Abstract
Background: The increasing prevalence of multidrug resistant strains of Vibrio cholerae in recent cholera epidemics across the world is a growing global public health challenge. Objectives: This study was undertaken to identify the patterns of antimicrobial resistance in isolates collected from laboratory-confirmed cases of cholera during an outbreak occurred between August and September 2013 in Sistan and Balouchestan province, southeast of Iran. Patients and Methods: Forty eight V. cholerae isolates were obtained from clinical samples. All the strains were identified as Inaba serotype. Antibiotic susceptibility of the isolates for sulfamethoxazole-trimethoprim, tetracycline, nalidixic acid, ciprofloxacin, ampicillin, ceftriaxone and erythromycin were determined. The method used for antimicrobial susceptibility testing (AST) was standard disk diffusion technique (Kirby-Bauer method). According to the criteria published by the Clinical and Laboratory Standards Institute (CLSI), the isolates were characterized as susceptible, intermediate, or resistant. Results: A ST revealed high levels of resistance to sulfamethoxazole-trimethoprim (89.6%), tetracycline (60.4%), ampicillin (56.3%), nalidixic acid (43.7%) and erythromycin (22.9%). Intermediate susceptibility levels to erythromycin (68.8%), nalidixic acid (56.3%) and ampicillin (33.3%) were identified. All the samples were susceptible to ciprofloxacin and ceftriaxone. Resistant to erythromycin, sulfamethoxazoletrimethoprim and ampicillin dominated in Afghan patients' samples, while a greater proportion of samples from Iranian patients showed resistance to tetracycline and nalidixic acid. All the differences were statistically significant. Conclusions: Our findings suggested a worrying increase in resistance of V. cholerae strains to commonly used antibiotics. Differences in patterns of resistance between Afghan and Iranian patients' samples were observed, which further emphasize a need for constant observation.
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