Antimicrobial resistance in invasive non-typhoid Salmonella from the Democratic Republic of the Congo: emergence of decreased fluoroquinolone susceptibility and extended-spectrum beta lactamases.
Antimicrobial resistance in invasive non-typhoid Salmonella from the Democratic Republic of the Congo: emergence of decreased fluoroquinolone susceptibility and extended-spectrum beta lactamases.
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DOI：
10.1371/journal.pntd.0002103
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发表时间：
2013
影响因子：
3.8
通讯作者：
Jacobs J
中科院分区：
文献类型：
--
作者：
Lunguya O;Lejon V;Phoba MF;Bertrand S;Vanhoof R;Glupczynski Y;Verhaegen J;Muyembe-Tamfum JJ;Jacobs J
非伤寒沙门氏菌 (NTS) 常见对一线抗生素氨苄西林、氯霉素和甲氧苄啶/磺胺甲恶唑的共耐药性或多重耐药性 (MDR)。氟喹诺酮类或第三代头孢菌素等替代抗生素的使用受到耐药性增加的威胁，但在中非仍然缺乏记录。作为刚果民主共和国微生物监测研究的一部分，在 2007 年至 2011 年间收集了血培养物。对分离的 NTS 进行了血清型和抗菌药物耐药性评估，包括环丙沙星敏感性降低和超广谱 β-内酰胺酶 (ESBL) 产生。总共收集到 233 株 NTS 分离株（占临床重要微生物的 23.6%），主要包括鼠伤寒沙门氏菌（79%）和肠炎沙门氏菌（18%）。大多数NTS是在雨季分离出来的，并从≤2岁的儿童中回收。 MDR、环丙沙星敏感性降低、阿奇霉素和头孢噻肟耐药率分别为80.7%、4.3%、3.0%和2.1%。三个 (1.3%) 分离株中发现了 ESBL 的产生。环丙沙星敏感性降低与gyrA基因第87位密码子突变有关，而ESBL均属于SHV-2a型。中非血培养中的 NTS 分离株中几乎完全存在耐多药性，这一点已得到证实。对氟喹诺酮类、阿奇霉素和第三代头孢菌素的耐药性仍然较低，但正在出现。刚果民主共和国加强微生物监测对于调整抗生素治疗和制定治疗指南至关重要。侵袭性非伤寒沙门氏菌。 (NTS) 是撒哈拉以南非洲地区血流感染的重要原因，并与高死亡率相关。多重耐药性水平已高得惊人。因此，治疗越来越依赖于口服氟喹诺酮类药物，如环丙沙星，以及第三代头孢菌素类药物，如头孢噻肟作为胃肠外治疗的替代品。阿奇霉素是另一种替代抗菌药物。在世界范围内，这些药物的使用增加也与耐药性的蔓延有关，这种现象在中非鲜有记录。在本研究中，从 2007 年至 2011 年间在刚果民主共和国采集的血培养物中收集了 233 株 NTS 分离株，主要来自 ≤2 岁的儿童。大多数分离株是在雨季恢复的。证实了广泛的多重耐药性以及对环丙沙星的敏感性降低、对阿奇霉素的耐药性和对第三代头孢菌素的耐药性。我们的研究结果表明刚果民主共和国 NTS 中出现了抗生素耐药性，并强调需要加强微生物监测，这是合理抗生素治疗和制定标准治疗指南的先决条件。
Co-resistance against the first-line antibiotics ampicillin, chloramphenicol and trimethoprim/sulphamethoxazole or multidrug resistance (MDR) is common in non typhoid Salmonella (NTS). Use of alternative antibiotics, such as fluoroquinolones or third generation cephalosporins is threatened by increasing resistance, but remains poorly documented in Central-Africa. As part of a microbiological surveillance study in DR Congo, blood cultures were collected between 2007 and 2011. Isolated NTS were assessed for serotype and antimicrobial resistance including decreased ciprofloxacin susceptibility and extended-spectrum beta-lactamase (ESBL) production. In total, 233 NTS isolates (representing 23.6% of clinically significant organisms) were collected, mainly consisting of Salmonella Typhimurium (79%) and Salmonella Enteritidis (18%). The majority of NTS were isolated in the rainy season, and recovered from children ≤2 years old. MDR, decreased ciprofloxacin susceptibility, azithromycin and cefotaxime resistance were 80.7%, 4.3%, 3.0% and 2.1% respectively. ESBL production was noted in three (1.3%) isolates. Decreased ciprofloxacin susceptibility was associated with mutations in codon 87 of the gyrA gene, while ESBLs all belonged to the SHV-2a type. Presence of almost full MDR among NTS isolates from blood cultures in Central Africa was confirmed. Resistance to fluoroquinolones, azithromycin and third generation cephalosporins is still low, but emerging. Increased microbiological surveillance in DR Congo is crucial for adapted antibiotic therapy and the development of treatment guidelines. Invasive non typhoid Salmonella spp. (NTS) are an important cause of bloodstream infection in sub-Saharan Africa and associated with a high mortality. Levels of multidrug resistance have become alarmingly high. Treatment therefore increasingly relies on the oral fluoroquinolones such as ciprofloxacin, with third generation cephalosporins such as cefotaxime as alternatives for parenteral treatment. Azithromycin represents another alternative antimicrobial drug. Worldwide, increased use of these drugs is associated with spread of resistance as well, a phenomenon poorly documented in Central-Africa. In the present study, 233 NTS isolates were collected from blood cultures sampled between 2007 and 2011 in DR Congo, mainly from children ≤2 years of age. Most isolates were recovered during the rainy season. Widespread multidrug resistance was confirmed as well as decreased susceptibility to ciprofloxacin, resistance to azithromycin and resistance to third generation cephalosporins. Our findings demonstrate emergence of antibiotic resistance among NTS in DR Congo and underline the need for increased microbiological surveillance, being a prerequisite for rational antibiotic therapy and the development of standard treatment guidelines.
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影响因子：
2.6
作者：
Cavaco, Lina Maria;Frimodt-Moller, Niels;Aarestrup, Frank Moller
通讯作者：
Aarestrup, Frank Moller
影响因子：
3.7
作者：
Nielsen, Maja Verena;Sarpong, Nimako;Schwarz, Norbert Georg
通讯作者：
Schwarz, Norbert Georg
影响因子：
168.9
作者：
Feasey, Nicholas A.;Dougan, Gordon;Kingsley, Robert A.;Heyderman, Robert S.;Gordon, Melita A.
通讯作者：
Gordon, Melita A.
DOI：
10.1016/j.trstmh.2012.03.006
发表时间：
2012-06-01
影响因子：
2.2
作者：
Lunguya, Octavie;Phoba, Marie-France;Jacobs, Jan
通讯作者：
Jacobs, Jan
DOI：
10.1016/s1201-9712(01)90067-0
发表时间：
2001-01-01
期刊：
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
影响因子：
--
作者：
Bahwere, P;Levy, J;De Mol, P
通讯作者：
De Mol, P