An observational clinic-based study of diarrheal illness in deployed United States military personnel in Thailand:: Presentation and outcome of Campylobacter infection
An observational clinic-based study of diarrheal illness in deployed United States military personnel in Thailand:: Presentation and outcome of Campylobacter infection
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DOI：
10.4269/ajtmh.2002.67.533
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发表时间：
2002-11-01
影响因子：
3.3
通讯作者：
Tribble, DR
中科院分区：
文献类型：
--
作者：
Sanders, JW;Isenbarger, DW;Tribble, DR
弯曲杆菌是泰国旅行者腹泻的主要原因。由于对喹诺酮类抗生素的耐药性在弯曲杆菌属分离株中很高，因此在该地区用喹诺酮类抗生素经验性治疗旅行者腹泻可能无效。我们对169名患有急性腹泻的美国军事人员进行了一项观察性研究，并将他们的微生物学结果与1998年5月部署到泰国的77名无症状人员的微生物学结果进行了比较。在146株致病菌中，最常见的是非伤寒沙门氏菌（n = 31），肠致病性大肠杆菌（n = 24）和C。空肠/结肠（n = 23）。弯曲杆菌与疾病密切相关（比值比= 5.9; 95%置信区间= 1.3-37.3），临床表现更严重，功能能力降低（P = 0.02）。在96%的弯曲杆菌分离株中观察到对环丙沙星的体外耐药性。在17%的弯曲杆菌感染病例中观察到对环丙沙星的次优治疗反应，而其他原因则为6%。这些结果突出了弯曲杆菌作为泰国严重旅行者腹泻原因的重要性，并说明了耐药菌株的持续问题和相关的治疗问题。
Campylobacter is a leading cause of traveler's diarrhea in Thailand. Since resistance to quinolones is high among Campylobacter isolates, empiric therapy with quinolones for traveler's diarrhea may be ineffective in this region. We conducted an observational study among 169 U.S. military personnel with acute diarrhea and compared their microbiologic findings to those of 77 asymptomatic personnel deployed to Thailand in May 1998. Of 146 pathogenic bacterial isolates, the most common were nontyphoidal Salmonella (n = 31), enterotoxigenic Escherichia coli (n = 24), and C. jejuni/coli (n = 23). Campylobacter was strongly associated with disease (odds ratio = 5.9; 95% confidence interval = 1.3-37.3), with a more severe clinical presentation, and with a reduced functional ability at presentation (P = 0.02). In vitro resistance to ciprofloxacin was observed in 96% of the Campylobacter isolates. Sub-optimal treatment response to ciprofloxacin was observed in 17% of the cases of Campylobacter infection versus 6% due to other causes. These results highlight the importance of Campylobacter as a cause of severe traveler's diarrhea in Thailand and illustrates the ongoing problem with antibiotic-resistant strains and associated treatment problems.