An Update on Isolation of Extensively Drug Resistant (XDR) Salmonella enterica from Blood Cultures in a Tertiary Care Centre

S. Hameed
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引用次数: 4

Abstract

Introduction: Typhoid fever is a public health issue, burdening many regions of the world with poor socioeconomic background. Management of this disease faces the major hurdle of antimicrobial resistance. The present study reveals current pattern of antimicrobial susceptibility among Salmonella enterica (Salmonella typhi & Salmonella paratyphi A) blood culture isolates from typhoid fever cases. Regular data collection about Salmonella infections and their response to antimicrobial agents, coupled with a long term commitment to providing adequate health information systems, is the key to effective planning and policy formation against typhoid fever. Aims & Objectives: To evaluate the prevalence of ceftriaxone resistant Salmonella enterica isolates from blood cultures in Shaikh Zayed Medical Complex for updating nosocomial antimicrobial resistance data. Place and duration of study: This research study was conducted at Shaikh Zayed Medical Complex, Lahore from March 2018 to May 2019. Material & Methods: Blood cultures positive for Salmonella enterica were analyzed, taking into consideration the gender & age of patients with typhoid fever. Antimicrobial susceptibility testing was carried out through disc diffusion method. The recommended antimicrobial agents for S. typhi (Salmonella typhi) & S. paratyphi A (Salmonella Parathyphi A) (as per CLSI, USA 2018/2019 guidelines; described later), were tested and analyzed during this study with the main focus on 3rd generation cephalosporin resistance pattern. Among second line treatment options, meropenem and azithromycin were selected for study. Results: Out of 899 isolates of Salmonella enterica (from 13964 samples for blood culture), 849 (94.4%) were S. typhi and 50 (5.6%) were S. paratyphi A. Of these, 57.1% isolates were from males, 42.9% from females, 81.7% from children (age less than 12 years) and 18.3% were from adults (age more than 12 years). A continuously rising resistance percentage was observed for 3rd generation cephalosporins over the span of fifteen months. It was 43.4% for ceftriaxone (CRO). No case of meropenem and azithromycin resistance was observed during study period. Conclusion: Demographic information was provided by this study regarding high level of resistance among Salmonella enterica isolates particularly S. typhi .The first line antibiotic drugs were a complete failure in ongoing outbreak of typhoid fever. The novel results of this study are the high resistance percentages for 3rd generation cehalosporins, whether oral or parenteral. This result is worrisome as it will leave us with no option but to resort to second line drugs. However, an increasing trend of blood culturing was observed in this research. Extensively drug resistant (XDR) Salmonella infection has definitely highlighted the importance of blood culture and its use as a more preferred diagnostic tool. Key words: Typhoid fever, Extensively drug resistant (XDR) Salmonella enterica, (S. typhi & S. paratyphi A), Antimicrobial Resistance, CRO (Ceftriaxone) resistance.
从三级保健中心血液培养中分离广泛耐药肠炎沙门氏菌的最新情况
伤寒是一个公共卫生问题,给世界上许多社会经济背景较差的地区造成负担。这种疾病的管理面临着抗微生物药物耐药性的主要障碍。本研究揭示了目前伤寒病例中肠沙门氏菌(沙门氏菌和副伤寒沙门氏菌)血培养分离株的抗菌药物敏感性模式。定期收集有关沙门氏菌感染及其对抗微生物药物反应的数据,再加上长期致力于提供适当的卫生信息系统,是有效规划和制定伤寒防治政策的关键。目的和目的:评估谢赫扎耶德医疗中心血液培养中头孢曲松耐药肠炎沙门氏菌的流行情况,以更新医院抗微生物药物耐药性数据。研究地点和时间:本研究于2018年3月至2019年5月在拉合尔的ShaikhZayed医疗中心进行。材料与方法:结合伤寒患者的性别、年龄,对肠炎沙门氏菌血培养阳性进行分析。药敏试验采用纸片扩散法。推荐的抗伤寒沙门氏菌(伤寒沙门氏菌)和副伤寒沙门氏菌A(副伤寒沙门氏菌)抗菌药物(根据CLSI, USA 2018/2019指南;在本研究中,对第3代头孢菌素耐药模式进行了测试和分析。在二线治疗方案中,选择美罗培南和阿奇霉素进行研究。结果:从13964份血培养标本中分离出899株肠沙门氏菌,其中伤寒沙门氏菌849株(94.4%),副伤寒沙门氏菌50株(5.6%),其中男性57.1%,女性42.9%,儿童(12岁以下)81.7%,成人(12岁以上)18.3%。在15个月的时间里,观察到第三代头孢菌素的耐药率持续上升。头孢曲松(CRO)为43.4%。研究期间未见美罗培南和阿奇霉素耐药病例。结论:本研究提供了沙门氏菌(尤其是伤寒沙门氏菌)高耐药性的人口统计学信息,一线抗生素药物在持续的伤寒暴发中完全失败。本研究的新结果是对第三代头孢菌素的高耐药率,无论是口服还是注射。这一结果令人担忧,因为它将使我们别无选择,只能求助于二线药物。然而,在本研究中发现了血液培养的增加趋势。广泛耐药沙门氏菌感染无疑突出了血液培养的重要性,并将其作为一种更优选的诊断工具。关键词:伤寒,广泛耐药(XDR)肠炎沙门氏菌,(S. typhi & S.副伤寒沙门氏菌),抗微生物药物耐药性,CRO(头孢曲松)耐药性
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