Sadeghabadi Azam Fatahi, Ajami Ali, Fadaei Reza, Zandieh Masoud, Heidari Elham, Sadeghi Mahmoud, Ataei Behrooz, Hoseini Shervin Ghaffari
Isfahan Provincial Health Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Med Sci. 2014 Mar;19(Suppl 1):S51-5.
Antibiotic resistance of enteric pathogens particularly Shigella species, is a critical world-wide problem and monitoring their resistant pattern is essential, because the choice of antibiotics is absolutely dependent on regional antibiotic susceptibility patterns. During summer 2013, an unusual increase in number of diarrheal diseases was noticed in Isfahan, a central province of Iran. Therefore, the antibiotic resistance of diarrheagenic Escherichia coli and Shigella species isolated were evaluated.
According to the guideline on National Surveillance System for Foodborn Diseases, random samples from patients with acute diarrhea were examined in local laboratories of health centers and samples suspicious of Shigella spp. were further assessed in referral laboratory. Isolated pathogens were identified by standard biochemical and serologic tests and antibiotic susceptibility testing was carried out by disc diffusion method.
A total of 1086 specimens were obtained and 58 samples suspicious of Shigella were specifically evaluated. The most prevalent isolated pathogen was Shigella sonnei (26/58) followed by E. coli (25/58) and Shigella flexneri (3/58). A large number of isolated bacteria were resistant to co-trimoxazole (Shigella spp: 100%, E. coli: 80%), azithromycin (Shigella spp: 70.4%, E. coli: 44.0%), ceftriaxone (Shigella spp: 88.9%, E. coli: 56.0%) and cefixime (Shigella spp: 85.2%, E. coli: 68.0%). About88.3% of S. sonnei isolates, one S. flexneri isolate, and 56% of E. coli strains were resistant to at least three antibiotic classes (multidrug resistant).
Due to high levels of resistance to recommended and commonly used antibiotics for diarrhea, continuous monitoring of antibiotic resistance seems essential for determining best options of empirical therapy.
肠道病原体尤其是志贺氏菌属的抗生素耐药性是一个严重的全球性问题，监测其耐药模式至关重要，因为抗生素的选择完全取决于区域抗生素敏感性模式。2013年夏季，伊朗中部省份伊斯法罕的腹泻病病例数出现异常增加。因此，对分离出的致泻性大肠杆菌和志贺氏菌属的抗生素耐药性进行了评估。
根据食源性疾病国家监测系统指南，在卫生中心的当地实验室对急性腹泻患者的随机样本进行检测，疑似志贺氏菌属的样本在转诊实验室进一步评估。通过标准生化和血清学试验鉴定分离出的病原体，并采用纸片扩散法进行抗生素敏感性试验。
共获得1086份标本，其中58份疑似志贺氏菌的样本进行了专门评估。最常见的分离病原体是宋内志贺氏菌（26/58），其次是大肠杆菌（25/58）和福氏志贺氏菌（3/58）。大量分离出的细菌对复方新诺明（志贺氏菌属：100%，大肠杆菌：80%）、阿奇霉素（志贺氏菌属：70.4%，大肠杆菌：44.0%）、头孢曲松（志贺氏菌属：88.9%，大肠杆菌：56.0%）和头孢克肟（志贺氏菌属：85.2%，大肠杆菌：68.0%）耐药。约88.3%的宋内志贺氏菌分离株、1株福氏志贺氏菌分离株和56%的大肠杆菌菌株对至少三类抗生素耐药（多重耐药）。
由于对推荐的和常用的腹泻治疗抗生素耐药水平较高，持续监测抗生素耐药性对于确定经验性治疗的最佳选择似乎至关重要。
