Increasingly limited options for the treatment of enteric fever in travellers returning to England, 2014–2019: a cross-sectional analytical study

Introduction. Enteric fever (caused by Salmonella enterica serovars Typhi and Paratyphi) frequently presents as an acute, undifferentiated febrile illness in returning travellers, requiring timely empirical antibiotics. Gap Statement. Determining which empirical antibiotics to prescribe for enteric fever requires up-to-date knowledge of susceptibility patterns. Aim. By characterising factors associated with antimicrobial resistance in cases of S. Typhi and S. Paratyphi imported to England, we aim to guide effective empirical treatment. Methodology. All English isolates of S. Typhi and S. Paratyphi 2014–2019 underwent antimicrobial susceptibility testing; results were compared to a previous survey in London 2005–2012. Risk factors for antimicrobial resistance were analysed with logistic regression models to predict adjusted odds ratios (aOR) for resistance to individual antibiotics and multi-drug resistance. Results. We identified 1088 cases of S. Typhi, 729 S. Paratyphi A, 93 S. Paratyphi B, and one S. Paratyphi C. In total, 93 % were imported. Overall, 90 % of S. Typhi and 97 % of S. Paratyphi A isolates were resistant to ciprofloxacin; 26 % of S. Typhi were multidrug resistant to ciprofloxacin, amoxicillin, co-trimoxazole, and chloramphenicol (MDR+FQ). Of the isolates, 4 % of S. Typhi showed an extended drug resistance (XDR) phenotype of MDR+FQ plus resistance to third-generation cephalosporins, with cases of XDR rising sharply in recent years (none before 2017, one in 2017, six in 2018, 32 in 2019). For S. Typhi isolates, resistance to ciprofloxacin was associated with travel to Pakistan (aOR=32.0, 95 % CI: 15.4–66.4), India (aOR=21.8, 95 % CI: 11.6–41.2), and Bangladesh (aOR=6.2, 95 % CI: 2.8–13.6) compared to travel elsewhere, after adjusting for rising prevalence of resistance over time. MDR+FQ resistance in S. Typhi isolates was associated with travel to Pakistan (aOR=3.5, 95 % CI: 2.4–5.2) and less likely with travel to India (aOR=0.07, 95 % CI 0.04–0.15) compared to travel elsewhere. All XDR cases were imported from Pakistan. No isolate was resistant to azithromycin. Comparison with the 2005–2012 London survey indicates substantial increases in the prevalence of resistance of S. Typhi isolates to ciprofloxacin associated with travel to Pakistan (from 79–98 %) and Africa (from 12–60 %). Conclusion. Third-generation cephalosporins and azithromycin remain appropriate choices for empirical treatment of enteric fever in most returning travellers to the UK from endemic countries, except from Pakistan, where XDR represents a significant risk.

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Changing patterns and widening of antibiotic resistance inShigellaspp. over a decade (2000–2011), Andaman Islands, India

Epidemiology and Infection ◽

10.1017/s0950268814000958 ◽

2014 ◽

Vol 143 (3) ◽

pp. 470-477 ◽

Cited By ~ 12

Author(s):

D. BHATTACHARYA ◽

H. BHATTACHARYA ◽

D. S. SAYI ◽

A. P. BHARADWAJ ◽

M. SINGHANIA ◽

...

Keyword(s):

Drug Resistance ◽

Antibiotic Resistance ◽

Wide Spectrum ◽

Resistance Pattern ◽

Third Generation ◽

Isolation And Identification ◽

Antimicrobial Drugs ◽

Drug Resistance Pattern ◽

Resistance Patterns ◽

Third Generation Cephalosporins

SUMMARYThis study is a part of the surveillance study on childhood diarrhoea in the Andaman and Nicobar Islands; here we report the drug resistance pattern of recent isolates ofShigellaspp. (2006–2011) obtained as part of that study and compare it with that ofShigellaisolates obtained earlier during 2000–2005. During 2006–2011, stool samples from paediatric diarrhoea patients were collected and processed for isolation and identification ofShigellaspp. Susceptibility to 22 antimicrobial drugs was tested and minimum inhibitory concentrations were determined for third-generation cephalosporins, quinolones, amoxicillin-clavulanic acid combinations and gentamicin. A wide spectrum of antibiotic resistance was observed in theShigellastrains obtained during 2006–2011. The proportions of resistant strains showed an increase from 2000–2005 to 2006–2011 in 20/22 antibiotics tested. The number of drug resistance patterns increased from 13 in 2000–2005 to 43 in 2006–2011. Resistance to newer generation fluoroquinolones, third-generation cephalosporins and augmentin, which was not observed during 2000–2005, appeared during 2006–2011. The frequency of resistance inShigellaisolates has increased substantially between 2000–2006 and 2006–2011, with a wide spectrum of resistance. At present, the option for antimicrobial therapy in shigellosis in Andaman is limited to a small number of drugs.

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Infections Due to Salmonella

10.2310/im.1482 ◽

2021 ◽

Author(s):

Marcia B Goldberg ◽

Molly Paras

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Therapy ◽

Enteric Fever ◽

Carrier State ◽

Surgical Removal ◽

Third Generation ◽

Food Borne ◽

Extraintestinal Disease ◽

Immunocompromised Hosts ◽

Third Generation Cephalosporins

Salmonella, which is acquired via ingestion, is classified as nontyphoidal or typhoidal disease. Typhoidal disease is caused by S typhi or S paratyphi, and nontyphoidal disease is caused by all other serovars. Salmonella causes a range of infectious syndromes that include gastroenteritis, bacteremia, endovascular infections, and enteric fever. For immunocompromised hosts or patients with extraintestinal disease, antibiotic therapy should be provided. Effective agents often include third-generation cephalosporins and fluoroquinolones, although rates of resistance of Salmonella isolates to many antibiotics are increasing. A carrier state exists whereby patients may shed bacteria despite being asymptomatic. To eradicate the carrier state, longer courses of antibiotics and, in rare instances, surgical removal of the reservoir, which is most commonly the gallbladder, may be required. This review contains 2 figures, 4 tables, and 24 references. Key Words: Salmonella, typhoidal, non-typhoidal, enteric fever, endovascular infection, gastroenteritis, carrier, food-borne, antibiotic resistance

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Distribution of TET, AAC and CTX-M Genes among Antibiotic Resistant Escherichia coli Isolated From Poultry under Various Farming System of A and N Islands

Indian Journal of Animal Research ◽

10.18805/ijar.b-4005 ◽

2021 ◽

Author(s):

Jai Sunder ◽

T. Sujatha ◽

S. Bhowmick ◽

S.C. Mayuri ◽

A.K. De ◽

...

Keyword(s):

Drug Resistance ◽

Antibiotic Resistance ◽

Antimicrobial Resistance ◽

Farming Systems ◽

Farming System ◽

Multi Drug Resistance ◽

Surveillance Program ◽

Poultry Production ◽

Animal Food ◽

E Coli

Background: Transmission of antibiotic resistance from animal food chain to human through animal food-borne pathogens have led to increased public concern. Wider surveillance on prevalence of antibiotic resistance in E. coli will provide information on evolution of resistance in various geographical locations. The purpose of this study was to investigate the presence of antimicrobial resistance of E. coli isolates from poultry under various farming system in A and N Islands and resistance genes of tet, ctx-M and aac encoding the isolates. Methods: Isolates were obtained from cloacal swabs in poultry under various farming systems and tested against major antimicrobial derivatives to study multi drug resistance. The presence of genes associated with resistance to tetracycline (tet A), ESBL (CTX-M) and Gentamycin (aac(3)-IV) were determined by PCR. Result: A total of 126 cloacal samples were analysed out of which 31.38% of the E.coli isolates from poultry under various farming systems were producing extended spectrum beta-lactamases and were multiple antimicrobial resistant. Poultry birds of commercial farms showed higher resistance levels (37.5%) than organised farms (24.76%) and desi birds (31.88%). Results indicate a high level of multi-drug resistance is emerging even in desi birds. It is suggested that an antimicrobial resistance surveillance program is needed in A and N Islands in order to detect bacterial resistance among rural poultry production as the 80 percentage of total poultry population belong to desi birds.

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Drug-Resistant Salmonella typhi in Pakistan

Clinical Pediatrics ◽

10.1177/0009922819881203 ◽

2019 ◽

Vol 59 (1) ◽

pp. 31-33 ◽

Cited By ~ 1

Author(s):

Christine E. Petrin ◽

Russell W. Steele ◽

Elizabeth A. Margolis ◽

Justin M. Rabon ◽

Holly Martin ◽

...

Keyword(s):

United States ◽

Typhoid Fever ◽

Enteric Fever ◽

The United States ◽

Salmonella Typhi ◽

Antimicrobial Treatment ◽

Third Generation ◽

Drug Resistant ◽

Oral Transmission ◽

Third Generation Cephalosporins

Enteric fever (formerly typhoid fever) is a bacterial illness caused by fecal-oral transmission of Salmonella typhi or paratyphi. In early 2018, an outbreak of Salmonella typhi resistant to third-generation cephalosporins, ampicillin, ciprofloxacin, trimethroprim-sulfamethoxazole, and chloramphenicol was reported in Pakistan. This strain, termed “extensively resistant typhi,” has infected more than 5000 patients in endemic areas of South Asia, as well as travelers to and from these areas, including 5 cases in the United States. We present the case of one such child who developed extensively resistant enteric fever during a recent visit to Pakistan and required broader antimicrobial treatment than typically required. Clinicians should be aware that incoming cases of enteric fever may be nonsusceptible to commonly recommended antibiotics and that extensively resistant typhi requires treatment with carbapenems such as meropenem or azithromycin.

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Burden of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay associated with bloodstream infections due to Escherichia coli resistant to third-generation cephalosporins

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkq412 ◽

2010 ◽

Vol 66 (2) ◽

pp. 398-407 ◽

Cited By ~ 128

Author(s):

M. E. A. de Kraker ◽

M. Wolkewitz ◽

P. G. Davey ◽

W. Koller ◽

J. Berger ◽

...

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Hospital Stay ◽

Excess Mortality ◽

Length Of Hospital Stay ◽

Bloodstream Infections ◽

Third Generation ◽

Third Generation Cephalosporins

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Comparison of resistance to third-generation cephalosporins inShigellabetween Europe-America and Asia-Africa from 1998 to 2012

Epidemiology and Infection ◽

10.1017/s0950268814003446 ◽

2015 ◽

Vol 143 (13) ◽

pp. 2687-2699 ◽

Cited By ~ 20

Author(s):

B. GU ◽

M. ZHOU ◽

X. KE ◽

S. PAN ◽

Y. CAO ◽

...

Keyword(s):

Systematic Review ◽

Drug Resistance ◽

Confidence Interval ◽

Literature Search ◽

Third Generation ◽

Rational Use ◽

Total Prevalence ◽

Rational Use Of Antibiotics ◽

Resistance Rates ◽

Third Generation Cephalosporins

SUMMARYWe conducted a systematic review to compare resistance to third-generation cephalosporins (TGCs) inShigellastrains between Europe-America and Asia-Africa from 1998 to 2012 based on a literature search of computerized databases. In Asia-Africa, the prevalence of resistance of total and different subtypes to ceftriaxone, cefotaxime and ceftazidime increased markedly, with a total prevalence of resistance up to 14·2% [95% confidence interval (CI) 3·9–29·4], 22·6% (95% CI 4·8–48·6) and 6·2% (95% CI 3·8–9·1) during 2010–2012, respectively. By contrast, resistance rates to these TGCs in Europe-America remained relatively low – less than 1·0% during the 15 years. A noticeable finding was that certain countries both in Europe-America and Asia-Africa, had a rapid rising trend in the prevalence of resistance ofS. sonnei, which even outnumberedS. flexneriin some periods. Moreover, comparison between countries showed that currently the most serious problem concerning resistance to these TGCs appeared in Vietnam, especially for ceftriaxone, China, especially for cefotaxime and Iran, especially for ceftazidime. These data suggest that monitoring of the drug resistance ofShigellastrains should be strengthened and that rational use of antibiotics is required.

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Prevalence and Antimicrobial Resistance of Salmonella Isolated from Broiler Farms, Chicken Carcasses, and Street-Vended Restaurants in Casamance, Senegal

Journal of Food Protection ◽

10.4315/0362-028x-72.11.2423 ◽

2009 ◽

Vol 72 (11) ◽

pp. 2423-2427 ◽

Cited By ~ 17

Author(s):

MICHEL M. DIONE ◽

MARGARETA IEVEN ◽

BENOÎT GARIN ◽

TANGUY MARCOTTY ◽

STANNY GEERTS

Keyword(s):

Antimicrobial Resistance ◽

Chicken Meat ◽

Third Generation ◽

Production Chain ◽

Broiler Production ◽

Chicken Feces ◽

Salmonella Serovars ◽

Third Generation Cephalosporins

This study was undertaken to determine the prevalence and distribution of Salmonella on 57 randomly selected broiler farms at the end of the rearing period and in chicken products in urban and periurban areas in Casamance, Senegal, and to evaluate the antimicrobial resistance profiles of the Salmonella serovars. Salmonella was detected in chicken feces, on carcass skin, and in muscle on 35.1, 38.6, and 29.8% of farms, respectively. Salmonella was found in chicken meat servings from 14.3% of the 42 street restaurants and in 40.4% of the 285 chicken carcasses examined. The prevalence on skin and in muscle was significantly associated with the detection of Salmonella in feces (P ≤ 0.001). Eighteen Salmonella serovars were identified; the most common were Brancaster (57.9%), Goelzau (10.7%), Kentucky (8.4%), and Hadar (7.3%). High levels of resistance were found to trimethoprim-sulfamethoxazole, tetracycline, trimethoprim, streptomycin, and sulfonamides. All Salmonella serovars were susceptible to fluoroquinolones and third-generation cephalosporins. A large proportion of the isolates belonging to 11 serovars were resistant to two or more antibiotics. Salmonella continues to be of serious concern in the broiler production chain in Senegal.

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Antimicrobial Resistance and Multi-Drug Resistance Patterns of Pathogenic Bacteria Isolated from Food Poisoning Patients in Incheon

The Korean Journal of Food And Nutrition ◽

10.9799/ksfan.2013.26.1.132 ◽

2013 ◽

Vol 26 (1) ◽

pp. 132-136 ◽

Cited By ~ 1

Author(s):

Myung-Je Huh ◽

Sung-Suck Oh ◽

Jae-Seon Jang

Keyword(s):

Drug Resistance ◽

Antimicrobial Resistance ◽

Pathogenic Bacteria ◽

Food Poisoning ◽

Multi Drug Resistance ◽

Resistance Patterns

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Health and economic impact of the pneumococcal conjugate vaccine in hindering antimicrobial resistance in China

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2004933118 ◽

2021 ◽

Vol 118 (13) ◽

pp. e2004933118

Author(s):

Ember (Yiwei) Lu ◽

Hui-Han Chen ◽

Hongqing Zhao ◽

Sachiko Ozawa

Keyword(s):

Antimicrobial Resistance ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Antibiotic Use ◽

Status Quo ◽

Third Generation ◽

Dynamic Representation ◽

The Status ◽

Third Generation Cephalosporins ◽

Coverage Increase

Antimicrobial resistance (AMR) poses a serious threat to global public health. However, vaccinations have been largely undervalued as a method to hinder AMR progression. This study examined the AMR impact of increasing pneumococcal conjugate vaccine (PCV) coverage in China. China has one of the world’s highest rates of antibiotic use and low PCV coverage. We developed an agent-based DREAMR (Dynamic Representation of the Economics of AMR) model to examine the health and economic benefits of slowing AMR against commonly used antibiotics. We simulated PCV coverage, pneumococcal infections, antibiotic use, and AMR accumulation. Four antibiotics to treat pneumococcal diseases (penicillin, amoxicillin, third-generation cephalosporins, and meropenem) were modeled with antibiotic utilization, pharmacokinetics, and pharmacodynamics factored into predicting AMR accumulation. Three PCV coverage scenarios were simulated over 5 y: 1) status quo with no change in coverage, 2) scaled coverage increase to 99% in 5 y, and 3) accelerated coverage increase to 85% over 2 y followed by 3 y to reach 99% coverage. Compared to the status quo, we found that AMR against penicillin, amoxicillin, and third-generation cephalosporins was significantly reduced by 6.6%, 10.9%, and 9.8% in the scaled scenario and by 10.5%, 17.0%, and 15.4% in the accelerated scenario. Cumulative costs due to AMR, including direct and indirect costs to patients and caretakers, were reduced by $371 million in the scaled and $586 million in the accelerated scenarios compared to the status quo. AMR-reducing benefits of vaccines are essential to quantify in order to drive appropriate investment.

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