The bacteria that cause typhoid fever are becoming more and more resistant to antibiotics that are common around the world. New analysis Indicates.
Resistant strain Salmonella Serotype typhoid (S Typhoid fever) — Almost all originated in South Asia — has spread almost 200 times across borders since 1990.
Previously, analysis was limited by small samples. This genomic analysis is the largest to date and is a newly sequenced 3489 isolate (2014-2019) from prospective surveillance studies in the four countries with the highest burden of typhoid fever (Bangladesh, Nepal, Pakistan, India). Collected during the year) is included.
The results of this study, led by Dr. Kesia Estherda Silva of the Department of Infectious Diseases and Geography and Medicine, Stanford University, California, were published online June 21. Lancet microorganisms.
World deaths: 100,000 a year
Typhoid fever remains a global public health threat, infecting 11 million people and killing more than 100,000 each year. Most cases (70%) are in South Asia, but typhoid fever also has a significant presence in sub-Saharan Africa, Southeast Asia, and Oceania.
The findings are further evidence of the need for a global response, the authors write.
Jason Andrews, MD, co-author and associate professor of infectious diseases and geography at Stanford University, said: Medscape Medical News This study helps identify where the greatest burdens and greatest needs of two highly effective typhoid vaccines are.
“We have a higher level of resistance to the latest and greatest antibiotics than we have ever seen,” he said.
He said so far, strategies for tackling typhoid fever include national-level decisions and local funding, which need to be moved to global priorities. “Given the modern travel migration patterns, we can see that when antimicrobial resistance develops in one country, it quickly spreads to other countries.”
According to Andrews, there are about 300-500 cases of typhoid fever annually in the United States. “Approximately 80% of these cases are related to people traveling from South Asia,” he said.
Infectious diseases also occur, especially from people in the United States who visit high-burden countries to meet their families. In many cases, they are unaware of the risks and skip vaccinations, he said. He added that US clinicians can help educate patients traveling to typhoid endemic areas for pre-travel vaccination.
Physician awareness is also important when patients recently return from such areas. The data from this study show that it is necessary to carefully consider which antibiotics are effective in increasing resistance.
The only oral option left in Pakistan
“There is a lack of treatment options for typhoid fever,” Andrews said. Pakistan’s resistance pattern, for example, leaves only one verbal choice. AzithromycinAnd there is increasing resistance to it.
Without that option, “the patient would have to be hospitalized and given an intravenous antibiotic,” he said. “I’m worried.”
In addition, several resistant strains from Pakistan have emerged in the United States.
“In fact, there are some cases that haven’t been tracked by travelers going to Pakistan at all and are believed to be from a local transmission in the United States,” he said.
Valida Bajrovic, MD, assistant professor of infectious disease medicine at Mount Sinai School of Medicine in New York City, said: Medscape Medical News In addition to vaccination of travelers before heading to typhoid endemic areas, doctors avoid careful hand washing, drinking bottled water, and foods that may have been cooked in unsanitary conditions. Therefore, it is necessary to educate patients about avoiding typhoid fever infection.
Bajilovich, who directs antimicrobial management efforts at Mount Sinai Morningside Hospital and Mount Sinai West Hospital, said stricter antimicrobial management efforts are needed, especially in Europe and South Asia, as well as in the United States. ..
“Restricting the use of antibiotics is a way to prevent antibiotic resistance,” she said, adding that such restrictions need to be part of a global effort.
The strains in this study were classified as multidrug resistance (MDR) if they contained a resistance gene. Ampicillin, ChloramphenicolWhen Trimethoprim / Sulfamethoxazole.. The authors also tracked the presence of genes that show resistance to macrolides and quinolones.
Initially, fluoroquinolones were effective against MDR S Typhoid fever became the main treatment in the 1990s. But by the 2010s, S Typhoid fever in South Asia contained mutations in the quinolone resistance-determining region.
The author writes: “Evidence of frequent international (n = 138) and intercontinental migration (n = 59) of antimicrobial resistance was found. S typhoid. “
Analysis shows that since 2000, MDR S Typhoid fever is steadily declining in Bangladesh and India, with a slight increase in Pakistan but less than 5% of typhoid fever strains in Nepal.
However, these are ” Ceftriaxone Resistance (widespread drug resistance), high levels of fluoroquinolone resistance, or azithromycin resistance. These reverse the decline in effective population. S Typhoid fever, “the author writes.
The authors state that this analysis supports the urgency of preventative measures, including the use of typhoid-conjugated vaccines in typhoid-endemic countries.
However, given the increasing spread of resistant strains internationally, they say precautions should not be limited to these countries.
This study was funded by the Bill & Melinda Gates Foundation. Da Silva, Andrews, and Bajrovic do not disclose any relevant financial relationships.
Lancet microorganisms.. Published June 21, 2022. Full text
Marcia Frellick is a freelance journalist based in Chicago. She previously contributed to the Chicago Tribune, Science News, Nurse.com and was the editor of the Chicago Sun-Times, The Cincinnati Enquirer, and St. Cloud (Minnesota) Times. Follow her on her Twitter @mfrellick..
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