Infectious Disease Epidemiology Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Clin Infect Dis. 2013 Nov;57(10):e167-76. doi: 10.1093/cid/cit563. Epub 2013 Aug 28.
Prospective time-trend analyses on shifting etiology and trends of drug resistance in enteric fever are scarce. Using published and unpublished datasets from Nepal, we performed a systematic review and meta-analysis to understand the trends in etiology and resistance to antimicrobials that have occurred since 1993. Thirty-two studies involving 21 067 Salmonella enterica serotype Typhi (ST) and S. enterica serotype Paratyphi A (SPA) isolates were included. There was an increasing trend in enteric fever caused by SPA during the last 2 decades (P < .01). We observed sharply increasing trends in resistance to nalidixic acid and ciprofloxacin for both ST and SPA. In contrast, multi-drug resistance (MDR), resistance to traditional first-line antibiotics such as chloramphenicol and co-trimoxazole have significantly decreased for both organisms. The resistance to ceftriaxone has remained low, suggesting it is likely to remain useful as a reserve antibiotic for treatment. Trends in decreasing resistance to traditional first-line antibiotics and decreasing MDR provide an opportunity to reconsider these first-line antimicrobials as therapeutic options.
前瞻性时间趋势分析表明，肠热病的病因和耐药性趋势正在发生变化。本研究利用尼泊尔已发表和未发表的数据，进行了一项系统综述和荟萃分析，以了解自 1993 年以来肠热病病因和对抗生素耐药性的变化趋势。共纳入了 32 项研究，涉及 21067 株伤寒沙门氏菌血清型 Typhi（ST）和副伤寒 A 沙门氏菌血清型 Paratyphi A（SPA）。在过去的 20 年中，SPA 引起的肠热病呈上升趋势（P<.01）。我们观察到 ST 和 SPA 对萘啶酸和环丙沙星的耐药性呈急剧上升趋势。相比之下，两种病原体对传统一线抗生素如氯霉素和复方磺胺甲噁唑的多药耐药性显著下降。头孢曲松的耐药率仍然较低，表明它可能仍然是一种有用的后备抗生素。传统一线抗生素耐药性下降和多药耐药性下降的趋势为重新考虑这些一线抗生素作为治疗选择提供了机会。
