Campylobacter antimicrobial resistance in Peru: a ten-year observational study.
BACKGROUND
Campylobacter jejuni and Campylobacter coli are food-borne pathogens of great importance and feature prominently in the etiology of developing world enteritis and travellers' diarrhoea. Increasing antimicrobial resistant Campylobacter prevalence has been described globally, yet data from Peru is limited. Our objective was to describe the prevalence trends of fluoroquinolone and macrolide-resistant C. jejuni and C. coli stool isolates from three regions in Peru over a ten-year period.


METHODS
Surveillance for enteric pathogens was conducted in Lima, Iquitos and Cusco between 2001 and 2010. Campylobacter stool isolates were tested for susceptibilities to ciprofloxacin, azithromycin and erythromycin. Susceptibilities were reviewed for 4652 isolates from Lima ( n = 3419), Iquitos ( n = 625) and Cusco ( n = 608).


RESULTS
Comparing the study periods of 2001-2005 and 2006-2010, prevalence of ciprofloxacin-resistant C. jejuni isolates rose in the study areas of Lima (73.1% to 89.8%, p < 0.001) and Iquitos (24.1% to 48.9%, p < 0.001). Ciprofloxacin-resistant C. coli rates also increased in Lima (48.1% to 87.4%, p < 0.001) and Cusco (10.0% to 65.9%, p = 0.005). Small but significant increases in azithromycin-resistant and erythromycin-resistant C. jejuni prevalence were noted in Iquitos (2.2% to 14.9%, p < 0.001; 3.2% to 14.9%, p = 0.002), and erythromycin-resistant C. coli rates increased in Lima (0.0% to 5.3%, p = 0.038). The prevalence of C. jejuni isolates resistant to both ciprofloxacin and azithromycin increased in Iquitos (0.3% to 14.9%, p < 0.001) and Lima (0.3% to 1.6%, p = 0.011), and prevalence of C. jejuni isolates resistant to both ciprofloxacin and erythromycin rose in Iquitos (0.0% to 14.9%, p < 0.001). Ciprofloxacin and erythromycin resistant C. coli prevalence increased in Lima (0.0% to 5.3%, p = 0.034).


CONCLUSIONS
These results have implications for the empirical management of enterocolitis in Peru. Ongoing surveillance is essential to guide appropriate antimicrobial use in this setting. Local epidemiological studies to explore the relationship between increasing antimicrobial resistance and agricultural or human antibiotic use may be valuable.
Bacteriology Department, U.S. Naval Medical Research Unit-6 (NAMRU-6), Venezuela Ave, Block 36, Callao 2, Lima, Peru. spollett@med.usyd.edu.au
Simon
S
Pollett
Claudio
C
Rocha
Rito
R
Zerpa
Lilian
L
Patiño
Augusto
A
Valencia
Máximo
M
Camiña
José
J
Guevara
Martha
M
Lopez
Nancy
N
Chuquiray
Eduardo
E
Salazar-Lindo
Carlos
C
Calampa
Martín
M
Casapia
Rina
R
Meza
Maruja
M
Bernal
Drake
D
Tilley
Michael
M
Gregory
Ryan
R
Maves
Eric
E
Hall
Franca
F
Jones
C Sofia
CS
Arriola
Marieke
M
Rosenbaum
Juan
J
Perez
Matthew
M
Kasper
D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D017963:Azithromycin / Q000494:pharmacology; D002169:Campylobacter Infections / Q000453:epidemiology* / Q000382:microbiology*; D017000:Campylobacter coli / Q000187:drug effects* / Q000302:isolation & purification; D016123:Campylobacter jejuni / Q000187:drug effects* / Q000302:isolation & purification; D002939:Ciprofloxacin / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D004917:Erythromycin / Q000494:pharmacology; D005243:Feces / Q000382:microbiology; D006801:Humans; D008826:Microbial Sensitivity Tests; D010568:Peru / Q000453:epidemiology; D015995:Prevalence
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D004917:Erythromycin; D017963:Azithromycin