Laboratory-Based Surveillance of Salmonella Serotype Typhi Infections in the United States Antimicrobial Resistance on the Rise
2000
ContextMultidrug-resistant Salmonella serotype Typhi
infections have been reported worldwide, but data on the incidence of resistant
strains in the United States are lacking.ObjectivesTo determine the incidence of antimicrobial-resistant Salmonella Typhi infections and to identify risk factors for infection.DesignCross-sectional laboratory-based surveillance study.Setting and ParticipantsA 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 MeasuresProportion of Salmonella Typhi isolates demonstrating
resistance to 12 antimicrobial agents; patient epidemiological factors associated
with drug-resistant infections.ResultsMedian 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).ConclusionsOur 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.
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