Ciprofloxacin 치료에 반응이 없는 유입된 장티푸스 1예
An Imported Case of Typhoid Fever Refractory to Ciprofloxacin Treatment
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장티푸스는 개발도상국에 흔하며, 항균제 내성이 증가하여 치료가 어렵다. 장티푸스 1차 치료제에 내성인 경우에도 퀴놀론은 치료 효과가 있으며, 경구 투여가 가능하므로 3세대 세팔로스포린 주사제에 비해 가격이 싸고 투여하기가 간편하여 개발도상국에서는 장티푸스 치료에 1차 선택제이다. 최근 아시아 지역에서 nalidixic acid에 내성인 장티푸스가 발생하고 이런 내성균은 퀴놀론 제제로 치료가 어렵다. 저자들은 최근 파키스탄에서 감염된 nalidixic acid 내성 장티푸스 예를 경험하였고 문헌 고찰과 함께 임상 경과를 보고한다. 31세 파키스탄 남자로 파키스탄에서 귀국한 후 열이 생겨 14일 후 내원하였다. 경험적으로 경구 ciprofloxacin을 7번 투여했으나 임상적 호전이 없었고, ceftriaxone 주사제로 바꾼 후 호전되었다. 혈액 배양에서 Salmonella Typhi가 확인되었고, nalidixic acid에 대해서는 최소억제 농도가 32 g/mL 이상으로 내성이었고 ciprofloxacin에 대해서는 최소억제농도가 1.0 g/mL으로 검사실 기준으로는 감수성이었다.
Abstract
Salmonella enterica serovar Typhi infection is widely prevalent in developing countries; its treatment has been complicated by the emergence of resistance to antimicrobial agents. Fluoroquinolones are orally administered antimicrobials effective against typhoid fever, including that caused by the multidrug-resistant S. Typhi. They are relatively inexpensive and more convenient to administer com pared to third-generation cephalosporins; hence, they constitute the drugs of choice for the treatment of typhoid fever in developing countries. In Asian countries, however, resistance to nalidixic acid-a prototype of quinolone antibiotics-diminishes the value of fluoroquinolones with regard to the treatment of typhoid fever. We experienced a case of nalidixic acid-resistant S. Typhi infection imported from Pakistan that was clinically refractory to ciprofloxacin treatment. A 31-year-old male presented with a fever of 14 days' duration after returning from his native Pakistan. Oral ciprofloxacin was empirically administered for three days without any beneficial effect. His illness, however, improved after the administration of ceftriaxone for three days. Blood culture revealed the presence of S. Typhi that was resistant to nalidixic acid (minimal inhibitory concentration ≥32 g/mL) but susceptible to ciprofloxacin (minimal inhibitory concentration=1.0 g/mL) in vitro.
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