Clinically and microbiologically derived azithromycin susceptibility breakpoints for Salmonella enterica serovars Typhi and Paratyphi A.

Autor:	Parry CM; Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam Centre for Tropical Medicine and Global Health, Old Road Campus, University of Oxford, Oxford, United Kingdom Liverpool School of Tropical Medicine, Liverpool, United Kingdom London School of Hygiene and Tropical Medicine, London, United Kingdom School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan chris.parry@lshtm.ac.uk., Thieu NT; Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Dolecek C; Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam Centre for Tropical Medicine and Global Health, Old Road Campus, University of Oxford, Oxford, United Kingdom., Karkey A; Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal., Gupta R; Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India., Turner P; Centre for Tropical Medicine and Global Health, Old Road Campus, University of Oxford, Oxford, United Kingdom Cambodia-Oxford Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia Shoklo Malaria Research Unit, Mae Sot, Thailand., Dance D; Centre for Tropical Medicine and Global Health, Old Road Campus, University of Oxford, Oxford, United Kingdom Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos., Maude RR; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand., Ha V; The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Tran CN; The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Thi PL; Dong Thap Provincial Hospital, Cao Lanh, Dong Thap Province, Vietnam., Be BP; Dong Thap Provincial Hospital, Cao Lanh, Dong Thap Province, Vietnam., Phi LT; An Giang Provincial Hospital, Long Xuyen, Vietnam., Ngoc RN; An Giang Provincial Hospital, Long Xuyen, Vietnam., Ghose A; Chittagong Medical College Hospital, Chittagong, Bangladesh., Dongol S; Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal., Campbell JI; Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam Centre for Tropical Medicine and Global Health, Old Road Campus, University of Oxford, Oxford, United Kingdom., Thanh DP; Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Thanh TH; Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Moore CE; Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam Cambodia-Oxford Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia., Sona S; Cambodia-Oxford Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia., Gaind R; Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India., Deb M; Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India., Anh HV; Dong Thap Provincial Hospital, Cao Lanh, Dong Thap Province, Vietnam., Van SN; The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Tinh HT; Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam Centre for Tropical Medicine and Global Health, Old Road Campus, University of Oxford, Oxford, United Kingdom., Day NP; Centre for Tropical Medicine and Global Health, Old Road Campus, University of Oxford, Oxford, United Kingdom Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand., Dondorp A; Centre for Tropical Medicine and Global Health, Old Road Campus, University of Oxford, Oxford, United Kingdom Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand., Thwaites G; Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam Centre for Tropical Medicine and Global Health, Old Road Campus, University of Oxford, Oxford, United Kingdom., Faiz MA; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Specialized Care and Research, Chittagong, Bangladesh., Phetsouvanh R; Centre for Tropical Medicine and Global Health, Old Road Campus, University of Oxford, Oxford, United Kingdom Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos., Newton P; Centre for Tropical Medicine and Global Health, Old Road Campus, University of Oxford, Oxford, United Kingdom Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos London School of Hygiene and Tropical Medicine, London, United Kingdom., Basnyat B; Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal., Farrar JJ; Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam Centre for Tropical Medicine and Global Health, Old Road Campus, University of Oxford, Oxford, United Kingdom., Baker S; Wellcome Trust Major Overseas Programme, The Hospital for Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam Centre for Tropical Medicine and Global Health, Old Road Campus, University of Oxford, Oxford, United Kingdom London School of Hygiene and Tropical Medicine, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Antimicrobial agents and chemotherapy [Antimicrob Agents Chemother] 2015 May; Vol. 59 (5), pp. 2756-64. Date of Electronic Publication: 2015 Mar 02.
DOI:	10.1128/AAC.04729-14
Abstrakt:	Azithromycin is an effective treatment for uncomplicated infections with Salmonella enterica serovar Typhi and serovar Paratyphi A (enteric fever), but there are no clinically validated MIC and disk zone size interpretative guidelines. We studied individual patient data from three randomized controlled trials (RCTs) of antimicrobial treatment in enteric fever in Vietnam, with azithromycin used in one treatment arm, to determine the relationship between azithromycin treatment response and the azithromycin MIC of the infecting isolate. We additionally compared the azithromycin MIC and the disk susceptibility zone sizes of 1,640 S. Typhi and S. Paratyphi A clinical isolates collected from seven Asian countries. In the RCTs, 214 patients who were treated with azithromycin at a dose of 10 to 20 mg/ml for 5 to 7 days were analyzed. Treatment was successful in 195 of 214 (91%) patients, with no significant difference in response (cure rate, fever clearance time) with MICs ranging from 4 to 16 μg/ml. The proportion of Asian enteric fever isolates with an MIC of ≤ 16 μg/ml was 1,452/1,460 (99.5%; 95% confidence interval [CI], 98.9 to 99.7) for S. Typhi and 207/240 (86.3%; 95% CI, 81.2 to 90.3) (P < 0.001) for S. Paratyphi A. A zone size of ≥ 13 mm to a 5-μg azithromycin disk identified S. Typhi isolates with an MIC of ≤ 16 μg/ml with a sensitivity of 99.7%. An azithromycin MIC of ≤ 16 μg/ml or disk inhibition zone size of ≥ 13 mm enabled the detection of susceptible S. Typhi isolates that respond to azithromycin treatment. Further work is needed to define the response to treatment in S. Typhi isolates with an azithromycin MIC of >16 μg/ml and to determine MIC and disk breakpoints for S. Paratyphi A. (Copyright © 2015, Parry et al.)
Databáze:	MEDLINE
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