Persistent circulation of a fluoroquinolone-resistant Salmonella enterica Typhi clone in the Indian subcontinent
Persistent circulation of a fluoroquinolone-resistant Salmonella enterica Typhi clone in the Indian subcontinent
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DOI：
10.1093/jac/dkz435
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发表时间：
2020-02-01
影响因子：
5.2
通讯作者：
Pollard, Andrew J.
中科院分区：
文献类型：
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作者：
Britto, Carl D.;Dyson, Zoe A.;Pollard, Andrew J.
背景 据我们所知，在印度南部的一个三级护理转诊中心，使用基于医院的基因组监测来研究循环肠热病病原体的分子结构，这是该地区血培养证实的肠热病的第一项基因组监测研究。方法血培养监测于 2016 年 7 月至 2017 年 6 月在班加罗尔圣约翰医学院医院进行。收集的细菌分离物与患者的人口统计变量相关联，并进行全基因组测序。由此产生的病原体基因组数据也适用于全球背景，以评估可能的系统地理学模式。 结果 印度班加罗尔医院肠热病基因组监测在一年内发现了 101 种伤寒沙门氏菌和 14 种甲型副伤寒沙门氏菌。百分之九十六的分离株表现出对氟喹诺酮类药物不敏感。 WGS 显示优势病原体为伤寒沙门氏菌基因型 4.3.1.2（H58 谱系 II）。先前在尼泊尔与加替沙星治疗失败相关的氟喹诺酮类耐药三重突变体伤寒沙门氏菌克隆 4.3.1.2 与 18% 的肠热病病例有关，表明该病正在发生区域间循环。 结论 印度南部的肠热病仍然是一个主要的公共卫生问题，并且与抗菌素耐药性密切相关。强有力的微生物监测对于指导适当的治疗和预防策略是必要的。特别值得关注的是高度氟喹诺酮类耐药的三突变体伤寒沙门氏菌克隆的出现和扩大及其在南亚持续的国家间和国家内传播，这凸显了干预战略的区域协调的必要性，包括疫苗接种和改善卫生和环境卫生等长期战略。
Background The molecular structure of circulating enteric fever pathogens was studied using hospital-based genomic surveillance in a tertiary care referral centre in South India as a first genomic surveillance study, to our knowledge, of blood culture-confirmed enteric fever in the region.Methods Blood culture surveillance was conducted at St John's Medical College Hospital, Bengaluru, between July 2016 and June 2017. The bacterial isolates collected were linked to demographic variables of patients and subjected to WGS. The resulting pathogen genomic data were also globally contextualized to gauge possible phylogeographical patterns.Results Hospital-based genomic surveillance for enteric fever in Bengaluru, India, identified 101 Salmonella enterica Typhi and 14 S. Paratyphi A in a 1year period. Ninety-six percent of isolates displayed non-susceptibility to fluoroquinolones. WGS showed the dominant pathogen was S. Typhi genotype 4.3.1.2 (H58 lineage II). A fluoroquinolone-resistant triple-mutant clone of S. Typhi 4.3.1.2 previously associated with gatifloxacin treatment failure in Nepal was implicated in 18% of enteric fever cases, indicating ongoing inter-regional circulation.Conclusions Enteric fever in South India continues to be a major public health issue and is strongly associated with antimicrobial resistance. Robust microbiological surveillance is necessary to direct appropriate treatment and preventive strategies. Of particular concern is the emergence and expansion of the highly fluoroquinolone-resistant triple-mutant S. Typhi clone and its ongoing inter- and intra-country transmission in South Asia, which highlights the need for regional coordination of intervention strategies, including vaccination and longer-term strategies such as improvements to support hygiene and sanitation.