Ciprofloxacin 치료에 실패한 국내에서감염된 장티푸스 1예
A Case of Typhoid Fever to Failed Ciprofloxacin, Infected in Korea
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장티푸스의 경험적 1차 치료 항생제는 현재 ciprofloxacin이 가장 많이 사용되고 있다. 하지만 최근 아시아의 여러 개발도상국에서 내성이 문제되고 있다. 국내에서도 약제내성균이 증가되고 있어서 임상적 치료에 반응이 없는 경우 nalidixic acid 내성균에 의한 장티푸스를 고려해야 한다. 저자들은 국내에서 내국인이 감염된 장티푸스가 ciprofloxacin 치료에 실패한 예를 경험하였기에 문헌 고찰과 함께 보고한다. 47세 여성은 발열과 두통을 주소로 입원하였다. 입원 4일 뒤 혈액 배양 검사에서 Salmonella enterica serovar Typhi 가 동정되어서 감수성을 보인 ciprofloxacin을 4일간 투여하였으나 39℃ 이상의 발열과 혈성 설사가 동반되고, 균혈증이 지속되었고 nalidixic acid 내성으로 나타나서 ampicillin/sulbactam으로 변경 치료 후 호전되었다.
Abstract
Typhoid fever caused by Salmonella enterica serovar Typhi (S. typhi) and usually ciprofloxacin is first used for treatment. However, the incidence of fluoroquinolone resistance or reduced susceptibility in S. typhi has been increased in Asia over the past decade and there have been reports of failed treatment with ciprofloxacin. Recently, if typhoid fever does not improved with ciprofloxacin treatment, S. typhi with reduced susceptibility to ciprofloxacin should be considered. We experienced a case of nalidixic acid-resistant S. typhi infection that was refractory to treatment with ciprofloxacin in Korea. A 47-year-old woman presented with fever and headache for 14 days. Blood culture revealed the presence of S. typhi that was susceptible to ciprofloxacin. However, she remained feverish and new symptoms of abdominal pain and bloody diarrhea developed after 5 days treatment with ciprofloxacin and subsequent testing showed that isolate was resistant to nalidixic acid.
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