Typhoid Fever in the US Pediatric Population, 1999–2015: Opportunities for Improvement

2020 ◽  
Author(s):  
Jarred McAteer ◽  
Gordana Derado ◽  
Michael Hughes ◽  
Amelia Bhatnagar ◽  
Felicita Medalla ◽  
...  
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
Typhoid Fever ◽  
Antimicrobial Susceptibility ◽  
Pediatric Population ◽  
The United States ◽  
International Travel ◽  
Typhoid Vaccine ◽  
Illness Onset ◽  
New Public Health

Abstract Background Typhoid fever in the United States is acquired primarily through international travel by unvaccinated travelers. There is currently no typhoid vaccine licensed in the United States for use in children <2 years. Methods We reviewed Salmonella enterica serotype Typhi infections reported to the Centers for Disease Control and Prevention (CDC) and antimicrobial-resistance data on Typhi isolates in CDC’s National Antimicrobial Resistance Monitoring System from 1999 through 2015. Results 5131 cases of typhoid fever were diagnosed and 5004 Typhi isolates tested for antimicrobial susceptibility. Among 1992 pediatric typhoid fever patients, 1616 (81%) had traveled internationally within 30 days of illness onset, 1544 (81%) of 1906 were hospitalized (median duration, 6 days; range, 0–50), and none died. Forty percent (799) were <6 years old; 12% were <2 years old. Based on age and travel destination, 1435 (83%) of 1722 pediatric patients were vaccine-eligible; only 68 (5%) of 1361 were known to be vaccinated. Of 2003 isolates tested for antimicrobial susceptibility, 1216 (61%) were fluoroquinolone-nonsusceptible, of which 272 (22%) were also resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug-resistant [MDR]). All were susceptible to ceftriaxone and azithromycin. MDR and fluoroquinolone-nonsusceptible isolates were more common in children than adults (16% vs 9%, P < .001, and 61% vs 54%, P < .001, respectively). Fluoroquinolone nonsusceptibility was more common among travel-associated than domestically acquired cases (70% vs 17%, P < .001). Conclusions Approximately 95% of currently vaccine-eligible pediatric travelers were unvaccinated, and antimicrobial-resistant infections were common. New public health strategies are needed to improve coverage with currently licensed vaccines. Introduction of an effective pretravel typhoid vaccine for children <2 years could reduce disease burden and prevent drug-resistant infections.

scholarly journals 918. Typhoid Fever in the US Pediatric Population, 1999–2015, and the Potential Benefits of New Vaccines

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S26-S26
Author(s):  
Jarred McAteer ◽  
Gordana Derado ◽  
Michael Hughes ◽  
Amelia Bhatnagar ◽  
Felicita Medalla ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Typhoid Fever ◽  
Pediatric Population ◽  
The United States ◽  
Multidrug Resistant ◽  
International Travel ◽  
Illness Onset ◽  
Current Vaccine ◽  
Visiting Friends And Relatives ◽  
Resistance Data

Abstract Background In the United States, typhoid fever is rare. About 300 typhoid cases are reported to CDC annually through the National Typhoid and Paratyphoid Fever Surveillance (NTPFS) system. Most are acquired during international travel and while visiting friends and relatives. CDC recommends pretravel vaccination of at-risk children with one of two currently available vaccines: oral (age ≥6 years) or injectable (age ≥2 years). In anticipation of licensure of new protein-conjugate typhoid vaccines that could be administered to children ≥6 months old, we characterized clinical, epidemiologic, and antimicrobial resistance data of pediatric typhoid fever cases reported to CDC. Methods We reviewed laboratory-confirmed Salmonella enterica serotype Typhi infections reported to NTPFS and antimicrobial resistance data on Typhi isolates in the National Antimicrobial Resistance Monitoring System (NARMS) from 1999 to 2015. Results Of 2,051 pediatric (≤18 years) cases of typhoid fever, 80% had traveled internationally within 30 days of illness onset (most frequently to South Asia [82%]), 81% were hospitalized (median duration 6 days; range 0–77 days), and none died. Eight hundred twenty-seven (40%) were <6 years old; 219 (26%) were 6 months–2 years old. While 76% of pediatric cases were vaccine eligible (travelers ≥2 years old), only 6% were known to be vaccinated. Of 2,020 isolates tested for antimicrobial susceptibility, 1,211 (60%) had decreased susceptibility or resistance to ciprofloxacin, of which 277 (23%) were also resistant to ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole (multidrug-resistant [MDR]). None were resistant to ceftriaxone or azithromycin. MDR isolates were more likely in children than adults (16% vs. 9%, P < 0.05) and in travel-associated than domestically acquired cases (16% vs. 6%, P < 0.05). Conclusion Among pediatric cases of typhoid fever, 94% of currently vaccine-eligible travelers were unvaccinated. Emphasis on current vaccine indications and an effective pretravel typhoid vaccine for children between 6 months and 2 years old available during routine immunization visits could begin to reduce the burden of disease, and help prevent drug-resistant infections, in this vulnerable age group. Disclosures All authors: No reported disclosures.

scholarly journals 165. Emergence of Extensively Drug-Resistant Salmonella enterica Serotype Typhi Infections—United States, 2008–2020

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S99-S100
Author(s):  
Felicita Medalla ◽  
Louise Francois Watkins ◽  
Michael Hughes ◽  
Meseret Birhane ◽  
Layne Dorough ◽  
...  
Keyword(s):  
United States ◽  
Typhoid Fever ◽  
The United States ◽  
Empiric Therapy ◽  
Salmonella Typhi ◽  
International Travel ◽  
Drug Resistant ◽  
Extensively Drug Resistant ◽  
Large Outbreak ◽  
Control And Prevention

Abstract Background Typhoid fever, caused by Salmonella Typhi, is fatal in 12%–30% of patients not treated with appropriate antibiotics. In 2016, a large outbreak of extensively drug-resistant (XDR) Typhi infections began in Pakistan with cases reported globally, including the United States. In 2021, the Centers for Disease Control and Prevention (CDC) issued a health advisory on XDR infections among U.S. residents without international travel. We describe resistance of Typhi infections diagnosed in the United States to help guide treatment decisions. Methods Typhoid fever is a nationally notifiable disease. Health departments report cases to CDC through the National Typhoid and Paratyphoid Fever Surveillance system. Isolates are submitted to the National Antimicrobial Resistance Monitoring System for antimicrobial susceptibility testing (AST) using broth microdilution. AST results are categorized by Clinical and Laboratory Standards Institute criteria. We defined XDR as resistant to ceftriaxone, ampicillin, chloramphenicol, and co-trimoxazole, and nonsusceptible to ciprofloxacin. Results During 2008–2019, of 4,637 Typhi isolates, 52 (1%) were ceftriaxone resistant (axo-R); 71% were ciprofloxacin nonsusceptible, 1 azithromycin resistant (azm-R), and none meropenem resistant. XDR was first detected in 2018, in 2% of 474 isolates and increased to 7% of 535 in 2019. Of the 52 axo-R isolates, 46 were XDR, of which 45 were from travelers to Pakistan, and one from a non-traveler; 6 were not XDR, of which 4 were linked to travel to Iraq. In preliminary 2020 reports, 23 isolates were XDR; 14 were from travelers to Pakistan, 8 from non-travelers, and 1 from someone with unknown travel status. Among those with XDR infection, median age was 11 years (range 1–62), 54% were female, and 62% were from 6 states. Conclusion Ceftriaxone-resistant Typhi infections, mostly XDR, are increasing. Clinicians should ask patients with suspected Typhi infections about travel and adjust treatment based on susceptibility results. Carbapenem, azithromycin, or both may be considered for empiric therapy of typhoid fever among travelers to Pakistan or Iraq and in uncommon instances when persons report no international travel. Ceftriaxone is an empiric therapy option for travelers to countries other than Pakistan and Iraq. Disclosures All Authors: No reported disclosures

scholarly journals Epidemiology and Antimicrobial Resistance of International Travel-Associated Campylobacter Infections in the United States, 2005–2011

2014 ◽  
Vol 104 (7) ◽  
pp. e108-e114 ◽  
Author(s):  
Emily E. Ricotta ◽  
Amanda Palmer ◽  
Katie Wymore ◽  
Paula Clogher ◽  
Nadine Oosmanally ◽  
...  
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
The United States ◽  
International Travel ◽  
Campylobacter Infections

scholarly journals A survey of methods used for antimicrobial susceptibility testing in veterinary diagnostic laboratories in the United States

2017 ◽  
Vol 29 (5) ◽  
pp. 669-675 ◽  
Author(s):  
David A. Dargatz ◽  
Matthew M. Erdman ◽  
Beth Harris
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Clinical Laboratory ◽  
The United States ◽  
Antimicrobial Susceptibility Testing ◽  
Disk Diffusion ◽  
Diffusion Method ◽  
Broth Microdilution

Antimicrobial resistance is a serious threat to animal and human health worldwide, requiring a collaborative, holistic approach. The U.S. Government has developed a national strategy to address antimicrobial resistance, with one component being to monitor antimicrobial resistance in agricultural settings. We developed a survey to collect information about antimicrobial susceptibility testing (AST) from the veterinary diagnostic laboratory community in the United States, assessing current practices and technologies and determining how AST information is shared. Of the 132 surveys administered, 52 (39%) were returned. Overall, responding laboratories conducted susceptibility tests on 98,788 bacterial isolates in 2014, with Escherichia coli being the most common pathogen tested across all animal species. The 2 most common AST methods employed were the disk diffusion method (71%) and the Sensititre platform broth microdilution system (59%). Laboratories primarily used the Clinical Laboratory Standards Institute (CLSI) VET-01 standard (69%) and the automatically calculated interpretations provided by the commercial AST systems (61%) for interpreting their AST data. Only 22% of laboratories published AST data on a periodic basis, usually via annual reports published on the laboratory’s website or through peer-reviewed journals for specific pathogens. Our results confirm that disk diffusion and broth microdilution remain the standard AST methods employed by U.S. veterinary diagnostic laboratories, and that CLSI standards are commonly used for interpreting AST results. This information will help determine the most efficient standardized methodology for future surveillance. Furthermore, the current infrastructure within laboratories, once harmonized, will help provide a mechanism for conducting national surveillance programs.

scholarly journals Clinically Important Resistance among Salmonella enterica Serotype Typhi Isolates—United States, 2003–2015

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S365-S365
Author(s):  
Felicita Medalla ◽  
Louise Francois Watkins ◽  
Kevin Chatham-Stephens ◽  
Jared Reynolds ◽  
Amelia Bicknese ◽  
...  
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
Typhoid Fever ◽  
Treatment Options ◽  
The United States ◽  
Empiric Therapy ◽  
Salmonella Typhi ◽  
Antimicrobial Treatment ◽  
Delayed Response ◽  
Azithromycin Resistance

Abstract Background Salmonella Typhi (Typhi) causes typhoid fever, accounting for an estimated 5,700 illnesses and 623 hospitalizations per year in the United States. Most infections are acquired during travel to regions outside the United States where typhoid fever is prevalent and antimicrobial resistance is a problem. Fluoroquinolones (e.g., ciprofloxacin) are considered the treatment of choice for susceptible Typhi infections due to their superior ability to concentrate intracellularly and in bile, however, nonsusceptibility has been associated with treatment failure or delayed response. Azithromycin and ceftriaxone are treatment options. We describe antimicrobial susceptibility among Typhi isolates in the United States and the implications for management. Methods The National Antimicrobial Resistance Monitoring System at CDC conducts susceptibility testing on all Typhi isolates submitted by public health laboratories. We used broth microdilution to determine minimum inhibitory concentrations (MICs) to agents representing 9 antimicrobial classes and categorized isolates according to criteria from the Clinical and Laboratory Standards Institute. We defined ciprofloxacin nonsusceptibility as MIC ≥0.12 μg/mL, ciprofloxacin resistance as MIC ≥1, azithromycin resistance as MIC ≥32, and ceftriaxone resistance as MIC ≥4. Results From 2003–2015, isolates were tested from 4,550 patients; 2,760 (61%) were ciprofloxacin nonsusceptible, 4% were ciprofloxacin resistant. One isolate was azithromycin resistant and none were ceftriaxone resistant. Ciprofloxacin nonsusceptibility increased from 39% in 2003 to 66% in 2015; resistance increased from 0.3% to 8%. Median age of patients was 23 years (range 1–99 years), 53% were male, most were from the Northeast (33%) or the West (29%), and 74% had an isolate from blood. Conclusion Two thirds of Typhi isolates exhibited ciprofloxacin nonsusceptibility, which has increased over the last decade, and full resistance is increasing. Clinicians should be aware of high rates of fluoroquinolone nonsusceptibility when selecting empiric therapy and should tailor antimicrobial treatment to susceptibility results when feasible. Azithromycin and ceftriaxone remain important treatment options. Disclosures All authors: No reported disclosures.

scholarly journals Strain Types and Antimicrobial Resistance Patterns of Clostridium difficile Isolates from the United States, 2011 to 2013

2014 ◽  
Vol 58 (7) ◽  
pp. 4214-4218 ◽  
Author(s):  
Isabella A. Tickler ◽  
Richard V. Goering ◽  
Joseph D. Whitmore ◽  
Ashley N. W. Lynn ◽  
David H. Persing ◽  
...  
Keyword(s):  
United States ◽  
Clostridium Difficile ◽  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
The United States ◽  
Geographic Region ◽  
Content Type ◽  
Resistance Patterns ◽  
Strain Type ◽  
Susceptibility Patterns

ABSTRACTWe determined the PCR ribotypes and antimicrobial susceptibility patterns of 508 toxigenicClostridium difficileisolates collected between 2011 and 2013 from 32 U.S. hospitals. Of the 29 PCR ribotypes identified, the 027 strain type was the most common (28.1%), although the rates varied by geographic region. Ribotype 014/020 isolates appear to be emerging. Clindamycin and moxifloxacin resistances (36.8% and 35.8%, respectively) were the most frequent resistance phenotypes observed. Reduced susceptibility to vancomycin was observed in 39.1% of 027 isolates.

scholarly journals THE EPIDEMIOLOGY OF PEDIATRIC MENISCAL ALLOGRAFT TRANSPLANTATION IN THE UNITED STATES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
Haley E. Smith ◽  
Madeline M. Lyons ◽  
Neeraj M. Patel
Keyword(s):  
United States ◽  
Pediatric Population ◽  
The United States ◽  
National Database ◽  
Control Group ◽  
Meniscal Allograft Transplantation ◽  
Children's Hospitals ◽  
Allograft Transplantation ◽  
Meniscal Allograft ◽  
Children’S Hospitals

Background: Meniscal allograft transplantation (MAT) is an option to slow the progression of degenerative disease in the setting of substantial meniscal deficiency. This may be especially important in children and adolescents, but there is little literature on MAT in this population. Hypothesis/Purpose: The purpose of this study was to evaluate the epidemiology of MAT in the pediatric population, with specific attention to regional and demographic trends. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing MAT between 2011 and 2018. Demographic information was collected for each subject as well as data regarding previous and subsequent surgeries. The database was also queried for all meniscus surgeries (including repairs and meniscectomies) performed during the study period. Demographic and geographic data from this control group were compared to that of children undergoing MAT. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 27,168 meniscus surgeries were performed in 47 hospitals, with MAT performed 67 times in 17 hospitals. Twelve patients (18%) underwent a subsequent procedure after transplantation. In multivariate analysis, each year of increasing age resulted in 1.1 times higher odds of having undergone MAT rather than repair or meniscectomy (95% CI 1.03-1.1, p=0.002). Patients that underwent transplantation had 2.0 times higher odds of being female (95% CI 1.2-3.3, p=0.01) and 2.0 times higher odds of being commercially insured (95% CI 1.1-3.6, p=0.02). MAT was performed most frequently in the Northeast (4.9/1000 meniscus surgeries) and least often in the South (1.1/1000 meniscus surgeries, p<0.001). Furthermore, transplantation was more likely to be performed in larger cities. The median pediatric population of cities in which MAT was performed was 983,268 (range 157,253-3,138,870) compared to 662,290 (range 4,420-4,311,500) in cities where it was not (p=0.04). Conclusion: In the United States, patients that underwent MAT were older, more likely to be female, and have commercial insurance than those undergoing meniscus repair or meniscectomy. MAT was only done in 17/47 children’s hospitals that perform meniscus surgery and was most frequently performed in the Northeast and in larger cities. These trends highlight the need for further research, especially regarding differences along the lines of sex and insurance status.

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