Journal Article

Quinolone-Resistant <i>Salmonella typhi</i> in Viet Nam: Molecular Basis of Resistance and Clinical Response to Treatment

John Wain, Nguyen T. T. Hoa, Nguyen T. Chinh, Ha Vinh, Martin J. Everett, To S. Diep, Nicholas P. J. Day, Tom Solomon, Nicholas J. White, Laura J. V. Piddock and Christopher M. Parry

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 25, issue 6, pages 1404-1410
Published in print December 1997 | ISSN: 1058-4838
Published online December 1997 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/516128
Quinolone-Resistant Salmonella typhi in Viet Nam: Molecular Basis of Resistance and Clinical Response to Treatment

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Nalidixic acid-resistant Salmonella typhi (NARST) was first isolated in Viet Nam in 1993. Analysis of the quinolone resistance-determining region of gyrA in 20 NARST isolates by polymerase chain reaction and single-stranded conformational polymorphism yielded two novel patterns: pattern II corresponding to a point mutation at nucleotide 87 Asp → Gly (n = 17), and pattern III corresponding to a point mutation at nucleotide 83 Ser → Phe (n = 3). In trials of short-course ofloxacin therapy for uncomplicated typhoid, 117 (78%) of 150 patients were infected with multidrug-resistant S. typhi, 18 (15%) of which were NARST. The median time to fever clearance was 156 hours (range, 30-366 hours) for patients infected with NARST and 84 hours (range, 12-378 hours) for those infected with nalidixic acid-susceptible strains (P < .001). Six (33.3%) of 18 NARST infections required retreatment, whereas 1 (0.8%) of 132 infections due to susceptible strains required retreatment (relative risk = 44; 95% confidence interval = 5.6-345; P < .0001). We recommend that short courses of quinolones not be used in patients infected with NARST.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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