Lurchachaiwong Woradee, Serichantalergs Oralak, Lertsethtakarn Paphavee, Ruamsap Nattaya, Srijan Apichai, Oransathid Wirote, Khemnu Nuanpan, Vesely Brian A, Demons Samandra T, Waters Norman C, Crawford John M, Swierczewski Brett E
1Department of Bacterial and Parasitic Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
2Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD USA.
Gut Pathog. 2020 Apr 9;12:17. doi: 10.1186/s13099-020-00356-7. eCollection 2020.
Diarrhea remains a major public health problem for both civilian and military populations. This study describes the prevalence of acute diarrheal illness etiological agents, their antibiotic resistance distribution patterns, the resulting impact upon military force health protection, and potential prevention and treatment strategies.
Forty-eight acute diarrhea stool samples from US military personnel deployed to Thailand from 2013-2017 were screened for enteric pathogens using ELISA, the TaqMan Array Card (TAC), and conventional microbiological methods. These isolates were also evaluated using antimicrobial susceptibility testing (AST) against ampicillin (AMP), azithromycin (AZM), ceftriaxone (CRO), ciprofloxacin (CIP), nalidixic acid (NA), erythromycin (ERY), and trimethoprim-sulfamethoxazole (SXT) using commercial methodology. Susceptibility results were interpreted following the CLSI and NARM guidelines. Questionnaire data obtained from 47/48 volunteers indicated that 89.4% (42/47) reported eating local food and the most common clinical symptoms were nausea and abdominal pain (51%; 24/47). Multiple bacterial species were identified from the 48 stool samples with diarrhea etiological agents being detected in 79% (38/48) of the samples distributed as follows: 43.8% (21/48) and species, 42% (20/48) diarrheagenic , and 23% (11/48) . Co-infections were detected in 46% (22/48) of the samples. All isolates were resistant to CIP and NA. One isolate exhibited resistance to both AZM and ERY. Lastly, an association between exposure to poultry and subsequent detection of the diarrhea-associated pathogens . and was significant (< ).
The detection of isolates with CIP, AZM and ERY resistance has critical force health protection and public health implications, as these data should guide effective Campylobacteriosis treatment options for deployed military members and travelers to Southeast Asia. Additional research efforts are recommended to determine the association of pathogen co-infections and/or other contributing factors towards diarrheal disease in military and traveler populations. Ongoing surveillance and AST profiling of potential disease-causing bacteria is required for effective disease prevention efforts and treatment strategies.
腹泻仍然是平民和军队人群面临的一个主要公共卫生问题。本研究描述了急性腹泻病病原体的流行情况、它们的抗生素耐药性分布模式、对军事力量健康保护的影响以及潜在的预防和治疗策略。
对2013年至2017年部署到泰国的美军人员的48份急性腹泻粪便样本，使用酶联免疫吸附测定（ELISA）、TaqMan阵列卡（TAC）和传统微生物学方法筛查肠道病原体。还使用商业方法对这些分离株进行了针对氨苄西林（AMP）、阿奇霉素（AZM）、头孢曲松（CRO）、环丙沙星（CIP）、萘啶酸（NA）、红霉素（ERY）和甲氧苄啶-磺胺甲恶唑（SXT）的抗菌药敏试验（AST）评估。药敏结果按照美国临床和实验室标准协会（CLSI）和国家抗菌药物耐药监测系统（NARM）指南进行解读。从47/48名志愿者获得的问卷数据表明，89.4%（42/47）的人报告食用了当地食物，最常见的临床症状是恶心和腹痛（51%；24/47）。从48份腹泻粪便样本中鉴定出多种细菌，79%（38/48）的样本检测到腹泻病原体，分布如下：43.8%（21/48） 和 菌属，42%（20/48）致泻性 菌，23%（11/48） 菌。46%（22/48）的样本检测到合并感染。所有 分离株对CIP和NA耐药。一株 分离株对AZM和ERY均耐药。最后，接触家禽与随后检测到腹泻相关病原体 和 之间存在显著关联（< ）。
检测到对CIP、AZM和ERY耐药的 分离株对军事力量健康保护和公共卫生具有重要意义，因为这些数据应指导为部署的军人和前往东南亚的旅行者提供有效的弯曲杆菌病治疗方案。建议进行更多研究，以确定病原体合并感染和/或其他促成因素与军人和旅行者人群腹泻疾病之间的关联。为了有效的疾病预防和治疗策略，需要对潜在致病细菌进行持续监测和AST分析。
