title: Susceptibility patterns of enteroaggregative Escherichia coli associated with traveller's diarrhoea: emergence of quinolone resistance.
abstract: Enteroaggregative Escherichia coli (EAggEC) isolates were identified as a cause of traveller's diarrhoea in 50 (9%) of 517 patients and their antimicrobial susceptibility was determined. Molecular epidemiological characterisation and investigation of the mechanisms of acquisition of quinolone resistance among nalidixic acid-resistant EAggEC strains was performed. Seventeen (34%) of 50 patients needed antimicrobial therapy, because of persistence of symptoms in nine cases and the severity of symptoms in eight cases. Ampicillin and tetracycline resistance was high, whereas chloramphenicol and co-trimoxazole showed moderate activity and amoxicillin plus clavulanic acid, nalidixic acid and ciprofloxacin showed very good activity. Resistance to nalidixic acid was demonstrated in three isolates, two from patients who had travelled to India. In all three strains the resistance was linked to mutations in the gyrA gene alone or in both gyrA and parC genes. Although ciprofloxacin shows excellent in-vitro activity and could be useful in the treatment of traveller's diarrhoea in patients travelling abroad, it may not be useful in patients who have journeyed to India or to Mexico.
authors.affiliation: Institut Clínic d'Infeccions i Immunologia, Institut d'Investigacions Biomédiques August Pí i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, School of Medicine, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vila
authors.affiliation: Institut Clínic d'Infeccions i Immunologia, Institut d'Investigacions Biomédiques August Pí i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, School of Medicine, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Martha
authors.initials: M
authors.lastname: Vargas
authors.affiliation: Institut Clínic d'Infeccions i Immunologia, Institut d'Investigacions Biomédiques August Pí i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, School of Medicine, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Institut Clínic d'Infeccions i Immunologia, Institut d'Investigacions Biomédiques August Pí i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, School of Medicine, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Mateu
authors.initials: M
authors.lastname: Espasa
authors.affiliation: Institut Clínic d'Infeccions i Immunologia, Institut d'Investigacions Biomédiques August Pí i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, School of Medicine, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Pujol
authors.affiliation: Institut Clínic d'Infeccions i Immunologia, Institut d'Investigacions Biomédiques August Pí i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, School of Medicine, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Corachán
authors.affiliation: Institut Clínic d'Infeccions i Immunologia, Institut d'Investigacions Biomédiques August Pí i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, School of Medicine, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: M Teresa Jiménez DE
authors.initials: MTJ
authors.lastname: Anta
authors.affiliation: Institut Clínic d'Infeccions i Immunologia, Institut d'Investigacions Biomédiques August Pí i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, School of Medicine, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gascón
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D000890:Anti-Infective Agents / Q000494:pharmacology; D027081:DNA Gyrase / Q000235:genetics; D027101:DNA Topoisomerase IV / Q000235:genetics; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial / Q000235:genetics; D004926:Escherichia coli / Q000187:drug effects* / Q000235:genetics; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology*; D024841:Fluoroquinolones; D006801:Humans; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D009268:Nalidixic Acid / Q000494:pharmacology; D014195:Travel
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D009268:Nalidixic Acid; D027101:DNA Topoisomerase IV; D027081:DNA Gyrase