Volume 13, Number 12—December 2007
Multidrug-Resistant Typhoid Fever Outbreak in Travelers Returning from Bangladesh
|Case- patient†||Age, y/ sex||Date of onset||Vi-phage type||Ciprofloxacin MIC, μg/mL||Cefotaxime MIC, μg/mL||Treatment‡||FCT, d|
|1C||28/F||Apr 19||E9||0.38||0.094||Ciprofloxacin 500 mg 2× a day for 3 d, cefotaxime 1 g every 12 h + tosulfoxacin 300 mg 2× a day for 11 d||4§|
|2C||17/F||Apr 20||E9||0.38||0.094||Levofloxacin 200 mg 2× a day for 14 d||6|
|3C||17/F||Apr 21||E9||0.38||0.094||Ciprofloxacin 500 mg 2× a day for 3 d, cefotaxime 1 g every 12 h + tosulfoxacin 300 mg 2× a day for 11 d||3|
|4P||19/F||Apr 21||NA||NA||NA||Levofloxacin 200 mg 2× a day for 3 d, cefotaxime 1 g every 12 h + tosulfoxacin 300 mg 2× a day for 13 d||12|
|5C||12/M||Apr 22||E9||0.38||0.094||Azithromycin 1 g for 1 d, 500 mg a day for 2 d; norfloxacin 250 mg 3× a day for 11 d||7|
|6C||16/F||Apr 23||E9||0.38||0.094||Levofloxacin 500 mg a day for 14 d||5|
|7C||19/M||Apr 23||E9||0.38||0.064||Ciprofloxacin 500 mg 2× a day for 5 d, ceftriaxone 2 g every 12 h for 16 d||6|
|8P||15/M||Apr 28||NA||NA||NA||Levofloxacin 200 mg 2× a day for 18 d||7|
*MICs were determined by E-test (AB Biodisk, Solna, Sweden). MICs of chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, and nalidixic acid were >256 μg/mL, >256 μg/mL, >32 μg/mL, and >256 μg/mL, respectively. FCT, fever clearance time (time from the start of treatment until the body temperature reached 37.5°C and remained at 37.5°C for 48 h); NA:, not available.
†C, confirmed case, i.e., a patient with fever (>38°C) for >3 d and a laboratory-confirmed positive blood culture for Salmonella enterica serotype Typhi; P, probable case, i.e., a patient with fever (>38°C) for >3 d without isolation of S. Typhi.
‡Daily dosages are shown. All fluoroquinolones were given orally. Tosufloxacin is a fluoroquinolone with properties similar to those of levofloxacin.
§Fever relapsed 15 d after completion of treatment. Retreatment with tosufloxacin, 600 mg/d for 14 d, was successful.