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First isolation of ciprofloxacin-resistant Salmonella enterica serovar Typhi in Taiwan.
J Microbiol Immunol Infect. 2013 Dec; 46(6):469-73.JM

Abstract

BACKGROUND/PURPOSE

Typhoid fever is a major cause of disease burden in developing countries. The use of fluoroquinolones, once considered the drugs of choice, should be re-evaluated due to the emergence of quinolone-resistant Salmonella enterica serovar Typhi. In Taiwan, typhoid fever is rare but constitutes an important public health concern.

METHODS

In August 2011, two ciprofloxacin-resistant S. Typhi isolates were identified from one patient who had recently travelled to India. The two isolates together with four other ciprofloxacin-susceptible S. Typhi isolates were subjected for molecular investigation. Polymerase chain reaction (PCR) and sequencing were used to analyze the resistance mechanisms. Pulsed-field gel electrophoresis (PFGE) was performed to delineate the genetic relatedness among the isolates.

RESULTS

In 2011, a total of 49 typhoid fever cases were reported to the Center for Disease Control in Taiwan, with a significant increase in indigenous cases in northern Taiwan from August to November. In the two S. Typhi isolates with complete resistance to ciprofloxacin [minimum inhibitory concentration (MIC) >32 μg/mL], multiple point mutations in the quinolone resistance-determining regions (QRDRs) of gyrA and parC genes were identified. A unique PFGE pattern was found in the resistant isolates and was different from the other representative susceptible isolates.

CONCLUSIONS

The first ciprofloxacin-resistant S. Typhi infection in Taiwan is reported. The emergence and spread of antimicrobial-resistant S. Typhi infection as a result of international travel may become a threat to public health in Taiwan. Clinicians should be well alert when treating patients who may have acquired resistant infections associated with international travel among endemic regions.

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Authors+Show Affiliations

Lee CJ
Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Su LH
Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan. Electronic address: sulh@adm.cgmh.org.tw.
Huang YC
Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Chiu CH
Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: chchiu@adm.cgmh.org.tw.

MeSH

Anti-Bacterial AgentsCiprofloxacinDNA GyraseDNA Topoisomerase IVDNA, BacterialDrug Resistance, BacterialElectrophoresis, Gel, Pulsed-FieldFemaleGenotypeHumansIndiaMicrobial Sensitivity TestsMutation, MissensePoint MutationPolymerase Chain ReactionSalmonella typhiSequence Analysis, DNATaiwanTravelTyphoid FeverYoung Adult

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23465712

Citation

Lee, Chia-Jie, et al. "First Isolation of Ciprofloxacin-resistant Salmonella Enterica Serovar Typhi in Taiwan." Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, vol. 46, no. 6, 2013, pp. 469-73.
Lee CJ, Su LH, Huang YC, et al. First isolation of ciprofloxacin-resistant Salmonella enterica serovar Typhi in Taiwan. J Microbiol Immunol Infect. 2013;46(6):469-73.
Lee, C. J., Su, L. H., Huang, Y. C., & Chiu, C. H. (2013). First isolation of ciprofloxacin-resistant Salmonella enterica serovar Typhi in Taiwan. Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, 46(6), 469-73. https://doi.org/10.1016/j.jmii.2013.01.002
Lee CJ, et al. First Isolation of Ciprofloxacin-resistant Salmonella Enterica Serovar Typhi in Taiwan. J Microbiol Immunol Infect. 2013;46(6):469-73. PubMed PMID: 23465712.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - First isolation of ciprofloxacin-resistant Salmonella enterica serovar Typhi in Taiwan. AU - Lee,Chia-Jie, AU - Su,Lin-Hui, AU - Huang,Yhu-Chering, AU - Chiu,Cheng-Hsun, Y1 - 2013/03/05/ PY - 2012/12/25/received PY - 2013/01/09/accepted PY - 2013/3/8/entrez PY - 2013/3/8/pubmed PY - 2014/7/30/medline KW - Ciprofloxacin resistance KW - International travel KW - Quinolone resistance-determining regions KW - Salmonella enterica serovar Typhi SP - 469 EP - 73 JF - Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi JO - J Microbiol Immunol Infect VL - 46 IS - 6 N2 - BACKGROUND/PURPOSE: Typhoid fever is a major cause of disease burden in developing countries. The use of fluoroquinolones, once considered the drugs of choice, should be re-evaluated due to the emergence of quinolone-resistant Salmonella enterica serovar Typhi. In Taiwan, typhoid fever is rare but constitutes an important public health concern. METHODS: In August 2011, two ciprofloxacin-resistant S. Typhi isolates were identified from one patient who had recently travelled to India. The two isolates together with four other ciprofloxacin-susceptible S. Typhi isolates were subjected for molecular investigation. Polymerase chain reaction (PCR) and sequencing were used to analyze the resistance mechanisms. Pulsed-field gel electrophoresis (PFGE) was performed to delineate the genetic relatedness among the isolates. RESULTS: In 2011, a total of 49 typhoid fever cases were reported to the Center for Disease Control in Taiwan, with a significant increase in indigenous cases in northern Taiwan from August to November. In the two S. Typhi isolates with complete resistance to ciprofloxacin [minimum inhibitory concentration (MIC) >32 μg/mL], multiple point mutations in the quinolone resistance-determining regions (QRDRs) of gyrA and parC genes were identified. A unique PFGE pattern was found in the resistant isolates and was different from the other representative susceptible isolates. CONCLUSIONS: The first ciprofloxacin-resistant S. Typhi infection in Taiwan is reported. The emergence and spread of antimicrobial-resistant S. Typhi infection as a result of international travel may become a threat to public health in Taiwan. Clinicians should be well alert when treating patients who may have acquired resistant infections associated with international travel among endemic regions. SN - 1995-9133 UR - https://www.unboundmedicine.com/medline/citation/23465712/First_isolation_of_ciprofloxacin_resistant_Salmonella_enterica_serovar_Typhi_in_Taiwan_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1684-1182(13)00017-0 DB - PRIME DP - Unbound Medicine ER -