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Ciprofloxacin resistant Campylobacter spp. in humans: an epidemiological and laboratory study
1Public Health Laboratory, Derriford Hospital, Plymouth, UK.
Abstract:
From the end of April 1991 until the end of 1991, 2209 isolates of Campylobacter spp. have been collected in Plymouth PHL of which 91 (4.1%) were resistant to ciprofloxacin. None of the 91 patients involved had taken a quinolone, but 30/91 (33%) had travelled abroad (16 to the Iberian peninsula) in the three months preceding isolation of the ciprofloxacin-resistant Campylobacter spp. In the case-control study 12/15 (80%) of the cases had recently consumed poultry as had 20/24 (83%) of controls with enteritis due to ciprofloxacin-susceptible Campylobacter spp. A small study of poultry purchased from the supermarket revealed that only 1/37 campylobacters isolated from 64 UK bred chickens was resistant to ciprofloxacin, whereas 7/26 campylobacters isolated from 50 imported chickens were ciprofloxacin-resistant. Of the 75 clinical isolates of ciprofloxacin-resistant Campylobacter spp. subjected to detailed analysis, 68 were Campylobacter jejuni, six were Campylobacter lari, and one was Campylobacter coli. All isolates from man and poultry were resistant to ciprofloxacin, norfloxacin, sparfloxacin and tosufloxacin, and there was an association between fluoroquinolone-resistance and increased MICs of tetracycline. The range of susceptibility to erythromycin and kanamycin were typical of the species. gyrA from C. jejuni P6 (a case with history of travel to Spain) and C. jejuni P16 (isolate from imported chicken) contained point mutations corresponding to an amino acid substitution of isoleucine for threonine at codon 86. It has been suggested that veterinary use of quinolones, notably enrofloxacin, is providing a selective pressure for emergence of resistance to ciprofloxacin amongst human isolates. Now that enrofloxacin has been licensed for use in broiler flocks in the UK, it will be interesting to monitor the prevalence of resistance of campylobacters to quinolones in UK-produced poultry and in UK-acquired human infection.
Insights
Ciprofloxacin-resistant Campylobacter infections were identified in Plymouth, with travel and poultry consumption as potential risk factors. Veterinary use of quinolones may drive this emerging resistance in both humans and poultry.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Ciprofloxacin resistance in Campylobacter spp. emerged in Plymouth, UK, in 1991.
- A significant proportion of patients with resistant infections had no prior quinolone exposure but had recent travel history, particularly to the Iberian Peninsula.
Purpose of the Study:
- To investigate the prevalence and potential sources of ciprofloxacin-resistant Campylobacter infections.
- To explore the association between travel, poultry consumption, and the emergence of fluoroquinolone resistance.
Main Methods:
- Collection and antimicrobial susceptibility testing of Campylobacter isolates from human patients.
- Case-control study to identify risk factors.
- Analysis of Campylobacter isolates from retail poultry (UK-bred and imported).
- Molecular analysis of gyrA gene in resistant isolates.
Main Results:
- 4.1% of 2209 Campylobacter isolates were ciprofloxacin-resistant.
- 33% of patients with resistant infections reported recent foreign travel.
- Poultry, especially imported, showed higher rates of ciprofloxacin resistance compared to UK-bred chickens.
- Resistant isolates exhibited cross-resistance to other fluoroquinolones and increased tetracycline MICs.
- Specific gyrA mutations were identified in resistant human and poultry isolates.
Conclusions:
- Travel and poultry consumption are associated with ciprofloxacin-resistant Campylobacter infections.
- Emergence of resistance is linked to fluoroquinolone use, potentially including veterinary applications.
- Continued monitoring of quinolone resistance in poultry and human infections is crucial, especially with the licensing of enrofloxacin for broiler flocks.