Changing Patterns in Enteric Fever Incidence and Increasing Antibiotic Resistance of Enteric Fever Isolates in the United States, 2008-2012.

Enteric fever in the United States has been primarily associated with travel and with worrisome changes in global patterns of antimicrobial resistance. We present the first comprehensive report of National Typhoid and Paratyphoid Fever Surveillance System (NTPFS) data for a 5-year period (2008-2012). We reviewed data on laboratory-confirmed cases reported to NTPFS, and related antimicrobial susceptibility results of Salmonella Typhi and Paratyphi A isolates sent for testing by participating public health laboratories to the Centers for Disease Control and Prevention's National Antimicrobial Resistance Monitoring System laboratory. During 2008-2012, 2341 enteric fever cases were reported, 80% typhoid and 20% paratyphoid A. The proportion caused by paratyphoid A increased from 16% (2008) to 22% (2012). Foreign travel within 30 days preceding illness onset was reported by 1961 (86%) patients (86% typhoid and 92% paratyphoid A). Travel to southern Asia was common (82% for typhoid, 97% for paratyphoid A). Among 1091 (58%) typhoid and 262 (56%) paratyphoid A isolates tested for antimicrobial susceptibility, the proportion resistant to nalidixic acid (NAL-R) increased from 2008 to 2012 (Typhi, 60% to 68%; Paratyphi A, 91% to 94%). Almost all NAL-R isolates were resistant or showed decreased susceptibility to ciprofloxacin. Resistance to at least ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug resistant [MDR]) was limited to Typhi isolates, primarily acquired in southern Asia (13%). Most MDR isolates were also NAL-R. Enteric fever in the United States is primarily associated with travel to southern Asia, and increasing resistance is adding to treatment challenges. A bivalent typhoid and paratyphoid vaccine is needed.

Date KA ，Newton AE ，Medalla F ，Blackstock A ，Richardson L ，McCullough A ，Mintz ED ，Mahon BE ... -  《-》

[Epidemiological characteristics and molecular typing of typhoid and paratyphoid in China, 2009-2013].

Cao Y ，Han YY ，Liu FF ，Liao QH ，Li J ，Diao BW ，Fan FX ，Kan B ，Yan MY ... -  《-》

A Retrospective Study of Laboratory-Based Enteric Fever Surveillance, Pakistan, 2012-2014.

Qamar FN ，Yousafzai MT ，Sultana S ，Baig A ，Shakoor S ，Hirani F ，Wassay A ，Khushboo S ，Mehmood J ，Freeman A ，Date K ，Garrett D ... -  《-》

Laboratory-based surveillance of paratyphoid fever in the United States: travel and antimicrobial resistance.

Gupta SK ，Medalla F ，Omondi MW ，Whichard JM ，Fields PI ，Gerner-Smidt P ，Patel NJ ，Cooper KL ，Chiller TM ，Mintz ED ... -  《-》

Enteric fever in Barcelona: Changing patterns of importation and antibiotic resistance.

Enteric fever's incidence is decreasing among residents of high-income countries, although it's rising in travelers coming from low-resource endemic settings. The study's aim is to describe epidemiological, clinical and laboratory features of patients with enteric fever. Retrospective descriptive study of enteric fever cases diagnosed at a Tropical Medicine Unit in Barcelona, 1993-2012. Out of 40 patients, 31(77,5%) were returning travelers, and 70% of them had been in Southern Asia. In the rest of patients without an antecedent of a recent travel, the infection occurred mainly before year 2000. The more frequently reported symptoms were fever and diarrhea, lacking significant differences between S. typhi and S. paratyphi infections. Quinolones were used as empiric treatment in 47.2% of patients, 36.1% received 3rd generation cephalosporins, 2.78% azithromycin and 13.89% other combinations. Resistance to quinolones in the S. paratyphi group (66.7%) was significantly higher compared with the S. typhi group (20%) (p:0.02). 22.5% of patients had treatment failure and 23.6% patients presented complications, none of them had been previously vaccinated. The diagnosis of enteric fever was more frequent among travelers coming from Southern-East Asia. Quinolone resistance is widely spread, particularly in S. paratyphi serotypes and should not be considered as first choice treatment anymore.

Requena-Méndez A ，Berrocal M ，Almela M ，Soriano A ，Gascón J ，Muñoz J ... -  《-》