Emergence of multiple drug-resistant Vibrio cholerae 01 in San Pedro Sula, Honduras
Authors: Carol J Palmer, Jose M Dubon, Arba L Ager, Gail Shor-Posner, Marianna K Baum
Journal: The Lancet (1997)

We investigated the occurrence of drug-resistant Vibrio cholerae among patients in the Hospital Regional de la Seguridad Social in San Pedro, Sula, Honduras. 11 patients were studied; five children and six adults. Stool samples were collected in sterile containers and processed for V cholerae isolation. Colonies presumptively identified as V cholerae were tested for antibiotic resistance with standardised disk diffusion.1National Committee for Clinical Laboratory Standards.Performance standards for antimicrobial disk susceptibility tests: approved standard. 4th ed. Vol 10. National Committee for Clinical Laboratory Standards, Villanova, PA1990: M2Google Scholar All suspect V cholerae isolates were sent to the INCIENSA Reference Laboratory for Cholera (Tres Rios, Costa Rica) for confirmation and serotyping. They reported that all strains were V cholerae O1, biotype El Tor, serotype Ogawa. Results of antibiograms indicated that 27% (3/11) of the patients were infected with multidrug-resistant strains. These strains were resistant to tetracycline, trimethoprim-sulfamethoxazole, kanamycin, gentamicin, chloramphenicol, ampicillin, cephalothin, and doxycycline. Isolates were sensitive to all other antibiotics tested (table). All patients recovered after administration of intravenous rehydration fluid and antibiotic treatment consisting of either tetracycline, trimethoprim-sulfamethoxazole, or erythromycin. Patients infected with multidrug-resistant strains were treated with nalidixic acid.TableAntibiograms from cholera strains isolated from 11 patientsAntibioticsPatients1234567891011AmpicillinSSSSSSSRRRRAmikacinSSSSSSSSSSSCefoxitinSSSSSSSSSSSCephalothinSSSSSSSIIRRCephaloridineSSSSSSSSSSSChloramphenicolSSSSSSSRRSRDoxycyclineNTNTNTNTNTNTNTRRSRErythromycinSSSSSSSSSRSGentamycinSSSSSSSRRSRKanamycinSSSSSSSRRSRPenicillinRRRRRRRRRRRNalidixic acidSSSSSSSSSSSTetracyclineSSSSSSSRRSRTrimethoprim-sulfamethoxazoleSSSSSSSRRSRR=resistant; S=sensitive; I=intermediate; NT=not tested. Open table in a new tab R=resistant; S=sensitive; I=intermediate; NT=not tested. Antimicrobial-resistant strains of V cholerae have been previously documented from cholera endemic areas.2Finch MJ Morris JG Kaviti J Kagwanja W Levine MM Epidemiology of antimicrobial resistant cholera in Kenya and East Africa.Am J Trop Med Hyg. 1988; 39: 484-490PubMed Google Scholar Latin America, however, has not been host to endemic cholera for over a century. Honduras witnessed its first case of cholera from the new pandemic on Oct 13, 1991.3Tauxe R Seminario L Tapia R Libel M The Latin American epidemic.in: Achsmuth IK Blake PA Olsvik O Vibrio cholera and cholera: molecular to global perspectives. American Society for Microbiology, Washington DC1994Google Scholar The rapid appearance of multidrug-resistant strains in Latin America may be due to overuse of antibiotics in this area of the world or may indicate that strains of multidrug-resistant cholera are becoming more prevalent as the dominant infecting form of the organism. A report from Guatemala indicated that 47% (7/15) of cholera isolates obtained from patients in Guatemala City were resistant to furazolidone, sulfisoxazole, and streptomycin.4Koo D Aragon A Moscoso V et al.Epidemic cholera in Guatemala, 1993: transmission of a newly introduced strain by street vendors.Epidemiol Infect. 1996; 116: 121-126Crossref PubMed Scopus (32) Google Scholar Guatemalan and Honduran isolates differ from the Latin American epidemic strain, which has been generally susceptible to antibiotics.5Guthmann JP Epidemic cholera in Latin America: spread and routes of transmission.J Trop Med Hyg. 1995; 98: 419-427PubMed Google Scholar Two of the drugs against which the cholera strains developed resistance in our study, tetracycline and trimethoprim, are the two first-line drugs used in Honduras and many other developing countries because they are relatively inexpensive. The development of resistance to these drugs is alarming since the public health consequences from the spread of multidrug-resistant strains of V cholerae through Latin America could necessitate the use of more expensive therapeutic drugs resulting in a severe economic burden. This study was supported by NIH and Fogarty International Center, Grant 5D43TW00017-08. We thank A Rivera, R Sanchez, and G Campos of Honduras for technical assistance with this project.