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Journal of Clinical Microbiology, October 2001, p. 3583-3585, Vol. 39, No. 10
Department of Microbiology, Institute of Child Health,
Dhaka Shishu Hospital,1 and Popular
Diagnostic Centre,2 Dhaka, Bangladesh;
Department of International Health, School of Hygiene and
Public Health, The Johns Hopkins Medical Institutions, Baltimore,
Maryland3; Office of Health, Save the
Children Federation, Washington, D.C.4; and
Department of Internal Medicine, Institute of Tropical
Medicine, Nagasaki University, Nagasaki, Japan5
Received 25 April 2001/Returned for modification 29 May
2001/Accepted 11 July 2001
The turnaround time (TAT) for Salmonella
enterica serovar Typhi identification and reporting
of the antibiotic susceptibility profile was determined for 391 cases of typhoid fever, using the lysis direct plating or lysis
centrifugation method of blood culture along with rapid
antimicrobial susceptibility testing. The TAT was more rapid (TAT for
90% of the patients [TAT90] = 30 h;
TAT100
0095-1137/01/$04.00+0 DOI: 10.1128/JCM.39.10.3583-3585.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.
Rapid Identification and Antibiotic Susceptibility Testing
of Salmonella enterica Serovar Typhi Isolated from
Blood: Implications for Therapy
67 h) than was possible with
conventional methodologies and was equivalent to that reported
previously using more advanced, costly technologies that are largely
unavailable in developing countries. Antibiotic susceptibility
profiles, determined by the rapid antimicrobial susceptibility testing
method, of randomly selected 60 S. enterica serovar
Typhi isolates were identical to those determined by overnight
conventional testing. Preliminary assessment of the impact of the
reduced TAT on physician practices revealed that initial
empirical therapy was prescribed at the time of presentation in most
cases (87 of 108 [81%]) despite awareness that the final report
would be available on the following day. Patients treated
empirically with first-line antibiotics and shown subsequently to be
infected with a multidrug-resistant strain benefited most (8 cases), since therapy was changed appropriately on the following day.
In an additional 21 cases, therapy with an appropriate antibiotic was
initiated after culture results were available. Thus, in approximately
one-fourth (29 of 108 [27%]) of the cases, a change in management to
an agent active for treatment of the isolate was made after receipt of
the test results. However, in no case was therapy changed from a
second-line to a first-line agent, even if the isolate was reported
on the day after presentation to be sensitive to first-line therapy (33 cases). Ways in which to utilize rapid-TAT result reporting in order to
positively influence physicians' prescribing in Bangladesh are the
subject of ongoing research.
*
Corresponding author. Mailing address: Department of
Microbiology, Institute of Child Health, Dhaka Shishu Hospital,
Dhaka-1207, Bangladesh. Phone: 880-2-811-6101. Fax:
880-2-9128308. E-mail: sksaha{at}bangla.net.
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