Reevaluating fluoroquinolone breakpoints for Salmonella enterica serotype Typhi and for non-Typhi salmonellae
Reevaluating fluoroquinolone breakpoints for Salmonella enterica serotype Typhi and for non-Typhi salmonellae
复制标题
DOI：
10.1086/375602
复制
发表时间：
2003-07-01
影响因子：
11.8
通讯作者：
Angulo, FJ
中科院分区：
文献类型：
--
作者：
Crump, JA;Barrett, TJ;Angulo, FJ
肠道沙门氏菌感染在世界范围内引起相当大的发病率和死亡率。抗微生物治疗可能是拯救病人的肠外感染与沙门氏菌。肠伤寒血清型或非伤寒沙门氏菌。由于在过去几十年中出现了对几类传统一线药物的抗菌药物耐药性，喹诺酮类抗菌药物，特别是氟喹诺酮类，已成为首选药物。最近，伤寒和非伤寒沙门氏菌血清型都出现了对萘啶酸的耐药性。此类沙门氏菌分离株通常对氟喹诺酮类药物的敏感性也有所降低，尽管氟喹诺酮类药物的最低抑菌浓度通常在NCCLS解释标准的敏感范围内。越来越多的临床和微生物学证据表明，这种耐萘啶酸的S。肠道感染也表现出对氟喹诺酮的临床反应降低。在这篇文章中，我们建议实验室测试肠外沙门氏菌分离株对萘啶酸的耐药性，我们建议避免使用短程氟喹诺酮治疗耐萘啶酸肠外沙门氏菌感染，我们总结了现有的数据和数据需求，这将有助于重新评估目前NCCLS氟喹诺酮沙门氏菌的折点。
Salmonella enterica infections cause considerable morbidity and mortality worldwide. Antimicrobial therapy may be life-saving for patients with extraintestinal infections with S. enterica serotype Typhi or non-Typhi salmonellae. Because antimicrobial resistance to several classes of traditional first-line drugs has emerged in the past several decades, the quinolone antimicrobial agents, particularly the fluoroquinolones, have become the drugs of choice. Recently, resistance to nalidixic acid has emerged among both Typhi and non-Typhi Salmonella serotypes. Such Salmonella isolates typically also have decreased susceptibility to fluoroquinolones, although minimum inhibitory concentrations of the fluoroquinolones usually are within the susceptible range of the interpretive criteria of the NCCLS. A growing body of clinical and microbiological evidence indicates that such nalidixic acid-resistant S. enterica infections also exhibit a decreased clinical response to fluoroquinolones. In this article, we recommend that laboratories test extraintestinal Salmonella isolates for nalidixic acid resistance, we recommend that short-course fluoroquinolone therapy be avoided for infection with nalidixic acid-resistant extraintestinal salmonellae, and we summarize existing data and data needs that would contribute to reevaluation of the current NCCLS fluoroquinolone breakpoints for salmonellae.