Rowe B, Ward L R, Threlfall E J
WHO Collaborating Centre for Phage Typing and Drug Resistance in Enterobacteria, Central Public Health Laboratory, London, United Kingdom.
Clin Infect Dis. 1997 Jan;24 Suppl 1:S106-9. doi: 10.1093/clinids/24.supplement_1.s106.
Since 1989, strains of Salmonella typhi resistant to chloramphenicol, ampicillin, and trimethoprim (i.e., multidrug-resistant [MDR] strains) have been responsible for numerous outbreaks in countries in the Indian subcontinent, Southeast Asia, and Africa. MDR strains have also been isolated with increasing frequency from immigrant workers in countries in the Arabian Gulf, as well as in developed countries from returning travelers. In all MDR strains so far examined, multiple resistance has been encoded by plasmids of the H1 incompatibility group. As a result of the widespread dissemination of such strains, chloramphenicol can no longer be regarded as the first-line drug for typhoid fever. Because strains are also resistant to ampicillin and trimethoprim, the efficacy of these antibiotics has also been impaired, and ciprofloxacin is now the drug of choice for typhoid fever. Chromosomally encoded resistance to ciprofloxacin has now been observed in a small number of strains isolated in the United Kingdom from patients returning from the Indian subcontinent, and in at least one case the patient did not respond to treatment with this antibiotic. It is regrettable that resistance to ciprofloxacin has now emerged in MDR S. typhi, and it is of paramount importance to limit the unnecessary use of this vital drug so that its efficacy should not be further jeopardized.
自1989年以来，对氯霉素、氨苄西林和甲氧苄啶耐药的伤寒沙门氏菌菌株（即多重耐药[MDR]菌株）在印度次大陆、东南亚和非洲国家引发了众多疫情。在阿拉伯湾国家的移民工人以及发达国家从归国旅行者中，也越来越频繁地分离出MDR菌株。在迄今检测的所有MDR菌株中，多重耐药性由H1不相容群质粒编码。由于此类菌株的广泛传播，氯霉素已不能再被视为治疗伤寒热的一线药物。由于菌株也对氨苄西林和甲氧苄啶耐药，这些抗生素的疗效也受到了影响，环丙沙星现在是治疗伤寒热的首选药物。在英国，从印度次大陆归国的患者中分离出的少数菌株中，现已观察到对环丙沙星的染色体编码耐药性，并且至少有一例患者对这种抗生素治疗无反应。令人遗憾的是，MDR伤寒沙门氏菌现已出现对环丙沙星的耐药性，限制这种重要药物的不必要使用至关重要，以免其疗效受到进一步损害。
