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首页> 外文期刊>Journal of Clinical Microbiology >Rapid Identification and Antibiotic Susceptibility Testing of Salmonella enterica Serovar Typhi Isolated from Blood: Implications for Therapy
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Rapid Identification and Antibiotic Susceptibility Testing of Salmonella enterica Serovar Typhi Isolated from Blood: Implications for Therapy

机译：从血液中分离出的肠炎沙门氏菌伤寒沙门氏菌的快速鉴定和药敏试验：对治疗的意义

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The turnaround time (TAT) for Salmonella enterica serovar Typhi identification and reporting of the antibiotic susceptibility profile was determined for 391 cases of typhoid fever, using the lysis direct plating or lysis centrifugation method of blood culture along with rapid antimicrobial susceptibility testing. The TAT was more rapid (TAT for 90% of the patients [TAT90] = 30 h; TAT100 ≤ 67 h) than was possible with conventional methodologies and was equivalent to that reported previously using more advanced, costly technologies that are largely unavailable in developing countries. Antibiotic susceptibility profiles, determined by the rapid antimicrobial susceptibility testing method, of randomly selected 60 S. enterica serovar Typhi isolates were identical to those determined by overnight conventional testing. Preliminary assessment of the impact of the reduced TAT on physician practices revealed that initial empirical therapy was prescribed at the time of presentation in most cases (87 of 108 [81%]) despite awareness that the final report would be available on the following day. Patients treated empirically with first-line antibiotics and shown subsequently to be infected with a multidrug-resistant strain benefited most (8 cases), since therapy was changed appropriately on the following day. In an additional 21 cases, therapy with an appropriate antibiotic was initiated after culture results were available. Thus, in approximately one-fourth (29 of 108 [27%]) of the cases, a change in management to an agent active for treatment of the isolate was made after receipt of the test results. However, in no case was therapy changed from a second-line to a first-line agent, even if the isolate was reported on the day after presentation to be sensitive to first-line therapy (33 cases). Ways in which to utilize rapid-TAT result reporting in order to positively influence physicians' prescribing in Bangladesh are the subject of ongoing research.
机译：使用溶血直接平板或溶血离心法快速鉴定了391例伤寒患者的沙门氏菌血清型伤寒鉴定和报告抗生素敏感性概况的周转时间（TAT）抗菌药敏试验。与传统方法相比，TAT更快（90％的患者[TAT 90 ] = 30小时; TAT 100 ≤67小时）更快，并且等效与先前报道的使用更先进，成本更高的技术相比，这些技术在发展中国家基本上是不可用的。通过快速抗菌药敏试验方法确定的随机选择的60 S的抗生素药敏曲线。肠型血清型伤寒分离株与常规过夜试验确定的相同。对TAT降低对医师执业的影响的初步评估显示，尽管意识到第二天将提供最终报告，但在大多数情况下，就诊时已开出了初步的经验疗法（108个中的87个[81％]）。由于第二天治疗发生了适当的变化，因此用一线抗生素进行经验治疗并随后被多重耐药菌株感染的患者受益最大（8例）。在另外21例中，在获得培养结果后开始使用适当的抗生素治疗。因此，在大约四分之一（108例中的29例[27％]）中，在收到测试结果后就改变了对用于治疗分离株的活性剂的管理。但是，即使在就诊后的第二天就报告了该分离株对一线治疗敏感，也从未将治疗从二线药物改为一线药物（33例）。正在进行快速研究的目的是利用快速TAT结果报告以积极影响孟加拉国医师开药的方式。

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