1887

Abstract

A retrospective analysis of 135 typhoid cases was conducted to review the clinical, epidemiological and microbiological characteristics of enteric fever cases diagnosed and treated at the Infectious Diseases Hospital, Kuwait, from 2002 to 2005. Diagnosis of patients was based on clinical features, serology and blood culture. The susceptibility testing of the isolates to ampicillin, chloramphenicol, trimethoprim–sulfamethoxazole, ceftriaxone, ciprofloxacin and nalidixic acid was performed by the disc diffusion method, and MICs of ceftriaxone and ciprofloxacin were determined by Etest. Of 135 typhoid fever patients, 108 (88 %) were treated with ceftriaxone and 27 (20 %) were treated with ciprofloxacin. The mean time for fever defervescence with ciprofloxacin therapy was 8 days and 6.3 days for those treated with ceftriaxone. Of the 135 serotypes Typhi and Paratyphi A isolated from patients, 50 (37 %) were multidrug resistant (MDR) and 94 (69.6 %) isolates of both serotypes were nalidixic acid resistant (NAR). Between 90 and 100 % of MDR and NAR strains had decreased susceptibility to ciprofloxacin (0.125–1 μg ml). Low-level resistance to ciprofloxacin (MIC 0.125−1 μg ml) was also detected in 13.8 and 33.3 % of nalidixic acid-susceptible isolates of Typhi and Paratyphi A, respectively. All isolates were susceptible to ceftriaxone. Two relapses occurred in the ciprofloxacin-treated group. MDR strains and strains resistant to ciprofloxacin and ceftriaxone are a major threat in the developing world. A situation is fast approaching where the emergence of highly resistant isolates is quite likely. Proper steps must be taken to avoid a pandemic spread of MDR Typhi strains.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.46814-0
2007-04-01
2024-12-12
Loading full text...

Full text loading...

/deliver/fulltext/jmm/56/4/538.html?itemId=/content/journal/jmm/10.1099/jmm.0.46814-0&mimeType=html&fmt=ahah

References

  1. Ackers M. L., Puhr N. D., Tauxe R. V., Mintz E. D. 2000; Laboratory-based surveillance of Salmonella serotype Typhi infections in the United States: antimicrobial resistance on the rise. JAMA 283:2668–2673 [CrossRef]
    [Google Scholar]
  2. Agarwal K. C., Panhotra B. R., Mahanta J., Arya V. K., Garg R. K. 1981; Typhoid fever due to chloramphenicol resistant Salmonella Typhi associated with R-plasmid. Indian J Med Res 73:484–488
    [Google Scholar]
  3. Anderson E. S., Smith H. R. 1972; Chloramphenicol resistance in the typhoid bacillus. BMJ 3:329–331 [CrossRef]
    [Google Scholar]
  4. Arya S. C., Agarwal N. 2006; Ciprofloxacin resistance in Salmonella enterica serotype Typhi/Paratyphi and antimicrobial agent quality and bioavailability. J Med Microbiol 55:965 [CrossRef]
    [Google Scholar]
  5. Borcherding S. M., Stevens R., Nicholas R. A., Corley C. R., Self T. 1996; Quinolones: a practical review of clinical uses, dosing considerations and drug interactions. J Fam Pract 42:69–78
    [Google Scholar]
  6. Chandel D. S., Chaudhry R., Dhawan B., Paudey A., Dey A. B. 2000; Drug-resistant Salmonella enterica serotype Paratyphi A in India. Emerg Infect Dis 6:420–421 [CrossRef]
    [Google Scholar]
  7. Chowta M. N., Chowta N. K. 2005; Study of clinical profile and antibiotic response in Typhoid fever. Indian J Med Microbiol 23:125–127 [CrossRef]
    [Google Scholar]
  8. Clinical and Laboratory Standards Institute 2005 Methods for Disk Susceptibility Tests for Bacteria that Grow Aerobicall y, 7th edn, document M2–A8. Wayne, PA: Clinical and Laboratory Standards Institute;
    [Google Scholar]
  9. Dimitrov Ts., Panigrahi D., Emara M., Al-Nakkas A., Awni F., Passadila R. 2005; Incidence of bloodstream infections in a specialty hospital in Kuwait: 8-years experience. Med Princ Pract 14:417–421 [CrossRef]
    [Google Scholar]
  10. Hakanen A., Kotilainen P., Jolava J., Siitonen A. 1999; Detection of decreased fluoroquinolone susceptibility and validation of nalidixic acid screening test. J Clin Microbiol 37:3572–3577
    [Google Scholar]
  11. Hakanen A., Kotilainen P., Huovinen P., Helenius H., Siitonen A. 2001; Reduced fluoroquinolone susceptibility in Salmonella enterica serotypes in travelers returning from Southeast Asia. Emerg Infect Dis 7:996–1003 [CrossRef]
    [Google Scholar]
  12. Ivanoff B., Levine M. M. 1997; Typhoid fever: continuing challenges from a resilient bacterial foe. Bull Inst Pasteur 95:129–142 [CrossRef]
    [Google Scholar]
  13. Jesudason M. V., Malathy B., John T. J. 1996; Trend of increasing levels of minimum inhibitory concentration of ciprofloxacin to Salmonella Typhi. Indian J Med Res 103:247–249
    [Google Scholar]
  14. Khosla S. N., Samar A., Khosla P., Sabharwal U., Khosla A. 1998; Drug-resistant typhoid fever. Trop Doct 28:235–237
    [Google Scholar]
  15. Mandal B. K. 2001; Salmonella infection. In Manson’s Tropical Diseases , 20th edn. pp 849–863 Edited by Cook G. London: WB Sanders;
    [Google Scholar]
  16. Munir T., Lodhi M., Butt T., Karamat K. A. 2001; Incidence and multidrug-resistance in typhoid salmonellae in Bahawalpur Area. Pak Armed Forces Med J 51:10–13
    [Google Scholar]
  17. Murdoch D. A., Banatvala N. A., Bone A., Shoismatalloev B. I., Ward L. R., Threlfall E. J. 1998; Epidemic ciprofloxacin-resistant Salmonella Typhi in Tajikista. Lancet 351:339 [CrossRef]
    [Google Scholar]
  18. Nadeem M., Ali N., Achkzai H., Ahmed I. 2002; A profile of enteric fever in adults at Quetta. Pakistan J Pathol 13:12–17
    [Google Scholar]
  19. Panigrahi D., Chugh T. D., West P. W., Dimitrov T. Z., Groower S., Mehta G. 2003; Antimicrobial susceptibility, phage typing and plasmid profile of Salmonella enterica serotype Paratyphi A strains isolated in Kuwait. Med Princ Pract 12:252–255 [CrossRef]
    [Google Scholar]
  20. Parry C. M., Hien T. T., Dougan G., White N. J., Farrar J. J. 2002; Typhoid fever. N Engl J Med 347:1770–1782 [CrossRef]
    [Google Scholar]
  21. Poutanen S. M., Low D. E. 2003; Is it time to change fluoroquinolones MIC breakpoints for Salmonella spp.?. Clin Microbiol Newsl 25:97–102 [CrossRef]
    [Google Scholar]
  22. Prabha Adhikari M. R., Baliga S. 2002; Ciprofloxacin-resistant typhoid with incomplete response to cefotaxime. J Assoc Physicians India 50:428–429
    [Google Scholar]
  23. Rodrigues C., Mehta A., Joshi V. R. 1998a; Quinolone resistant enteric fever-problems and remedies. J Assoc Physicians India 46:751–752
    [Google Scholar]
  24. Rodrigues C., Mehta A., Andrews R., Joshi V. R. 1998b; Clinical resistance to ciprofloxacin in Salmonella Typhi. J Assoc Physicians India 46:323–324
    [Google Scholar]
  25. Rodrigues C., Mehta A., Joshi V. R. 1999; Nalidixic acid resistant Salmonella Typhi in Mumbai. Natl Med J India 12:88
    [Google Scholar]
  26. Rowe B., Ward L. R., Threlfall E. J. 1997; Multidrug-resistant Salmonella Typhi: a worldwide epidemic. Clin Infect Dis 24, Suppl. 1:S106–S109 [CrossRef]
    [Google Scholar]
  27. Saha S. K., Ruhulamin M., Hanif M., Islam M., Khan W. A. 1996; Interpretation of the Widal test in the diagnosis of typhoid fever in Bangladeshi children. Ann Trop Paediatr 16:75–78
    [Google Scholar]
  28. Senewiratne B., Senewiratne K. 1977; Reassessment of the Widal test in the diagnosis of typhoid fever. Gastroenterology 73:233–236
    [Google Scholar]
  29. Threlfall E. J., Ward L. R. 2001; Decreased susceptibility to ciprofloxacin in Salmonella enterica serotype Typhi, United Kingdom. Emerg Infect Dis 7:448–450 [CrossRef]
    [Google Scholar]
  30. Wain J., Hoa N. T. T., Chinh N. T., Vinh H., Everett M. J., Diep T. S., Day N. P. J., Solomon T., White N. J. other authors 1997; Quinolone-resistant Salmonella Typhi in Viet Nam: molecular basis of resistance and clinical response to treatment. Clin Infect Dis 25:1404–1410 [CrossRef]
    [Google Scholar]
  31. Weinstein M. P. 1996; Current blood culture methods and systems: clinical concepts, technology and interpretation of results. Clin Infect Dis 23:40–46 [CrossRef]
    [Google Scholar]
/content/journal/jmm/10.1099/jmm.0.46814-0
Loading
/content/journal/jmm/10.1099/jmm.0.46814-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error