Department of Paediatrics, University of Oxford & NIHR Oxford Biomedical Research Centre, Oxford, UK.
Department of Community Medicine, Christian Medical College, Vellore, India.
Indian J Med Res. 2019 Feb;149(2):151-163. doi: 10.4103/ijmr.IJMR_830_18.
BACKGROUND & OBJECTIVES: The temporal trends in the development of antimicrobial resistance (AMR) among Salmonella Typhi and Salmonella Paratyphi in India have not been systematically reported. We aimed to systematically review the temporal AMR trends (phenotypic and molecular mechanisms) in bacterial isolates from patients with enteric fever over two decades in India.
To identify trends in AMR in India, resistance patterns among 4611 individual S. Typhi isolates and 800 S. Paratyphi A isolates, reported from 1992 to 2017 in 40 publications, were analysed. Molecular resistance determinants were extracted from 22 publications and also reviewed in accordance with the PRISMA guidelines. Articles were sourced using a predefined search strategy from different databases.
The analyses suggested that multidrug-resistant (MDR) enteric fever was declining in India and being replaced by fluoroquinolone (FQ) resistance. Mutations in gyrA and parC were key mechanisms responsible for FQ resistance, whereas MDR was largely driven by resistance determinants encoded on mobile genetic elements (plasmids, transposons).
INTERPRETATION & CONCLUSIONS: The results reflect the effect of antimicrobial pressure which has been driving AMR in typhoidal Salmonella in India. Understanding these trends is important in planning future approaches to therapy, which serve as a baseline for assessment of the impact of new typhoid conjugate vaccines against these resistant organisms.
印度伤寒沙门氏菌和副伤寒沙门氏菌的抗菌药物耐药性（AMR）发展趋势尚未得到系统报告。我们旨在系统回顾印度 20 多年来肠热病患者分离的细菌中 AMR 的时间趋势（表型和分子机制）。
为了确定印度的 AMR 趋势，我们分析了 40 篇文献中报告的 1992 年至 2017 年间 4611 株伤寒沙门氏菌和 800 株副伤寒 A 沙门氏菌分离株的耐药模式。根据 PRISMA 指南，从 22 篇文献中提取了分子耐药决定因素并进行了综述。使用预定义的搜索策略从不同的数据库中获取文章。
分析表明，印度的多重耐药（MDR）肠热病正在减少，而氟喹诺酮（FQ）耐药性正在增加。gyrA 和 parC 的突变是 FQ 耐药的关键机制，而 MDR 主要由移动遗传元件（质粒、转座子）上编码的耐药决定因素驱动。
这些结果反映了抗菌药物压力对印度伤寒沙门氏菌 AMR 的影响。了解这些趋势对于规划未来的治疗方法很重要，这是评估新的伤寒结合疫苗对这些耐药菌的影响的基线。
