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Laboratory-Based Surveillance of Salmonella Serotype Typhi Infections in the United States
Antimicrobial Resistance on the Rise
Marta-Louise Ackers, MD, MPH;
Nancy D. Puhr;
Robert V. Tauxe, MD, MPH;
Eric D. Mintz, MD, MPH
JAMA. 2000;283:2668-2673.
Context Multidrug-resistant Salmonella serotype Typhi infections have been reported worldwide, but data on the incidence of resistant strains in the United States are lacking.
Objectives To determine the incidence of antimicrobial-resistant Salmonella Typhi infections and to identify risk factors for infection.
Design Cross-sectional laboratory-based surveillance study.
Setting and Participants A total of 293 persons with symptomatic typhoid fever who had Salmonella Typhi isolates and epidemiological information submitted to US public health departments and laboratories from June 1, 1996, to May 31, 1997.
Main Outcome Measures Proportion of Salmonella Typhi isolates demonstrating resistance to 12 antimicrobial agents; patient epidemiological factors associated with drug-resistant infections.
Results Median age was 21 years (range, 3 months to 84 years); 56% were male. Two hundred twenty-eight (80%) were hospitalized; 2 died. In the 6 weeks before illness onset, 81% of patients had traveled abroad. Seventy-four Salmonella Typhi isolates (25%) were resistant to 1 or more antimicrobial agent, and 51 (17%) were resistant to 5 or more agents, including ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug-resistant Salmonella Typhi [MDRST]). Although no resistance to ciprofloxacin or ceftriaxone was observed, 20 isolates (7%) were nalidixic acid–resistant (NARST). Patients with MDRST and NARST infections were more likely to report travel outside the United States, particularly to the Indian subcontinent (Bangladesh, India, and Pakistan) (odds ratio [OR], 29.3; 95% confidence interval [CI], 6.8-126.7; P<.001 and OR, 35.9; 95% CI, 3.4-377.3; P<.001, respectively).
Conclusions Our data suggest that ciprofloxacin and ceftriaxone are appropriate empirical therapy for suspected typhoid fever; however, resistance may be anticipated. Continued monitoring of antimicrobial resistance among Salmonella Typhi strains will help determine vaccination and treatment policies.
Author Affiliations: Epidemiology Program Office (Dr Ackers) and Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases (Ms Puhr and Drs Tauxe and Mintz), Centers for Disease Control and Prevention, Atlanta, Ga. Dr Ackers is now with the Division of HIV/AIDS, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga.
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