title: First isolation of ciprofloxacin-resistant Salmonella enterica serovar Typhi in Taiwan.
abstract: OBJECTIVE
  Typhoid fever is a major cause of disease burden in developing countries. The use of fluoroquinolones, once considered the drugs of choice, should be re-evaluated due to the emergence of quinolone-resistant Salmonella enterica serovar Typhi. In Taiwan, typhoid fever is rare but constitutes an important public health concern.
  
  
  METHODS
  In August 2011, two ciprofloxacin-resistant S. Typhi isolates were identified from one patient who had recently travelled to India. The two isolates together with four other ciprofloxacin-susceptible S. Typhi isolates were subjected for molecular investigation. Polymerase chain reaction (PCR) and sequencing were used to analyze the resistance mechanisms. Pulsed-field gel electrophoresis (PFGE) was performed to delineate the genetic relatedness among the isolates.
  
  
  RESULTS
  In 2011, a total of 49 typhoid fever cases were reported to the Center for Disease Control in Taiwan, with a significant increase in indigenous cases in northern Taiwan from August to November. In the two S. Typhi isolates with complete resistance to ciprofloxacin [minimum inhibitory concentration (MIC) >32 μg/mL], multiple point mutations in the quinolone resistance-determining regions (QRDRs) of gyrA and parC genes were identified. A unique PFGE pattern was found in the resistant isolates and was different from the other representative susceptible isolates.
  
  
  CONCLUSIONS
  The first ciprofloxacin-resistant S. Typhi infection in Taiwan is reported. The emergence and spread of antimicrobial-resistant S. Typhi infection as a result of international travel may become a threat to public health in Taiwan. Clinicians should be well alert when treating patients who may have acquired resistant infections associated with international travel among endemic regions.
authors: Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors: Chia-Jie
authors: CJ
authors: Lee
authors: Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan. Electronic address: sulh@adm.cgmh.org.tw.
authors: Lin-Hui
authors: LH
authors: Su
authors: Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors: Yhu-Chering
authors: YC
authors: Huang
authors: Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: chchiu@adm.cgmh.org.tw.
authors: Cheng-Hsun
authors: CH
authors: Chiu
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002939:Ciprofloxacin / Q000494:pharmacology*; D027081:DNA Gyrase / Q000235:genetics; D027101:DNA Topoisomerase IV / Q000235:genetics; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006801:Humans; D007194:India; D008826:Microbial Sensitivity Tests; D020125:Mutation, Missense; D017354:Point Mutation; D016133:Polymerase Chain Reaction; D012485:Salmonella typhi / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*; D017422:Sequence Analysis, DNA; D013624:Taiwan; D014195:Travel; D014435:Typhoid Fever / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D002939:Ciprofloxacin; D027101:DNA Topoisomerase IV; D027081:DNA Gyrase
keywords: Ciprofloxacin resistance; International travel; Quinolone resistance-determining regions; Salmonella enterica serovar Typhi