伤寒沙门氏菌中的抗菌药物耐药性。

Antimicrobial resistance in typhoidal salmonellae.

作者信息

Harish B N, Menezes G A

机构信息

Department of Microbiology, Institute of National Importance, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry - 605 006, India.

出版信息

Indian J Med Microbiol. 2011 Jul-Sep;29(3):223-9. doi: 10.4103/0255-0857.83904.

Abstract

Infections with Salmonella are an important public health problem worldwide. On a global scale, it has been appraised that Salmonella is responsible for an estimated 3 billion human infections each year. The World Health Organization (WHO) has estimated that annually typhoid fever accounts for 21.7 million illnesses (217,000 deaths) and paratyphoid fever accounts for 5.4 million of these cases. Infants, children, and adolescents in south-central and South-eastern Asia experience the greatest burden of illness. In cases of enteric fever, including infections with S. Typhi and S. Paratyphi A and B, it is often necessary to commence treatment before the results of laboratory sensitivity tests are available. Hence, it is important to be aware of options and possible problems before beginning treatment. Ciprofloxacin has become the first-line drug of choice since the widespread emergence and spread of strains resistant to chloramphenicol, ampicillin, and trimethoprim. There is increase in the occurrence of strains resistant to ciprofloxacin. Reports of typhoidal salmonellae with increasing minimum inhibitory concentration (MIC) and resistance to newer quinolones raise the fear of potential treatment failures and necessitate the need for new, alternative antimicrobials. Extended-spectrum cephalosporins and azithromycin are the options available for the treatment of enteric fever. The emergence of broad spectrum β-lactamases in typhoidal salmonellae constitutes a new challenge. Already there are rare reports of azithromycin resistance in typhoidal salmonellae leading to treatment failure. This review is based on published research from our centre and literature from elsewhere in the world. This brief review tries to summarize the history and recent trends in antimicrobial resistance in typhoidal salmonellae.

摘要

沙门氏菌感染是全球重要的公共卫生问题。在全球范围内,据估计沙门氏菌每年导致约30亿人感染。世界卫生组织(WHO)估计,每年伤寒热导致2170万例疾病(21.7万例死亡),副伤寒热占其中540万例。亚洲中南部和东南部的婴儿、儿童及青少年患病负担最重。在伤寒热病例中,包括感染伤寒沙门氏菌、甲型副伤寒沙门氏菌和乙型副伤寒沙门氏菌,通常需要在实验室药敏试验结果出来之前就开始治疗。因此,在开始治疗前了解治疗方案及可能出现的问题很重要。自从对氯霉素、氨苄西林和甲氧苄啶耐药的菌株广泛出现和传播以来,环丙沙星已成为一线首选药物。对环丙沙星耐药的菌株发生率在增加。伤寒沙门氏菌对环丙沙星的最低抑菌浓度(MIC)增加及对新型喹诺酮类药物耐药的报道引发了对潜在治疗失败的担忧,因此需要新的替代抗菌药物。广谱头孢菌素和阿奇霉素是可用于治疗伤寒热的选择。伤寒沙门氏菌中广谱β-内酰胺酶的出现构成了新的挑战。已有罕见报道称伤寒沙门氏菌对阿奇霉素耐药导致治疗失败。本综述基于我们中心已发表的研究以及世界其他地方的文献。这篇简短的综述试图总结伤寒沙门氏菌抗菌药物耐药性的历史和近期趋势。

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