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首页> 外文期刊>Diagnostic microbiology and infectious disease >Treatment failure in typhoid fever with ciprofloxacin susceptible Salmonella enterica Serotype Typhi.
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Treatment failure in typhoid fever with ciprofloxacin susceptible Salmonella enterica Serotype Typhi.

机译：环丙沙星易感肠炎沙门氏菌血清型伤寒导致伤寒的治疗失败。

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摘要

Fluoroquinolones are considered the most effective drugs for the treatment of typhoid fever and hence are widely used in the empiric treatment of acute undifferentiated febrile illnesses in India. Recent reports of Salmonella enterica serotype Typhi (S. Typhi) strains with increasing minimum inhibitory concentration (MIC) of ciprofloxacin have raised the fear of potential treatment failures. In this case series of 109 consecutive patients hospitalized with typhoid fever (S. Typhi grown from blood), we documented clinical failure (fever persisting >6 days) in 25 of 46 (54.3%) adults who could be evaluated. Among these, eight (17.4%) had microbiological failure (S. Typhi recovered from blood after 6 days of ciprofloxacin therapy) despite adequate serum ciprofloxacin levels, and all required alternative drugs for treatment. These 8 S. Typhi strains, although susceptible to ciprofloxacin (MIC < 1 microg/mL) (NCCLS 2000), had MICs (median MIC 0.5 microg/mL) that were increased 15-fold compared to S. Typhi strains from patients with typhoid fever seen at our center in 1995 (median MIC 0.032 microg/mL), and were nalidixic acid resistant S. Typhi (NARST) (MIC >/=32 microg/mL). The poor treatment outcomes with ciprofloxacin therapy in patients infected with NARST strains that exhibit an increased ciprofloxacin MIC call for a need to revise the ciprofloxacin breakpoints for S. Typhi.
机译：氟喹诺酮类被认为是治疗伤寒的最有效药物，因此在印度被广泛用于急性未分化发热性疾病的经验治疗。环丙沙星的最低抑菌浓度（MIC）增加的沙门氏菌血清型伤寒沙门氏菌（S. Typhi）菌株的最新报道引起了人们对潜在治疗失败的担忧。在本例连续109例因伤寒住院（伤寒沙门氏菌从血液中生长）住院的患者中，我们记录了46名（54.3％）成年人中有25名可评估的临床失败（发烧持续> 6天）。在这些患者中，尽管血清环丙沙星水平足够高，但仍有八种（17.4％）发生了微生物衰竭（伤寒沙门氏菌从血液中恢复），所有这些都需要替代药物治疗。这8株伤寒沙门氏菌菌株虽然对环丙沙星敏感（MIC <1 microg / mL）（NCCLS 2000），但其MIC（中位数MIC 0.5 microg / mL）与伤寒患者的伤寒沙门氏菌菌株相比增加了15倍。 1995年在我们中心见到的发烧（中等MIC为0.032微克/毫升），并且是耐萘啶酸的伤寒沙门氏菌（NARST）（MIC> / = 32微克/毫升）。对于环丙沙星MIC升高的NARST株感染的患者，环丙沙星治疗的治疗效果较差，因此需要修改伤寒沙门氏菌的环丙沙星断点。

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