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Suboptimal clinical response to ciprofloxacin in patients with enteric fever due to Salmonella spp. with reduced fluoroquinolone susceptibility: a case series.
BMC Infect Dis. 2004 Sep 20; 4:36.BI

Abstract

BACKGROUND

Salmonella spp. with reduced susceptibility to fluoroquinolones have higher than usual MICs to these agents but are still considered "susceptible" by NCCLS criteria. Delayed treatment response to fluoroquinolones has been noted, especially in cases of enteric fever due to such strains. We reviewed the ciprofloxacin susceptibility and clinical outcome of our recent enteric fever cases.

METHODS

Salmonella enterica Serotype Typhi (S. Typhi) and Serotype Paratyphi (S. Paratyphi) blood culture isolates (1998-2002) were tested against nalidixic acid by disk diffusion (DD) and agar dilution (AD) and to ciprofloxacin by AD using NCCLS methods and interpretive criteria. Reduced fluoroquinolone susceptibility was defined as a ciprofloxacin MIC of 0.125-1.0 mg/L. The clinical records of patients treated with ciprofloxacin for isolates with reduced fluoroquinolone susceptibility were reviewed.

RESULTS

Seven of 21 (33%) S. Typhi and S. Paratyphi isolates had reduced susceptibility to fluoroquinolones (MIC range 0.125-0.5 mg/L). All 7 were nalidixic acid resistant by DD (no zone) and by AD (MIC 128- >512 mg/L). The other 14 isolates were nalidixic acid susceptible and fully susceptible to ciprofloxacin (MIC range 0.015-0.03 mg/L). Five of the 7 cases were treated initially with oral ciprofloxacin. One patient remained febrile on IV ciprofloxacin until cefotaxime was added, with fever recurrence when cefotaxime was discontinued. Two continued on oral or IV ciprofloxacin alone but had prolonged fevers of 9-10 days duration, one was switched to IV beta-lactam therapy after remaining febrile for 3 days on oral/IV ciprofloxacin and one was treated successfully with oral ciprofloxacin. Four of the 5 required hospitalization.

CONCLUSIONS

Our cases provide further evidence that reduced fluoroquinolone susceptibility of S. Typhi and S. Paratyphi is clinically significant. Laboratories should test extra-intestinal Salmonella spp. for reduced fluoroquinolone susceptibility.

Authors+Show Affiliations

Division of Infectious Disease, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, Canada. slinger@cheo.on.ca.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15380025

Citation

Slinger, Robert, et al. "Suboptimal Clinical Response to Ciprofloxacin in Patients With Enteric Fever Due to Salmonella Spp. With Reduced Fluoroquinolone Susceptibility: a Case Series." BMC Infectious Diseases, vol. 4, 2004, p. 36.
Slinger R, Desjardins M, McCarthy AE, et al. Suboptimal clinical response to ciprofloxacin in patients with enteric fever due to Salmonella spp. with reduced fluoroquinolone susceptibility: a case series. BMC Infect Dis. 2004;4:36.
Slinger, R., Desjardins, M., McCarthy, A. E., Ramotar, K., Jessamine, P., Guibord, C., & Toye, B. (2004). Suboptimal clinical response to ciprofloxacin in patients with enteric fever due to Salmonella spp. with reduced fluoroquinolone susceptibility: a case series. BMC Infectious Diseases, 4, 36.
Slinger R, et al. Suboptimal Clinical Response to Ciprofloxacin in Patients With Enteric Fever Due to Salmonella Spp. With Reduced Fluoroquinolone Susceptibility: a Case Series. BMC Infect Dis. 2004 Sep 20;4:36. PubMed PMID: 15380025.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Suboptimal clinical response to ciprofloxacin in patients with enteric fever due to Salmonella spp. with reduced fluoroquinolone susceptibility: a case series. AU - Slinger,Robert, AU - Desjardins,Marc, AU - McCarthy,Anne E, AU - Ramotar,Karam, AU - Jessamine,Peter, AU - Guibord,Christiane, AU - Toye,Baldwin, Y1 - 2004/09/20/ PY - 2004/04/22/received PY - 2004/09/20/accepted PY - 2004/9/24/pubmed PY - 2005/5/20/medline PY - 2004/9/24/entrez SP - 36 EP - 36 JF - BMC infectious diseases JO - BMC Infect Dis VL - 4 N2 - BACKGROUND: Salmonella spp. with reduced susceptibility to fluoroquinolones have higher than usual MICs to these agents but are still considered "susceptible" by NCCLS criteria. Delayed treatment response to fluoroquinolones has been noted, especially in cases of enteric fever due to such strains. We reviewed the ciprofloxacin susceptibility and clinical outcome of our recent enteric fever cases. METHODS: Salmonella enterica Serotype Typhi (S. Typhi) and Serotype Paratyphi (S. Paratyphi) blood culture isolates (1998-2002) were tested against nalidixic acid by disk diffusion (DD) and agar dilution (AD) and to ciprofloxacin by AD using NCCLS methods and interpretive criteria. Reduced fluoroquinolone susceptibility was defined as a ciprofloxacin MIC of 0.125-1.0 mg/L. The clinical records of patients treated with ciprofloxacin for isolates with reduced fluoroquinolone susceptibility were reviewed. RESULTS: Seven of 21 (33%) S. Typhi and S. Paratyphi isolates had reduced susceptibility to fluoroquinolones (MIC range 0.125-0.5 mg/L). All 7 were nalidixic acid resistant by DD (no zone) and by AD (MIC 128- >512 mg/L). The other 14 isolates were nalidixic acid susceptible and fully susceptible to ciprofloxacin (MIC range 0.015-0.03 mg/L). Five of the 7 cases were treated initially with oral ciprofloxacin. One patient remained febrile on IV ciprofloxacin until cefotaxime was added, with fever recurrence when cefotaxime was discontinued. Two continued on oral or IV ciprofloxacin alone but had prolonged fevers of 9-10 days duration, one was switched to IV beta-lactam therapy after remaining febrile for 3 days on oral/IV ciprofloxacin and one was treated successfully with oral ciprofloxacin. Four of the 5 required hospitalization. CONCLUSIONS: Our cases provide further evidence that reduced fluoroquinolone susceptibility of S. Typhi and S. Paratyphi is clinically significant. Laboratories should test extra-intestinal Salmonella spp. for reduced fluoroquinolone susceptibility. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/15380025/Suboptimal_clinical_response_to_ciprofloxacin_in_patients_with_enteric_fever_due_to_Salmonella_spp__with_reduced_fluoroquinolone_susceptibility:_a_case_series_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-4-36 DB - PRIME DP - Unbound Medicine ER -