Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Faculty of Science and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru.
Antimicrob Agents Chemother. 2019 Jan 29;63(2). doi: 10.1128/AAC.01911-18. Print 2019 Feb.
The objective of this study was to determine the phenotypic patterns of antibiotic resistance and the epidemiology of drug-resistant spp. from a low-resource setting. A birth cohort of 303 patients was followed until 5 years of age. Stool samples from asymptomatic children ( = 10,008) and those with diarrhea ( = 3,175) were cultured for Disk diffusion for ciprofloxacin (CIP), nalidixic acid (NAL), erythromycin (ERY), azithromycin (AZM), tetracycline (TE), gentamicin (GM), ampicillin (AMP), amoxicillin and clavulanic acid (AMC), ceftriaxone (CRO), chloramphenicol (C), and trimethoprim-sulfamethoxazole (TMS) was determined. Antibiotic resistances in and non- isolates from surveillance and diarrhea samples were compared, and the association between personal macrolide exposure and subsequent occurrence of a macrolide-resistant spp. was assessed. Of 917 isolates, 77.4% of isolates and 79.8% of non- isolates were resistant to ciprofloxacin, while 4.9% of isolates and 24.8% of non- isolates were not susceptible to azithromycin. Of the 303 children, 33.1% had been diagnosed with a strain nonsusceptible to both azithromycin and ciprofloxacin. Personal macrolide exposure did not affect the risk of macrolide-resistant Amoxicillin and clavulanic acid (94.0%) was one of the antibiotics with the highest rates of susceptibility. There is a high incidence of quinolone- and macrolide-resistant infections in infants under 24 months of age. Given the lack of association between personal exposure to macrolides and a subsequent infection resistant to macrolides, there is a need to evaluate the source of multidrug-resistant (MDR) This study provides compelling evidence to propose amoxicillin/clavulanic acid as a treatment for campylobacteriosis.
本研究旨在确定来自低资源环境的 spp. 抗生素耐药表型模式和耐药流行病学。对 303 名患者进行了出生队列研究，随访至 5 岁。对无症状儿童（=10008）和腹泻儿童（=3175）的粪便样本进行培养，采用 Disk 扩散法检测环丙沙星（CIP）、萘啶酸（NAL）、红霉素（ERY）、阿奇霉素（AZM）、四环素（TE）、庆大霉素（GM）、氨苄西林（AMP）、阿莫西林和克拉维酸（AMC）、头孢曲松（CRO）、氯霉素（C）和复方磺胺甲噁唑（TMS）的耐药性。比较了监测和腹泻样本中 和非- 分离株的抗生素耐药性，并评估了个体大环内酯类药物暴露与随后发生大环内酯类耐药 spp. 的相关性。在 917 株分离株中，77.4%的 分离株和 79.8%的非- 分离株对环丙沙星耐药，而 4.9%的 分离株和 24.8%的非- 分离株对阿奇霉素不敏感。在 303 名儿童中，33.1%的儿童被诊断为同时对阿奇霉素和环丙沙星均不敏感的 菌株。个体大环内酯类药物暴露不会影响大环内酯类耐药 株的风险。阿莫西林和克拉维酸（94.0%）是抗生素中耐药率最高的药物之一。24 个月以下婴儿中存在较高比例的喹诺酮类和大环内酯类耐药 感染。鉴于个体接触大环内酯类药物与随后大环内酯类耐药 感染之间没有关联，有必要评估多药耐药（MDR） 株的来源。本研究提供了有力证据，建议阿莫西林/克拉维酸作为治疗弯曲菌病的药物。
