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Predicting cholera epidemics through monitoring the environment for the presence of pathogenic Vibrio cholerae is complicated by the presence in water of a large number of mostly nonpathogenic V. cholerae strains. V. cholerae strains causing recent cholera epidemics in Bangladesh carry the sulfamethoxazole-trimethoprim (SXT) element, which encodes resistance to several antibiotics. Here, we show that the use of a culture medium containing streptomycin, sulfamethoxazole, and trimethoprim (the antibiotic selection technique [AST]) can significantly enhance the isolation of environmental V. cholerae O1 with epidemic potential (P&lt;.001). The AST was also used to monitor the recent emergence and spread of a new multiple-antibiotic-resistant strain of V. cholerae in Bangladesh. The results of this study support the hypothesis that pre-epidemic amplification of pathogenic V. cholerae occurs in the human host and leads to the start of an epidemic cycle dominated by a single clone of V. cholerae that spreads rapidly through environmental waters.

the journal of infectious diseases (online. university of chicago press)/the journal of infectious diseases

An Improved Technique for Isolation of Environmental<i>Vibrio cholerae</i>with Epidemic Potential: Monitoring the Emergence of a Multiple‐Antibiotic–Resistant Epidemic Strain in Bangladesh

An Improved Technique for Isolation of EnvironmentalVibrio choleraewith Epidemic Potential: Monitoring the Emergence of a Multiple‐Antibiotic–Resistant Epidemic Strain in Bangladesh