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Journal of Clinical Microbiology, October 2001, p. 3583-3585, Vol. 39, No. 10
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

Samir K. Saha,1,2,* Gary L. Darmstadt,3,4 Abdullah H. Baqui,3 M. Hanif,1,2 M. Ruhulamin,1,2 Mathuram Santosham,3 T. Nagatake,5 and Robert E. Black3

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 <=  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.


Journal of Clinical Microbiology, October 2001, p. 3583-3585, Vol. 39, No. 10
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.10.3583-3585.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.



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