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An Epidemic of Vibrio Cholerae el Tor Inaba Resistant to Several Antibiotics with a Conjugative Group C Plasmid Coding for Type II Dihydrofolate Reductase in Thailand
Between June and October 1982, Vibrio cholerae el tor Inaba phage type Russian 13, resistant to ampicillin (Ap), chloramphenicol (Cm), colistin, neomycin (Nm), kanamycin (Km), gentamicin (Gm), trimethoprim sulfamethoxazole (TMP-SMZ), and tetracycline (Tc), was isolated from 31 children with diarrhea at a hospital in Samutsakorn, Thailand. Thirty of these children were <2 years of age and were admitted to a single pediatric ward. Seventeen of the cases, infected with V. cholerae (MARV) resistant to several antibiotics, were admitted to the hospital for non-gastrointestinal illnesses; these children developed diarrhea and positive cultures for MARV 1–>10 days after admission. The majority of cases occurred in September, when the attack rate in the patient population in 1 pediatric ward was 11.5%. During this period, MARV with the same characteristics was isolated from water used for bathing in a reservoir on the pediatric ward where most of the cases occurred. MARV was not isolated from adults with diarrhea at the hospital. No further MARV infections occurred at the hospital after the water reservoir had been drained and disinfected. V. cholerae isolates from children and water contained a conjugative incompatibility group C plasmid of 100 megadaltons (mDa) encoding resistance to Ap, Cm, Nm, Km, Gm, TMP-SMZ, and Tc. This plasmid hybridized with a DNA probe for genes encoding Type II dihydrofolate reductase (DHFR). As far as we know, this is the first report of MARV with V. cholerae that contained genes coding for Type II DHFR. Water provided for bathing in a reservoir on one pediatric ward was identified as a likely source of infection in some children at the hospital.