Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal.
Department of Clinical Laboratory Services, Manmohan Memorial Medical College and Teaching Hospital, Kathmandu, Nepal.
Biomed Res Int. 2017;2017:2868143. doi: 10.1155/2017/2868143. Epub 2017 Sep 5.
Enteric fever caused by is a life-threatening systemic illness of gastrointestinal tract especially in tropical countries. Antimicrobial therapy is generally indicated but resistance towards commonly used antibiotics has limited their therapeutic usefulness. Therefore, we aimed to determine the antimicrobial susceptibility pattern by minimum inhibitory concentration method of common therapeutic regimens against from enteric fever clinical cases. clinical isolates recovered from the patients with suspected enteric fever whose blood samples were submitted to microbiology laboratory of Manmohan Memorial Community Hospital, Kathmandu, from March 2016 to August 2016, were studied. These isolates were subjected to antimicrobial susceptibility testing against common therapeutic antimicrobials by Kirby-Bauer disk diffusion method. The minimum inhibitory concentration of ciprofloxacin, azithromycin, chloramphenicol, and cefixime was determined by Agar dilution method based on the latest CLSI protocol. A total of 88 isolates of were recovered from blood samples of enteric fever cases. Out of them, 74 (84.09%) were Typhi and 14 (15.91%) were Paratyphi A. On Kirby-Bauer disk diffusion antimicrobial susceptibility testing, entire isolates were susceptible to cotrimoxazole, cefixime, ceftriaxone, azithromycin, and chloramphenicol. Sixty-four (72.7%) isolates were nalidixic acid resistant and nonsusceptible to ciprofloxacin and levofloxacin. On MIC determination, four isolates were ciprofloxacin resistant with MIC 1 g/ml and two isolates were ciprofloxacin intermediate with MIC 0.5 g/ml. The MIC range of azithromycin was from 0.125 g/ml to 2.0 g/ml, whereas that for chloramphenicol was 2.0 g/ml-8.0 g/ml and for cefixime was 0.0075-0.5 g/ml, respectively. Despite global surge of antimicrobial resistance among clinical isolates, the level of drug resistance in our study was not so high. However, higher level of NARST strains limits therapeutic use of fluoroquinolones and necessitates the routine monitoring of such resistance determinants in order to effectively and rationally manage enteric fever cases.
由 引起的肠热病是一种危及生命的胃肠道全身疾病,特别是在热带国家。一般来说,抗生素治疗是有效的,但由于常用抗生素的耐药性,限制了它们的治疗效果。因此,我们旨在通过最低抑菌浓度法确定常见治疗方案对来自肠热病临床病例的 的药敏模式。
本研究从 2016 年 3 月至 2016 年 8 月期间,将送往加德满都曼莫汉纪念社区医院微生物实验室的疑似肠热病患者的血液样本中分离出的 临床分离株作为研究对象。这些分离株采用 Kirby-Bauer 纸片扩散法对常见治疗性抗生素进行了药敏试验。根据最新的 CLSI 方案,采用琼脂稀释法测定环丙沙星、阿奇霉素、氯霉素和头孢克肟的最低抑菌浓度。
从肠热病患者的血液样本中分离出 88 株 。其中,74 株(84.09%)为 Typhi,14 株(15.91%)为 Paratyphi A。在 Kirby-Bauer 纸片扩散药敏试验中,所有分离株均对复方磺胺甲噁唑、头孢克肟、头孢曲松、阿奇霉素和氯霉素敏感。64 株(72.7%)分离株对萘啶酸耐药,对环丙沙星和左氧氟沙星均不敏感。通过 MIC 测定,4 株 分离株对环丙沙星耐药,MIC 值为 1μg/ml,2 株分离株对环丙沙星中介,MIC 值为 0.5μg/ml。阿奇霉素的 MIC 范围为 0.125μg/ml 至 2.0μg/ml,而氯霉素的 MIC 范围为 2.0μg/ml-8.0μg/ml,头孢克肟的 MIC 范围为 0.0075μg/ml-0.5μg/ml。尽管全球范围内 临床分离株对抗生素的耐药性不断增加,但本研究中的耐药水平并没有那么高。然而,高水平的 NARST 菌株限制了氟喹诺酮类药物的治疗应用,因此需要常规监测这些耐药决定因素,以便有效地和合理地管理肠热病病例。