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Multi-drug resistance and reduced susceptibility to ciprofloxacin among Salmonella enterica serovar Typhi isolates from the Middle East and Central Asia.
[typhoid]
Typhoid
fever
is
common
in
developing
countries
,
with
an
estimated
120
million
infections
and
700
000
annual
deaths
,
worldwide
.
Fluoroquinolones
have
been
the
treatment
of
choice
for
infection
with
multidrug-resistant
(
MDR
)
Salmonella
enterica
serovar
Typhi
(
S
.
Typhi
)
.
However
,
alarming
reports
of
fluoroquinolone-resistance
and
failure
of
typhoid
fever
treatment
have
recently
been
published
.
To
determine
the
proportion
of
S
.
Typhi
isolates
with
reduced
susceptibility
to
ciprofloxacin
(
RSC
)
from
six
countries
in
the
Middle
East
and
Central
Asia
,
968
S
.
Typhi
isolates
collected
between
2002
and
2007
from
Egypt
,
Uzbekistan
,
Pakistan
,
Qatar
,
Jordan
and
Iraq
were
tested
for
antibiotic
susceptibility
to
five
antibiotics
using
the
disc-diffusion
method
.
MDR
was
defined
as
resistance
to
amicillin
,
chloramphenicol
and
trimethoprim-sulfamethoxazole
.
The
E
-
test
was
employed
to
determine
the
MIC
of
ciprofloxacin
only
.
Nalidixic
acid
resistance
was
evaluated
as
a
marker
for
RSC
.
Interpretations
were
made
according
to
CLSI
guidelines
.
MDR
strains
were
considerably
more
prevalent
in
Iraq
(
83
%
)
and
Pakistan
(
52
%
)
compared
with
the
other
countries
studied
(
13
-
52
%
)
.
Nearly
all
isolates
were
susceptible
(
99
.
7
%
)
to
ceftriaxone
.
RSC
was
detected
in
a
total
of
218
isolates
(
22
%
)
,
mostly
from
Iraq
(
54
/
59
,
92
%
)
,
Uzbekistan
(
98
/
123
,
80
%
)
,
Qatar
(
23
/
43
,
54
%
)
and
Pakistan
(
31
/
65
,
47
%
)
.
Many
of
these
(
21
%
)
were
also
MDR
.
Use
of
nalidixic
acid
resistance
as
an
indicator
for
RSC
was
99
%
sensitive
and
98
%
specific
.
This
study
reinforces
the
need
for
routine
antimicrobial
susceptibility
surveillance
of
enteric
fever
isolates
and
close
review
of
current
therapeutic
policies
in
the
region
.
Diseases
Validation
Diseases presenting
"failure of typhoid fever treatment"
symptom
typhoid
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