1465. Antibiotic Resistance in Travelersí diarrhea. A 13-year retrospective review in hospitalized patients in Lima, Peru
Session: Poster Abstract Session: Global Health
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Poster Resistance in TD IDWEEK2013 version 1024 x 768.pdf (539.6 kB)
  • Background:

    Travelers’ diarrhea is a common cause of illness in travelers. Antimicrobial resistance is becoming a concern worldwide and resistance to enteropathogens is increasing some areas of the world. We did a retrospective analysis of the enteric pathogens causing travelers’ diarrhea that required hospitalization, determining the frequency of antibiotic resistance.

    Methods:

    Patients with travelers’ diarrhea hospitalized at the British American Hospital between 2000 and 2012 with positive stool cultures were included in the study. Charts were reviewed for demographic data and microbiologic results. 

    Results:

    During our study period 352 travelers were hospitalized because of diarrhea. Of the 242 who had a stool culture done, 107 (44.2%) had a positive stool culture. The median age was 36.3 years (range: 18-72,SD 13.1). Most travelers were from North America (42%) and Europe (39%). More than one third of cases (35.5%) occurred during the summer months. The most common pathogen isolated was diarrheogenic  E.coli (66 cases, 61.7%), followed by Shigella (21 cases, 19.6%) and Salmonella (15 cases. 14%). There were 2 cases of Vibrio parahemolyticus and one case each of Aeromonas, Plesiomonas shigelloides and Campylobacter.

    In E.coli resistance to trimethoprim-sulfamethoxazole (TMP-SMX), ampicillin, nalidixic acid (NA), and tetracycline was common (52.3%, 69.2%, 23.4%, 23.1% respectively). There were only 4 (6.3%) cases of documented ciprofloxacin resistance. Among Shigella, 60% of strains were resistant to ampicillin, and 45% to TMP-SMX. Quinolone resistance was seen only in one case (5%). In Salmonella resistance to ampicillin was seen in 57% and to TMP-SMX and chloramphenicol in 46.2% of isolates. Only 2 cases (15.4%) were resistant to NA, and no cases resistant to ciprofloxacin. All isolates were susceptible to third-generation cephalosporins. Among all the isolates, 12 of 18 cases resistant to NA and 4 of 5 cases resistant to ciprofloxacin occurred over the last 6 years.

    Conclusion:

    Ciprofloxacin is still usually adequate for empirically treating travelers’ diarrhea in Lima. However, quinolone resistance is beginning to emerge. Surveillance studies are critical to determine when ciprofloxacin will be no longer a drug of choice for empiric treatment in travelers visiting Peru.

    Melissa Beraun Villa, MD1, Daniel Pita Ortigas1, Eduardo Luna, MD1, Hugo Siu, MD1 and Luis Valdez, MD1,2, (1)British American Hospital, Lima, Peru, (2)Universidad Peruana Cayetano Heredia, Lima, Peru

    Disclosures:

    M. Beraun Villa, None

    D. Pita Ortigas, None

    E. Luna, None

    H. Siu, None

    L. Valdez, None

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