Update on Extensively Drug-Resistant <i>Salmonella</i> Serotype Typhi Infections Among Travelers to or from Pakistan and Report of Ceftriaxone-Resistant <i>Salmonella</i> Serotype Typhi Infections Among Travelers to Iraq — United States, 2018–2019

Watkins, Louise Francois; Winstead, Alison; Appiah, Grace D.; Friedman, Cindy R.; Medalla, Felicita; Hughes, Michael; Birhane, Meseret; Schneider, Zachary; Marcenac, Perrine; Hanna, Simon; Godbole, Gauri; Walblay, Kelly; Wiggington, Ashley E.; Leeper, Molly; Meservey, Elizabeth H; Tagg, Kaitlin A.; Chen, Jessica C.; Abubakar, Abdinasir; Lami, Faris; Asaad, Asaad M.; Sabaratnam, Vickneswaran; Ikram, Aamer; Angelo, Kristina M.; Walker, Allison Taylor; Mintz, Eric D.

doi:10.15585/mmwr.mm6920a2

Cited by 48 publications

(24 citation statements)

References 7 publications

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“…Ever since the first outbreak in Sindh, more than 17,000 cases of XDR typhoid have been reported [13]. Although many studies in Pakistan have been previously limited to Sindh, there have been reports of emerging cases nationwide [14,15] and elsewhere due to provincial and international travel [16]. Moreover, a rise in typhoid cases with similar clinical manifestations to COVID has been observed during the pandemic, with more than 20,000 cases being diagnosed in Pakistan in the month of June 2020 [17].…”

Section: Introductionmentioning

confidence: 99%

Emerging Trends of Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) Salmonella Typhi in a Tertiary Care Hospital of Lahore, Pakistan

et al. 2021

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Salmonella Typhi is a Gram-negative pathogen that causes typhoid fever in humans. The use of antibiotics to treat typhoid has considerably mitigated its fatality risk, but rising multidrug-resistant (MDR) and extensively drug-resistant (XDR) resistance in Pakistan threatens effective treatment. This study determined the prevalence of MDR and XDR S. Typhi at a local hospital in Lahore. Blood samples (n = 3000) were obtained and processed for bacterial identification. Antibiotic susceptibility test was performed using VITEK® 2 Compound 30 System. Statistical data analysis was performed using a Mann–Whitney U and Kruskal–Wallis H test, respectively. The results revealed 600 positive cultures, of which the majority were found to be XDR S. Typhi (46.1%) and MDR S. Typhi (24.5%) strains. The disease burden of resistant Salmonella strains was greater in males (60.67%) than females (39.33%), with the most affected age group being 0–10 years old (70.4 %). In both the outpatient department (OPD) and general ward, the prevalence of XDR S. Typhi cases was found to be alarmingly high (48.24%), followed by MDR S. Typhi (25.04 %). The results of the statistical analysis demonstrated that the incidence of resistance in MDR and XDR S. Typhi strains was not affected by the age as well as the gender of patients (p > 0.05). The occurrence of resistant strains against four tested antibiotics (azithromycin, ciprofloxacin, imipenem, and meropenem) was found to be similar in different wards and among hospitalized and OPD patients (p > 0.05). Maximum resistance was observed against chloramphenicol and ampicillin in the OPD and pediatric ward. Piperacillin/Tazobactam was observed to be the most effective antibiotic, followed by co-amoxiclav (p < 0.001). This study is effective in validating the existence of MDR and XDR S. Typhi in Lahore, where stringent methods should be applied for controlling its spread.

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Section: Introductionmentioning

confidence: 99%

Emerging Trends of Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) Salmonella Typhi in a Tertiary Care Hospital of Lahore, Pakistan

et al. 2021

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“…The most extreme example is Pakistan, where an outbreak of extensively drug-resistant typhoid has been ongoing since 2016. 7 , 8 , 9 The outbreak is widespread, with over 21 000 cases as of mid-2020, over 70% of which were identified as extensively drug resistant; additional mutations might be emerging. 24 In response, a mass vaccination campaign of children aged 6 months to 10 years was carried out in Hyderabad, Pakistan, in early 2018.…”

Section: Discussionmentioning

confidence: 99%

“… 2 , 5 First identified in 2016, an extensively drug-resistant strain of typhoid fever, exhibiting resistance to third-generation cephalosporins, in addition to ampicillin, chloramphenicol, co-trimoxazole, and fluoroquinolones, has emerged and spread in Pakistan, with sporadic cases reported in travellers throughout the world. 7 , 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

Estimating the effect of vaccination on antimicrobial-resistant typhoid fever in 73 countries supported by Gavi: a mathematical modelling study

Birger

Antillón

Bilcke

et al. 2022

The Lancet Infectious Diseases

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“…Resistance to all three agents is appearing 3536. Since a large outbreak of extensively drug resistant typhoid (resistant to ciprofloxacin, ceftriaxone, amoxycillin, chloramphenicol, and trimethoprim-sulphamethoxazole) in Pakistan in 2016, the treatment choice for such infections has shifted to oral azithromycin or parenteral meropenem 3738…”

Section: How Is It Treated?mentioning

confidence: 99%

Enteric fever

Basnyat

Qamar

Rupali

et al. 2021

BMJ

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Update on Extensively Drug-Resistant Salmonella Serotype Typhi Infections Among Travelers to or from Pakistan and Report of Ceftriaxone-Resistant Salmonella Serotype Typhi Infections Among Travelers to Iraq — United States, 2018–2019

Cited by 48 publications

References 7 publications

Emerging Trends of Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) Salmonella Typhi in a Tertiary Care Hospital of Lahore, Pakistan

Emerging Trends of Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) Salmonella Typhi in a Tertiary Care Hospital of Lahore, Pakistan

Estimating the effect of vaccination on antimicrobial-resistant typhoid fever in 73 countries supported by Gavi: a mathematical modelling study

Enteric fever

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