Low-level quinolone-resistance in multi-drug resistant typhoid.
OBJECTIVE
To find out the frequency of low-level quinolone-resistance in Multi-Drug Resistant (MDR) typhoid using nalidixic acid screening disc.


METHODS
Descriptive study.


METHODS
Armed Forces Institute of Pathology, Rawalpindi, from January 2005 to December 2005.


METHODS
Blood was obtained from suspected cases of typhoid fever and cultured in to BacT/ALERT. The positive blood cultures bottles were subcultured. The isolates were identified by colony morphology and biochemical tests using API-20E galleries. Susceptibility testing of isolates was done by modified Kirby-Bauer disc diffusion method on Muellar Hinton Agar. For the isolates, which were resistant to nalidixic acid by disc diffusion method, Minimal Inhibitory Concentrations (MICs) of ciprofloxacin and nalidixic acid were determined by using the E-test strips. Disc diffusion susceptibility tests and MICs were interpreted according to the guidelines provided by National Committee for Control Laboratory Standard (NCCLS).


RESULTS
A total of 21(65.5%) out of 32 isolates of Salmonellae were nalidixic acid-resistant by disk diffusion method. All the nalidixic acid-resistant isolates by disc diffusion method were confirmed by MICs for both ciprofloxacin and nalidixic acid. All the nalidixic acid-resistant isolates had a ciprofloxacin MIC of 0.25-1microg/ml (reduced susceptibility) and nalidixic acid MICs > or = 32 microg (resistant). Out of all Salmonella isolates, 24 (75%) were found to be MDR, and all were S. typhi.


CONCLUSIONS
Low-level quinolone-resistance in typhoid was high in this small series. Screening for nalidixic acid resistance with a 30 microg nalidixic acid disk is a reliable and cost-effective method to detect low-level fluoroquinolone resistance, especially in the developing countries.
Mirza
Sajjad Hussain
SH
Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan. menahel@brain.net.pk
Khan
Mumtaz Ahmad
MA
D000890:Anti-Infective Agents / Q000494:pharmacology* / Q000627:therapeutic use; D000962:Antimalarials / Q000494:pharmacology / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000494:pharmacology* / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D009268:Nalidixic Acid / Q000494:pharmacology* / Q000627:therapeutic use; D019384:Nucleic Acid Synthesis Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D010865:Pilot Projects; D011802:Quinidine / Q000494:pharmacology* / Q000627:therapeutic use; D012485:Salmonella typhi / Q000187:drug effects*; D014435:Typhoid Fever / Q000188:drug therapy*
D000890:Anti-Infective Agents; D000962:Antimalarials; D019384:Nucleic Acid Synthesis Inhibitors; D009268:Nalidixic Acid; D002939:Ciprofloxacin; D011802:Quinidine