Suitable Disk Antimicrobial Susceptibility Breakpoints Defining Salmonella enterica Serovar Typhi Isolates with Reduced Susceptibility to Fluoroquinolones

Christopher M. Parry, Chau Tran Thuy, Sabina Dongol, Abhilasha Karkey, Ha Vinh, Nguyen Tran Chinh, Pham Thanh Duy, Tran Vu Thieu Nga, James I. Campbell, Nguyen Van Minh Hoang, Amit Arjyal, Zulfiqar A. Bhutta, Sujit K. Bhattacharya, Magdarina D. Agtini, Baiqing Dong, Do Gia Canh, Aliya Naheed, John Wain, Tran Tinh Hien, Buddha BasnyatLeon Ochiai, John Clemens, Jeremy J. Farrar, Christiane Dolecek, Stephen Baker

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Abstract

Infections with Salmonella enterica serovar Typhi isolates that have reduced susceptibility to ofloxacin (MIC = 0.25 µg/ml) or ciprofloxacin (MIC = 0.125 µg/ml) have been associated with a delayed response or clinical failure following treatment with these antimicrobials. These isolates are not detected as resistant using current disk susceptibility breakpoints. We examined 816 isolates of S. Typhi from seven Asian countries. Screening for nalidixic acid resistance (MIC = 16 µg/ml) identified isolates with an ofloxacin MIC of =0.25 µg/ml with a sensitivity of 97.3% (253/260) and specificity of 99.3% (552/556). For isolates with a ciprofloxacin MIC of =0.125 µg/ml, the sensitivity was 92.9% (248/267) and specificity was 98.4% (540/549). A zone of inhibition of =28 mm around a 5-µg ofloxacin disc detected strains with an ofloxacin MIC of =0.25 µg/ml with a sensitivity of 94.6% (246/260) and specificity of 94.2% (524/556). A zone of inhibition of =30 mm detected isolates with a ciprofloxacin MIC of =0.125 µg/ml with a sensitivity of 94.0% (251/267) and specificity of 94.2% (517/549). An ofloxacin MIC of =0.25 µg/ml and a ciprofloxacin MIC of =0.125 µg/ml detected 74.5% (341/460) of isolates with an identified quinolone resistance-inducing mutation and 81.5% (331/406) of the most common mutant (carrying a serine-to-phenylalanine mutation at codon 83 in the gyrA gene). Screening for nalidixic acid resistance or ciprofloxacin and ofloxacin disk inhibition zone are suitable for detecting S. Typhi isolates with reduced fluoroquinolone susceptibility.
Original languageEnglish
Pages (from-to)5201-5208
Number of pages8
JournalAntimicrobial Agents and Chemotherapy
Volume54
Issue number12
DOIs
Publication statusPublished - Dec 2010

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