纽约州食源性疾病主动监测网络县的耐药非伤寒沙门氏菌。

Multidrug-resistant nontyphoidal Salmonella in New York state's foodborne diseases active surveillance network counties.

机构信息

Emerging Infections Program, New York State Department of Health, Albany, New York 12237, USA.

出版信息

Foodborne Pathog Dis. 2010 Feb;7(2):167-73. doi: 10.1089/fpd.2009.0329.

DOI:10.1089/fpd.2009.0329

PMID:19821741

Abstract

With the emergence of multidrug-resistant nontyphoidal (NT) Salmonella, knowledge of resistance patterns is critical for appropriate presumptive treatment. This report describes the prevalence and trends of NT Salmonella antimicrobial susceptibility within the New York State (NYS) Foodborne Diseases Active Surveillance Network (FoodNet). The NYS Department of Health, Wadsworth Center Public Health Laboratory tested all Salmonella isolates from the NYS FoodNet catchment area between May 2003 and December 2007 for antimicrobial susceptibility to ampicillin, chloramphenicol, streptomycin, sulfisoxazole, tetracycline, nalidixic acid, and ciprofloxacin. Isolate susceptibility results were linked to their corresponding demographic and clinical data and analyzed. Multidrug-resistant isolates were defined as resistant to ampicillin, chloramphenicol, streptomycin, sulfisoxazole, and tetracycline (R-type ACSSuT). Antimicrobial susceptibility for 2189 FoodNet cases (98.5% of total cases) showed 79.6% pansusceptible, 6.9% R-type ACSSuT, and 13.5% resistant to at least one antimicrobial agent but not R-type ACSSuT. Four (0.2%) isolates were resistant to ciprofloxacin. From 2004 to 2007, cases with R-type ACSSuT significantly decreased from 8.7% (37/424) to 4.8% (24/499) (p < 0.01). Serotypes with the highest proportion of R-type ACSSuT included Salmonella Typhimurium 17.9% (79/444), and Salmonella Newport 29.1% (51/175). Among Salmonella Typhimurium isolates, over 40% of the African-American cases (19/46) had R-type ACSSuT isolates, compared with 15.7% of the Caucasian cases (58/369) (p < 0.01). R-type ACSSuT Salmonella Typhimurium cases were hospitalized (41.8%) more frequently than pansusceptible Salmonella Typhimurium cases (24.9%), after controlling for age (p < 0.05). Length of hospitalization was not significantly different. Although R-type ACSSuT NT Salmonella has decreased since 2003 within the NYS FoodNet catchment area, monitoring resistance patterns remains important in identifying emerging resistant strains, vulnerable populations, and determining appropriate presumptive treatment regimens. The higher rate of R-type ACSSuT among the African-American cases requires further study.

摘要

随着耐多药非伤寒型（NT）沙门氏菌的出现，了解耐药模式对于进行适当的经验性治疗至关重要。本报告描述了纽约州（NYS）食源性疾病主动监测网络（FoodNet）中 NT 沙门氏菌抗菌药物敏感性的流行情况和趋势。NYS 卫生部，Wadsworth 中心公共卫生实验室对 2003 年 5 月至 2007 年 12 月期间 NYS FoodNet 监测区域内所有沙门氏菌分离株进行了抗菌药物敏感性测试，以确定对氨苄西林、氯霉素、链霉素、磺胺甲噁唑、四环素、萘啶酸和环丙沙星的敏感性。将分离株的药敏结果与其相应的人口统计学和临床数据相关联并进行分析。多重耐药分离株被定义为对氨苄西林、氯霉素、链霉素、磺胺甲噁唑和四环素（R 型 ACSSuT）耐药。对 2189 例 FoodNet 病例（总病例的 98.5%）的抗菌药物敏感性显示，79.6%为全敏感，6.9%为 R 型 ACSSuT，13.5%对至少一种抗菌药物耐药但不是 R 型 ACSSuT。有 4 例（0.2%）分离株对环丙沙星耐药。从 2004 年到 2007 年，R 型 ACSSuT 病例从 8.7%（37/424）显著下降到 4.8%（24/499）（p<0.01）。R 型 ACSSuT 比例最高的血清型包括鼠伤寒沙门氏菌 17.9%（79/444）和纽波特沙门氏菌 29.1%（51/175）。在鼠伤寒沙门氏菌分离株中，超过 40%的非裔美国人病例（19/46）为 R 型 ACSSuT 分离株，而白种人病例（58/369）为 15.7%（p<0.01）。在控制年龄因素后，R 型 ACSSuT 鼠伤寒沙门氏菌病例的住院率（41.8%）明显高于全敏感鼠伤寒沙门氏菌病例（24.9%）（p<0.05）。住院时间没有显著差异。尽管自 2003 年以来，NYS FoodNet 监测区域内的 R 型 ACSSuT NT 沙门氏菌有所减少，但监测耐药模式对于识别新出现的耐药菌株、易感人群和确定适当的经验性治疗方案仍然很重要。非裔美国人病例中 R 型 ACSSuT 比例较高需要进一步研究。