
Enteric fever is prevalent in developing countries including Nepal, where it still remains as a major health problem. Appropriate antibiotics are essential for the treatment of typhoid and paratyphoid fever. A prospective study was carried out to characterize the epidemiological features of enteric fever in Kathmandu, Nepal and to analyse the recent trend of antimicrobial resistance pattern of the Salmonella isolated from the cases of enteric fever from different hospitals in Kathmandu during June, 2002 to June, 2004. A total of 1469 Salmonella typhi and Salmonella paratyphi 'A' isolates collected during this period from five different hospital laboratories situated in Kathmandu were studied. The antimicrobial susceptibilities of the isolates towards Ampicillin (10 mcg), Chloramphenicol (30 mcg), Cotrimoxazole (25 mcg), Ciprofloxacin (5 mcg) and Ceftriaxone (5 mcg) were determined by standard disc diffusion technique and Agar dilution technique were used to determine the minimum inhibitory concentration (MIC) for Ampicillin, Ciprofloxacin, Chloramphenicol and Ceftriaxone. All the isolates tested were found to be sensitive to Ceftriaxone and Ciprofloxacin, the most commonly used antibiotic for treatment of enteric fever in Nepal. Of the total isolates studied, 15.5% from 2002, 8% from 2003 and 3.45% from 2004 were found to be multidrug resistant (exhibiting resistance towards Ampicillin, Chloramphenicol and Cotrimoxazole). Of the total multi drug resistant Salmonella isolates, 92% were Salmonella typhi. All the multidrug resistant isolates were also further tested for susceptibilities towards Tetracycline (30 mcg), Nalidixic acid (30 mcg), Streptomycin (10 units), Gentamycin (25 mcg), Azithromycin (15 mcg), Kanamycin (30 mcg), Neomycin (30 mcg). 50% of the multi drug resistant Salmonella typhi were also resistant to Tetracycline. Plasmid analysis revealed that all of the multidrug resistant Salmonella typhi isolates with Tetracycline resistance harbored a large molecular weight (147 Kb) plasmid.
伤寒在包括尼泊尔在内的发展中国家较为普遍，在尼泊尔它仍然是一个主要的健康问题。合适的抗生素对于治疗伤寒和副伤寒至关重要。开展了一项前瞻性研究，以描述尼泊尔加德满都伤寒热的流行病学特征，并分析2002年6月至2004年6月期间从加德满都不同医院的伤寒热病例中分离出的沙门氏菌的抗菌耐药模式的近期趋势。在此期间，对从加德满都五个不同医院实验室收集的总共1469株伤寒沙门氏菌和甲型副伤寒沙门氏菌分离株进行了研究。采用标准纸片扩散法测定分离株对氨苄西林（10微克）、氯霉素（30微克）、复方新诺明（25微克）、环丙沙星（5微克）和头孢曲松（5微克）的抗菌敏感性，并用琼脂稀释法测定氨苄西林、环丙沙星、氯霉素和头孢曲松的最低抑菌浓度（MIC）。所有测试的分离株均对头孢曲松和环丙沙星敏感，这两种药物是尼泊尔治疗伤寒热最常用的抗生素。在研究的所有分离株中，2002年的分离株中有15.5%、2003年的分离株中有8%、2004年的分离株中有3.45%被发现对多种药物耐药（对氨苄西林、氯霉素和复方新诺明表现出耐药性）。在所有多重耐药沙门氏菌分离株中，92%为伤寒沙门氏菌。所有多重耐药分离株还进一步检测了对四环素（30微克）、萘啶酸（30微克）、链霉素（10单位）、庆大霉素（25微克）、阿奇霉素（15微克）、卡那霉素（30微克）、新霉素（30微克）的敏感性。50%的多重耐药伤寒沙门氏菌也对四环素耐药。质粒分析显示，所有对四环素耐药的多重耐药伤寒沙门氏菌分离株都携带一个大分子量（147千碱基）的质粒。
