title: Highly resistant Salmonella enterica serovar Typhi with a novel gyrA mutation raises questions about the long-term efficacy of older fluoroquinolones for treating typhoid fever.
abstract: As a consequence of multidrug resistance, clinicians are highly dependent on fluoroquinolones for treating the serious systemic infection typhoid fever. While reduced susceptibility to fluoroquinolones, which lessens clinical efficacy, is becoming ubiquitous, comprehensive resistance is exceptional. Here we report ofloxacin treatment failure in typhoidal patient infected with a novel, highly fluoroquinolone-resistant isolate of Salmonella enterica serovar Typhi. The isolation of this organism has serious implications for the long-term efficacy of ciprofloxacin and ofloxacin for typhoid treatment.
authors.affiliation: Oxford University Clinical Research Unit—Patan Academy of Health Sciences, Kathmandu, Nepal.
authors.forename: Kanika Deshpande
authors.initials: KD
authors.lastname: Koirala
authors.forename: Duy Pham
authors.initials: DP
authors.lastname: Thanh
authors.forename: Sudeep Dhoj
authors.initials: SD
authors.lastname: Thapa
authors.forename: Amit
authors.initials: A
authors.lastname: Arjyal
authors.forename: Abhilasha
authors.initials: A
authors.lastname: Karkey
authors.forename: Sabina
authors.initials: S
authors.lastname: Dongol
authors.forename: Upendra Man
authors.initials: UM
authors.lastname: Shrestha
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Farrar
authors.forename: Buddha
authors.initials: B
authors.lastname: Basnyat
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D000595:Amino Acid Sequence; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000235:genetics*; D027081:DNA Gyrase / Q000235:genetics*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D009154:Mutation; D009390:Nepal; D015242:Ofloxacin / Q000627:therapeutic use; D012485:Salmonella typhi / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification / Q000472:pathogenicity; D017211:Treatment Failure; D014435:Typhoid Fever / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D024841:Fluoroquinolones; D017963:Azithromycin; D015242:Ofloxacin; D027081:DNA Gyrase