Vala Snehal, Shah Urvesh, Ahmad Syed Amir, Scolnik Dennis, Glatstein Miguel
1Division of Neonatal and Pediatric Emergency Medicine, Synergy Neonatal and Pediatric Hospital, Ahmedabad, India; 2GCS Medical College & Hospital, Ahmedabad, India; 3Department of Emergency Medicine (Pediatrics), King Khalid University Hospital, College of Medicine and Dentistry, King Saud University, Riyadh, Saudi Arabia; 4Divisions of Pediatric Emergency Medicine Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Ontario, Canada; and 5Division of Clinical Pharmacology and Toxicology, Ichilov Hospital, University of Tel Aviv, Israel.
Am J Ther. 2016 Sep-Oct;23(5):e1151-4. doi: 10.1097/MJT.0000000000000094.
Salmonella typhi and S. paratyphi are important causes of bacteremia in children, especially those from the developing world. There is a lack of standardized treatment protocols for such patients in the literature, and there are also reports of therapeutic failure related to resistance to commonly used antibiotics. We analyzed the epidemiological, clinical, and antimicrobiological sensitivity patterns of disease in patients diagnosed with blood culture-positive typhoid fever over a 6-month period in a tertiary-care pediatric hospital in western India. Data were retrospectively analyzed for all patients with Salmonella isolates on blood culture between January 1 and June 30, 2011 at the Synergy Neonatal and Pediatric Hospital. Susceptibility of isolates to antimicrobials and minimum inhibitory concentrations were determined. Demographic data, symptoms and signs, basic laboratory results, treatment courses, and clinical outcomes were collected from clinical charts. All of the 61 isolates of S. typhi were sensitive to cefepime (fourth-generation cephalosporin), 96% to third-generation cephalosporins, and 95% to quinolones. There was intermediate sensitivity to ampicillin (92%) and chloramphenicol (80%). Notably, azithromycin resistance was observed in 63% of isolates. All patients ultimately made full recoveries. There is an urgent need for large scale, community-based clinical trials to evaluate the effectiveness of different antibiotics in enteric fever. Our antimicrobial susceptibility data suggest that quinolones and third-generation cephalosporins should be used as first-line antimicrobials in enteric fever. Although fourth-generation cephalosporins are useful, we feel their use should be restricted to complicated or resistant cases.
伤寒沙门氏菌和副伤寒沙门氏菌是儿童菌血症的重要病因，尤其是来自发展中世界的儿童。文献中缺乏针对此类患者的标准化治疗方案，也有关于因对常用抗生素耐药而导致治疗失败的报道。我们分析了印度西部一家三级儿科医院在6个月期间诊断为血培养阳性伤寒热患者的疾病流行病学、临床和抗菌药物敏感性模式。对2011年1月1日至6月30日在协同新生儿和儿科医院血培养分离出沙门氏菌的所有患者的数据进行回顾性分析。测定分离株对抗菌药物的敏感性和最低抑菌浓度。从临床病历中收集人口统计学数据、症状和体征、基本实验室结果、治疗过程和临床结局。所有61株伤寒沙门氏菌分离株对头孢吡肟（第四代头孢菌素）敏感，对第三代头孢菌素的敏感率为96%，对喹诺酮类的敏感率为95%。对氨苄西林（92%）和氯霉素（80%）有中度敏感性。值得注意的是，63%的分离株对阿奇霉素耐药。所有患者最终均完全康复。迫切需要开展大规模的社区临床试验，以评估不同抗生素在肠热症中的有效性。我们的抗菌药物敏感性数据表明，喹诺酮类和第三代头孢菌素应作为肠热症的一线抗菌药物使用。虽然第四代头孢菌素有用，但我们认为其使用应限于复杂或耐药病例。
