Akinyemi Kabir O, Bamiro Babajide S, Coker Akitoye O
Department of Microbiology, Lagos State University, Ojo PMB 1087, Apapa, Lagos, Nigeria.
J Health Popul Nutr. 2007 Sep;25(3):351-8.
The present study was undertaken to examine the status of antimicrobial resistance in Salmonella-associated diseases, by verifying possible emergence of reduced susceptibility to fluoroquinolones in Salmonella isolates and determining the incidence of Plasmodium falciparum-associated co-infection with Salmonella serotypes. Antimicrobial resistance in clinical isolates of Salmonellae was examined for a 12-month period. Four hundred and forty-one patients comprising two groups were recruited. Group A comprised 235 patients diagnosed by clinicians of having pyrexia, and group B included stool samples of 206 patients presenting with gastroenteritis. Samples were cultured and isolates identified, and drug susceptibility testing was performed using the standard methods. Of the 235 samples screened in group A, 42 Salmonella isolates and 107 Plasmodium spp. were identified. Of the 42 Salmonella isolates, 19 (45.2%) were Salmonella Typhi, 9 (21.4%) S. Enteritidis, and 7 (16.7%) each of S. Paratyphi and S. Arizonae. Plasmodium spp.-associated co-infection with Salmonellae was observed in 16 patients mostly in complicated typhoidal cases and S. Enteritidis-associated bacteraemia. Fifty-three of the 206 stool samples from group B patients were confirmed positive for bacterial pathogens, made up of 35 Salmonella and 18 Shigella isolates. Of the Salmonella isolates, 18 (51.4%) were S. Enteritidis, 11 (31.4%) S. Arizonae, 4 (11.4%) S. Paratyphi, and 2 (5.7%) S. Typhi. There was no statistically significant difference (p < 0.01) in antimicrobial resistance patterns exhibited among typhoidal Salmonellae isolated in 2000 and 2005. A similar trend in resistance was recorded for non-typhoidal Salmonellae (p < 0.05). For the first time in Lagos, Nigeria, Salmonella isolates (10-18%) with reduced susceptibility to both ciprofloxacin and ofloxacin at MIC50 and MIC90 values of 0.015 and 0.03 microg/mL respectively were found. Despite this development, ciprofloxacin and ofloxacin remain the drug of choice for severe cases of salmonellosis, although caution should be exercised by clinicians in their prescriptions such that fluoroquinolone antibiotic therapy is used only in laboratory-proven cases of typhoid fever and Salmonella-associated bacteraemia to preserve its efficacy.
本研究旨在通过核实沙门氏菌分离株中对氟喹诺酮类药物敏感性降低的可能出现情况，并确定恶性疟原虫与沙门氏菌血清型合并感染的发生率，来研究沙门氏菌相关疾病中的抗菌药物耐药性状况。对临床分离的沙门氏菌进行了为期12个月的抗菌药物耐药性检测。招募了包括两组的441名患者。A组包括235名经临床医生诊断为发热的患者，B组包括206名出现肠胃炎症状患者的粪便样本。对样本进行培养并鉴定分离株，使用标准方法进行药敏试验。在A组筛查的235个样本中，鉴定出42株沙门氏菌分离株和107株疟原虫属。在42株沙门氏菌分离株中，19株（45.2%）为伤寒沙门氏菌，9株（21.4%）为肠炎沙门氏菌，甲型副伤寒沙门氏菌和亚利桑那沙门氏菌各7株（16.7%）。在16名患者中观察到疟原虫属与沙门氏菌的合并感染， mostly in complicated typhoidal cases and S. Enteritidis-associated bacteraemia（这段英文表述有误，推测可能是“mostly in complicated typhoidal cases and S. Enteritidis-associated bacteraemia”，翻译为“主要发生在复杂伤寒病例和肠炎沙门氏菌相关菌血症中”）。B组206名患者的粪便样本中有53份经证实为细菌病原体阳性，由35株沙门氏菌和18株志贺氏菌分离株组成。在沙门氏菌分离株中，18株（51.4%）为肠炎沙门氏菌，11株（31.4%）为亚利桑那沙门氏菌，4株（11.4%）为甲型副伤寒沙门氏菌，2株（5.7%）为伤寒沙门氏菌。2000年和2005年分离出的伤寒沙门氏菌所表现出的抗菌药物耐药模式没有统计学显著差异（p<0.01）。非伤寒沙门氏菌也记录到了类似的耐药趋势（p<0.05）。在尼日利亚拉各斯，首次发现对环丙沙星和氧氟沙星敏感性降低的沙门氏菌分离株（10 - 18%），其MIC50和MIC90值分别为0.015和0.03微克/毫升。尽管出现了这种情况，环丙沙星和氧氟沙星仍然是沙门氏菌病严重病例的首选药物，不过临床医生在开处方时应谨慎，仅在实验室确诊的伤寒热和沙门氏菌相关菌血症病例中使用氟喹诺酮类抗生素治疗，以保持其疗效。
