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Bacteremia, Thailand by CDCdocs

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									                                                                                                                             LETTERS



      Drug-resistant                          evaluate MICs for nalidixic acid,              enrofloxacin, a veterinary fluoro-
      Nontyphoidal
                                              ciprofloxacin,      and   ceftriaxone.         quinolone, is used in animals in the
                                              Susceptibility was defined according           poultry, swine, and seafood industries.
       Salmonella                             to the 2005 criteria for Salmonella of         Ceftiofur, a third-generation cephalo-
       Bacteremia,                            the Clinical Laboratory Standards              sporin, is used extensively in swine
        Thailand1
                                              Institute (CLSI, formerly NCCLS) (6).          for treatment and prevention of dis-
                                                   Isolates showed high frequencies          ease and for growth promotion. When
     To the Editor: Despite improved          of antimicrobial drug resistance               compared with previous susceptibility
public health, serious infections with        (Figure). All S. Choleraesuis isolates         patterns (5), current nontyphoidal
nontyphoidal Salmonella enterica              with ceftriaxone resistance also               Salmonella infections in humans in
remain a major clinical and public            showed high levels of resistance to            Thailand are more resistant to
health concern in Thailand and                nalidixic acid (MIC >256 µg/mL);               quinolones and cephalosporins.
worldwide (1,2). Life-threatening             most of these also had reduced sus-            Susceptibility to nalidixic acid corre-
Salmonella infections resistant to flu-       ceptibility to ciprofloxacin (MIC              lates well with reduced susceptibility
oroquinolones, extended-spectrum              >0.125 µg/mL). Of 73 nalidixic                 to ciprofloxacin. An alarming increase
cephalosporins, or both, have been            acid–resistant Salmonella isolates, 55         in ceftriaxone resistance in S.
increasingly reported (3). Use of             (75%) required a ciprofloxacin MIC             Choleraesuis may be associated with
antimicrobial drugs for disease pre-          >0.125 µg/mL, 14 (19%) required an             inappropriate cephalosporin use in
vention and growth promotion in               MIC of 0.094 µg/mL, and 4 (6%)                 swine farming. Major revisions in
food animals has been implicated in           required an MIC of 0.064 µg/mL. One            current policies for use of antimicro-
this increase in drug resistance (4).         patient with aortitis caused by ceftri-        bial drugs in food animals in Thailand
Because of extensive global travel,           axone-resistant S. Choleraesuis died           are warranted.
such increases affect the medical             of a ruptured mycotic aneurysm.
community domestically and interna-                In the food animal industry, the
                                                                                                  This study was supported by a
tionally (5). We report a pilot survey        effect of using antimicrobial drugs has
                                                                                             research grant from the National Research
of drug resistance in Salmonella spp.         long been a subject of concern (7–9).
                                                                                             Council of Thailand through Chulalong-
in Thailand.                                  Evidence from molecular epidemio-
                                                                                             korn University, Ratchadapiseksompotch
     We studied archival nontyphoidal         logic studies (9) suggests that these
                                                                                             Fund from Faculty of Medicine,
Salmonella isolates from bacteremic           concerns are genuine and that serious
                                                                                             Chulalongkorn University, and a develop-
patients at King Chulalongkorn                problems must be addressed. This
                                                                                             ment grant for new faculty/researchers,
Memorial Hospital from January 2003           concern is also supported by reports
                                                                                             Chulalongkorn University. W.K. was sup-
to October 2005 and from bacteremic           of fatal, invasive, nontyphoidal
                                                                                             ported by the Faculty Fund, Faculty of
patients in Thailand sent to the World        Salmonella infections resistant to
                                                                                             Medicine and Research Scholar Fund,
Health      Organization      National        quinolones or extended-spectrum
                                                                                             Thailand Research Fund.
Salmonella and Shigella Center in             cephalosporins (7,10). In Thailand,
Bangkok during the first half of 2005.
The isolates from these archives were
nonoverlapping and were kept frozen
at −80°C. Isolates were divided into
Salmonella serovar Choleraesuis and
other nontyphoidal Salmonella (non-
Choleraesuis) because we observed
that Choleraesuis isolates show a high-
er frequency of resistance to fluoro-
quinolones and extended-spectrum
cephalosporins than non-Choleraesuis
isolates. A standard Etest method (AB
Biodisk, Solna, Sweden) was used to           Figure. Percentage of nontyphoidal Salmonella isolates resistant to nalidixic acid (NA) and
                                              ceftriaxone (CTRX), Thailand. KCMH, King Chulalongkorn Memorial Hospital; WHO-
                                              Salm, World Health Organization Salmonella and Shigella Center. Cho, Choleraesuis;
1Presented     at the 16th European           non-Cho, non-Choleraesuis. The analysis included 10 Cho isolates from KCMH, 44 Cho
Congress of Clinical Microbiology and         isolates from WHO-Salm, 27 non-Cho isolates from KCMH, and 41 non-Cho isolates from
Infectious Diseases, April 1–4, 2006, Nice,   WHO-Salm. Two Cho isolates from WHO-Salm with intermediate MICs for ceftriaxone are
France.                                       also included.


                             Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 13, No. 3, March 2007                             501
LETTERS


    Wanla Kulwichit,* Tanittha                     9. Su LH, Chiu CH, Chu C, Ou JT.               tinued. Results of laboratory studies
   Chatsuwan,* Chudaachhara                           Antimicrobial resistance in nontyphoid      were the following: leukocyte count
                                                      Salmonella serotypes: a global challenge.
 Unhasuta,* Chaiwat Pulsrikarn,†                      Clin Infect Dis. 2004;39:546–51.            13.3/mm3 (71% polymorphonuclear
  Aroon Bangtrakulnonth,† and                     10. Helms M, Vastrup P, Gerner-Smidt P,         leukocytes, 18% bands) and normal
     Anan Chongthaleong*                              Molbak K. Excess mortality associated       hematocrit, platelet count, blood urea
*Chulalongkorn University, Bangkok,                   with     antimicrobial     drug–resistant   nitrogen and creatinine concentra-
Thailand; and †World Health Organization              Salmonella typhimurium. Emerg Infect
                                                      Dis. 2002;8:490–5.                          tions, and liver-associated enzymes.
National Salmonella and Shigella Center,
                                                                                                       A marker pen was used to track
Bangkok, Thailand
                                                  Address for correspondence: Wanla Kulwichit,    the rapid advance of erythema
                                                  Department of Medicine, Faculty of Medicine,    overnight from her anterior, inferior
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502                            Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 13, No. 3, March 2007

								
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