越南耐喹诺酮伤寒沙门氏菌：耐药的分子基础及治疗的临床反应

Quinolone-resistant Salmonella typhi in Viet Nam: molecular basis of resistance and clinical response to treatment.

作者信息

Wain J, Hoa N T, Chinh N T, Vinh H, Everett M J, Diep T S, Day N P, Solomon T, White N J, Piddock L J, Parry C M

机构信息

Wellcome Trust Clinical Research Unit, Cho Quan Hospital, Ho Chi Minh City, Viet Nam.

出版信息

Clin Infect Dis. 1997 Dec;25(6):1404-10. doi: 10.1086/516128.

DOI:10.1086/516128

PMID:9431387

Abstract

Nalidixic acid-resistant Salmonella typhi (NARST) was first isolated in Viet Nam in 1993. Analysis of the quinolone resistance-determining region of gyrA in 20 NARST isolates by polymerase chain reaction and single-stranded conformational polymorphism yielded two novel patterns: pattern II corresponding to a point mutation at nucleotide 87 Asp-->Gly (n = 17), and pattern III corresponding to a point mutation at nucleotide 83 Ser-->Phe (n = 3). In trials of short-course ofloxacin therapy for uncomplicated typhoid, 117 (78%) of 150 patients were infected with multidrug-resistant S. typhi, 18 (15%) of which were NARST. The median time to fever clearance was 156 hours (range, 30-366 hours) for patients infected with NARST and 84 hours (range, 12-378 hours) for those infected with nalidixic acid-susceptible strains (P < .001). Six (33.3%) of 18 NARST infections required retreatment, whereas 1 (0.8%) of 132 infections due to susceptible strains required retreatment (relative risk = 44; 95% confidence interval = 5.6-345; P < .0001). We recommend that short courses of quinolones not be used in patients infected with NARST.

摘要

耐萘啶酸伤寒沙门菌（NARST）于1993年首次在越南分离出来。通过聚合酶链反应和单链构象多态性分析20株NARST分离株的gyrA喹诺酮耐药决定区，得出两种新模式：模式II对应于第87位核苷酸的点突变Asp→Gly（n = 17），模式III对应于第83位核苷酸的点突变Ser→Phe（n = 3）。在针对非复杂性伤寒的短程氧氟沙星治疗试验中，150例患者中有117例（78%）感染了多重耐药伤寒沙门菌，其中18例（15%）为NARST。感染NARST的患者发热消退的中位时间为156小时（范围为30 - 366小时），而感染萘啶酸敏感菌株的患者为84小时（范围为12 - 378小时）（P <.001）。18例NARST感染中有6例（33.3%）需要再次治疗，而132例敏感菌株感染中有1例（0.8%）需要再次治疗（相对危险度 = 44；95%置信区间 = 5.6 - 345；P <.0001）。我们建议不要对感染NARST的患者使用短疗程喹诺酮类药物。