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Typhoid fever in the United States, 1999-2006.
JAMA. 2009 Aug 26; 302(8):859-65.JAMA

Abstract

CONTEXT

Typhoid fever in the United States has increasingly been due to infection with antimicrobial-resistant Salmonella ser Typhi. National surveillance for typhoid fever can inform prevention and treatment recommendations.

OBJECTIVE

To assess trends in infections with antimicrobial-resistant S. Typhi.

DESIGN

Cross-sectional, laboratory-based surveillance study.

SETTING AND PARTICIPANTS

We reviewed data from 1999-2006 for 1902 persons with typhoid fever who had epidemiologic information submitted to the Centers for Disease Control and Prevention (CDC) and 2016 S. Typhi isolates sent by participating public health laboratories to the National Antimicrobial Resistance Monitoring System Laboratory at the CDC for antimicrobial susceptibility testing.

MAIN OUTCOME MEASURES

Proportion of S. Typhi isolates demonstrating resistance to 14 antimicrobial agents and patient risk factors for antimicrobial-resistant infections.

RESULTS

Patient median age was 22 years (range, <1-90 years); 1295 (73%) were hospitalized and 3 (0.2%) died. Foreign travel within 30 days of illness was reported by 1439 (79%). Only 58 travelers (5%) had received typhoid vaccine. Two hundred seventy-two (13%) of 2016 isolates tested were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug-resistant S. Typhi [MDRST]); 758 (38%) were resistant to nalidixic acid (nalidixic acid-resistant S. Typhi [NARST]) and 734 NARST isolates (97%) had decreased susceptibility to ciprofloxacin. The proportion of NARST increased from 19% in 1999 to 54% in 2006. Five ciprofloxacin-resistant isolates were identified. Patients with resistant infections were more likely to report travel to the Indian subcontinent: 85% of patients infected with MDRST and 94% with NARST traveled to the Indian subcontinent, while 44% of those with susceptible infections did (MDRST odds ratio, 7.5; 95% confidence interval, 4.1-13.8; NARST odds ratio, 20.4; 95% confidence interval, 12.4-33.9).

CONCLUSION

Infection with antimicrobial-resistant S. Typhi strains among US patients with typhoid fever is associated with travel to the Indian subcontinent, and an increasing proportion of these infections are due to S. Typhi strains with decreased susceptibility to fluoroquinolones.

Authors+Show Affiliations

Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-22, Atlanta, GA 30341, USA. mlynch1@cdc.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19706859

Citation

Lynch, Michael F., et al. "Typhoid Fever in the United States, 1999-2006." JAMA, vol. 302, no. 8, 2009, pp. 859-65.
Lynch MF, Blanton EM, Bulens S, et al. Typhoid fever in the United States, 1999-2006. JAMA. 2009;302(8):859-65.
Lynch, M. F., Blanton, E. M., Bulens, S., Polyak, C., Vojdani, J., Stevenson, J., Medalla, F., Barzilay, E., Joyce, K., Barrett, T., & Mintz, E. D. (2009). Typhoid fever in the United States, 1999-2006. JAMA, 302(8), 859-65. https://doi.org/10.1001/jama.2009.1229
Lynch MF, et al. Typhoid Fever in the United States, 1999-2006. JAMA. 2009 Aug 26;302(8):859-65. PubMed PMID: 19706859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Typhoid fever in the United States, 1999-2006. AU - Lynch,Michael F, AU - Blanton,Elizabeth M, AU - Bulens,Sandra, AU - Polyak,Christina, AU - Vojdani,Jazmin, AU - Stevenson,Jennifer, AU - Medalla,Felicia, AU - Barzilay,Ezra, AU - Joyce,Kevin, AU - Barrett,Timothy, AU - Mintz,Eric Daniel, PY - 2009/8/27/entrez PY - 2009/8/27/pubmed PY - 2009/9/1/medline SP - 859 EP - 65 JF - JAMA JO - JAMA VL - 302 IS - 8 N2 - CONTEXT: Typhoid fever in the United States has increasingly been due to infection with antimicrobial-resistant Salmonella ser Typhi. National surveillance for typhoid fever can inform prevention and treatment recommendations. OBJECTIVE: To assess trends in infections with antimicrobial-resistant S. Typhi. DESIGN: Cross-sectional, laboratory-based surveillance study. SETTING AND PARTICIPANTS: We reviewed data from 1999-2006 for 1902 persons with typhoid fever who had epidemiologic information submitted to the Centers for Disease Control and Prevention (CDC) and 2016 S. Typhi isolates sent by participating public health laboratories to the National Antimicrobial Resistance Monitoring System Laboratory at the CDC for antimicrobial susceptibility testing. MAIN OUTCOME MEASURES: Proportion of S. Typhi isolates demonstrating resistance to 14 antimicrobial agents and patient risk factors for antimicrobial-resistant infections. RESULTS: Patient median age was 22 years (range, <1-90 years); 1295 (73%) were hospitalized and 3 (0.2%) died. Foreign travel within 30 days of illness was reported by 1439 (79%). Only 58 travelers (5%) had received typhoid vaccine. Two hundred seventy-two (13%) of 2016 isolates tested were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug-resistant S. Typhi [MDRST]); 758 (38%) were resistant to nalidixic acid (nalidixic acid-resistant S. Typhi [NARST]) and 734 NARST isolates (97%) had decreased susceptibility to ciprofloxacin. The proportion of NARST increased from 19% in 1999 to 54% in 2006. Five ciprofloxacin-resistant isolates were identified. Patients with resistant infections were more likely to report travel to the Indian subcontinent: 85% of patients infected with MDRST and 94% with NARST traveled to the Indian subcontinent, while 44% of those with susceptible infections did (MDRST odds ratio, 7.5; 95% confidence interval, 4.1-13.8; NARST odds ratio, 20.4; 95% confidence interval, 12.4-33.9). CONCLUSION: Infection with antimicrobial-resistant S. Typhi strains among US patients with typhoid fever is associated with travel to the Indian subcontinent, and an increasing proportion of these infections are due to S. Typhi strains with decreased susceptibility to fluoroquinolones. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/19706859/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2009.1229 DB - PRIME DP - Unbound Medicine ER -