IHA Infectious Diseases Consultants, 5333 McAuley Dr., Ypsilanti, MI, USA.
Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand.
J Travel Med. 2019 Dec 23;26(8). doi: 10.1093/jtm/taz054.
We conducted a comprehensive investigation to update our knowledge of traveler's diarrhea (TD) etiology and antimicrobial resistance (AMR) in Nepal.
A case-control study of TD etiology was conducted at the CIWEC Clinic Travel Medicine Center in Kathmandu from 2012 to 2014. Stool samples were tested by microscopy, culture and molecular techniques for identification of bacterial, viral and parasitic enteric pathogens, and AMR. We analysed patient demographic data, pre-treatment information and clinical outcomes.
We enrolled 433 TD cases and 209 non-diarrhea controls. At least one of enteric pathogens was identified among 82% of cases and 44% of controls (P < 0.001). Multiple pathogens were observed among 35% of cases and 10% of controls. The most common pathogens significantly identified among cases in comparison with controls were Campylobacter (20%), norovirus (17%), enterotoxigenic E. coli (ETEC) (12%), rotavirus (9%) and Shigella (8%) (P < 0.001). We noted Campylobacter, Shigella and ETEC resistance to azithromycin at 8, 39 and 22% and to ciprofloxacin at 97, 78 and 23%, respectively.
Among travellers to Nepal with TD, viral pathogens were commonly found and norovirus was the second most common pathogen after campylobacter. We noted increased AMR to fluoroquinolones (FQs) and azithromycin (AZM). There is heightened concern for AZM treatment failures, though this continues to remain the drug of choice for TD treatment in our setting where FQs should not be used.
我们进行了一项全面调查，以更新我们对尼泊尔旅行者腹泻（TD）病因和抗生素耐药性（AMR）的认识。
2012 年至 2014 年，在加德满都的 CIWEC 诊所旅行医学中心进行了旅行者腹泻病因的病例对照研究。通过显微镜检查、培养和分子技术对粪便样本进行检测，以鉴定细菌、病毒和寄生虫性肠道病原体和 AMR。我们分析了患者的人口统计学数据、治疗前信息和临床结果。
我们纳入了 433 例 TD 病例和 209 例非腹泻对照。82%的病例和 44%的对照中至少有一种肠道病原体被检出（P<0.001）。35%的病例和 10%的对照中观察到多种病原体。与对照组相比，病例中最常见的病原体分别为弯曲杆菌（20%）、诺如病毒（17%）、肠毒素性大肠杆菌（ETEC）（12%）、轮状病毒（9%）和志贺菌（8%）（P<0.001）。我们注意到弯曲杆菌、志贺菌和 ETEC 对阿奇霉素的耐药率分别为 8%、39%和 22%，对环丙沙星的耐药率分别为 97%、78%和 23%。
在前往尼泊尔的腹泻旅行者中，病毒病原体很常见，诺如病毒是继弯曲杆菌之后的第二大常见病原体。我们注意到氟喹诺酮类药物（FQs）和阿奇霉素（AZM）的抗生素耐药性增加。阿奇霉素治疗失败的情况令人担忧，尽管在我们的环境中，氟喹诺酮类药物不应使用，阿奇霉素仍然是 TD 治疗的首选药物。
