RESUMEN
Shigella flexneri 4a caused sustained outbreaks in a large long-stay psychiatric centre, Taiwan, 2001-2006. Trimethoprim-sulphamethoxazole (SXT) prophylaxis was administered in 2004. We recovered 108 S. flexneri 4a isolates from 83 symptomatic (including one caregiver) and 12 asymptomatic subjects (11 contacts, one caregiver). The isolates were classified into eight antibiogram types and 15 genotypes (six clusters) by using antimicrobial susceptibility testing and pulsed-field gel electrophoresis of NotI-digested DNA, respectively. These characteristics altered significantly after SXT prophylaxis (P < 0·05), with concomitant emergence of SXT-resistant isolates in two antibiogram types. P01 (n = 71), the predominant epidemic genotype, caused infection in two caregivers and five patients under their care; two P01 isolates were recovered from the same patient 6 months apart. These results indicate the importance of sustained person-to-person transmission of S. flexneri 4a by long-term convalescent, asymptomatic or caregiver carriers, and support the emergence of SXT-resistant strains following selective pressure by SXT prophylaxis.
Asunto(s)
Antibacterianos/farmacología , Profilaxis Antibiótica , Farmacorresistencia Bacteriana/genética , Disentería Bacilar/epidemiología , Shigella flexneri/clasificación , Combinación Trimetoprim y Sulfametoxazol/farmacología , ADN Bacteriano/genética , Brotes de Enfermedades , Disentería Bacilar/microbiología , Disentería Bacilar/prevención & control , Disentería Bacilar/transmisión , Electroforesis en Gel de Campo Pulsado , Genotipo , Humanos , Cuidados a Largo Plazo , Pruebas de Sensibilidad Microbiana , Epidemiología Molecular , Shigella flexneri/genética , Shigella flexneri/aislamiento & purificación , Taiwán/epidemiologíaRESUMEN
PIP: This study examines the social and biological determinants of age at first marriage in 2 townships in Northern Taiwan, one very rural and traditional and the other urban and modernized. Using a sample of 5707 once-married women, a path analysis examined age at first marriage as a function of age, educational status, urban origin, premarital labor force participation, and age at menarche. Age at menarche, with a positive effect on the dependent variable, was the most important direct cause of age at first marriage. This biological factor is interrelated with socioeconomic influences as predictors of age at marriage. Older cohorts of women tended to marry about 2 years earlier than did the women below 30. Urban women had a mean age at first marriage 1.76 year later than did rural women. Age at marriage steadily increases as education increases; a 4 year age differntial exists between those who have no formal education and those who have at least 12 years of education. Also, women who worked before marriage married later than those who had never worked. This study reemphasizes that in Taiwan, as elsewhere, there is a complex interplay of socioeconomic and biological factors embedded within a cultural context that influences age at first marriage for females.^ieng