Trends in antimicrobial resistance amongst Salmonella Paratyphi A isolates in Bangladesh: 1999-2021.
<h4>Background</h4>Typhoid and paratyphoid remain common bloodstream infections in areas with suboptimal water and sanitation infrastructure. Paratyphoid, caused by Salmonella Paratyphi A, is less prevalent than typhoid and its antimicrobial resistance (AMR) trends are less documented. E...
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2023-11-01
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| Series: | PLoS Neglected Tropical Diseases |
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| author | Mohammad S I Sajib Arif M Tanmoy Yogesh Hooda Hafizur Rahman Sira J Munira Anik Sarkar Dipu Das Md Asadur Rahman Nazrul Islam Mohammod Shahidullah Md Ruhul Amin Md Jahangir Alam Mohammed Hanif Stephen P Luby Denise O Garrett Samir K Saha Senjuti Saha |
| author_facet | Mohammad S I Sajib Arif M Tanmoy Yogesh Hooda Hafizur Rahman Sira J Munira Anik Sarkar Dipu Das Md Asadur Rahman Nazrul Islam Mohammod Shahidullah Md Ruhul Amin Md Jahangir Alam Mohammed Hanif Stephen P Luby Denise O Garrett Samir K Saha Senjuti Saha |
| author_sort | Mohammad S I Sajib |
| collection | DOAJ |
| description | <h4>Background</h4>Typhoid and paratyphoid remain common bloodstream infections in areas with suboptimal water and sanitation infrastructure. Paratyphoid, caused by Salmonella Paratyphi A, is less prevalent than typhoid and its antimicrobial resistance (AMR) trends are less documented. Empirical treatment for paratyphoid is commonly based on the knowledge of susceptibility of Salmonella Typhi, which causes typhoid. Hence, with rising drug resistance in Salmonella Typhi, last-line antibiotics like ceftriaxone and azithromycin are prescribed for both typhoid and paratyphoid. However, unlike for typhoid, there is no vaccine to prevent paratyphoid. Here, we report 23-year AMR trends of Salmonella Paratyphi A in Bangladesh.<h4>Methods</h4>From 1999 to 2021, we conducted enteric fever surveillance in two major pediatric hospitals and three clinics in Dhaka, Bangladesh. Blood cultures were performed at the discretion of the treating physicians; cases were confirmed by culture, serological and biochemical tests. Antimicrobial susceptibility was determined following CLSI guidelines.<h4>Results</h4>Over 23 years, we identified 2,725 blood culture-confirmed paratyphoid cases. Over 97% of the isolates were susceptible to ampicillin, chloramphenicol, and cotrimoxazole, and no isolate was resistant to all three. No resistance to ceftriaxone was recorded, and >99% of the isolates were sensitive to azithromycin. A slight increase in minimum inhibitory concentration (MIC) is noticed for ceftriaxone but the current average MIC is 32-fold lower than the resistance cut-off. Over 99% of the isolates exhibited decreased susceptibility to ciprofloxacin.<h4>Conclusions</h4>Salmonella Paratyphi A has remained susceptible to most antibiotics, unlike Salmonella Typhi, despite widespread usage of many antibiotics in Bangladesh. The data can guide evidence-based policy decisions for empirical treatment of paratyphoid fever, especially in the post typhoid vaccine era, and with the availability of new paratyphoid diagnostics. |
| format | Article |
| id | doaj-art-e956e4f0cef24c42b0134e7d2ed4a9c1 |
| institution | DOAJ |
| issn | 1935-2727 1935-2735 |
| language | English |
| publishDate | 2023-11-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS Neglected Tropical Diseases |
| spelling | doaj-art-e956e4f0cef24c42b0134e7d2ed4a9c12025-08-20T02:50:08ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352023-11-011711e001172310.1371/journal.pntd.0011723Trends in antimicrobial resistance amongst Salmonella Paratyphi A isolates in Bangladesh: 1999-2021.Mohammad S I SajibArif M TanmoyYogesh HoodaHafizur RahmanSira J MuniraAnik SarkarDipu DasMd Asadur RahmanNazrul IslamMohammod ShahidullahMd Ruhul AminMd Jahangir AlamMohammed HanifStephen P LubyDenise O GarrettSamir K SahaSenjuti Saha<h4>Background</h4>Typhoid and paratyphoid remain common bloodstream infections in areas with suboptimal water and sanitation infrastructure. Paratyphoid, caused by Salmonella Paratyphi A, is less prevalent than typhoid and its antimicrobial resistance (AMR) trends are less documented. Empirical treatment for paratyphoid is commonly based on the knowledge of susceptibility of Salmonella Typhi, which causes typhoid. Hence, with rising drug resistance in Salmonella Typhi, last-line antibiotics like ceftriaxone and azithromycin are prescribed for both typhoid and paratyphoid. However, unlike for typhoid, there is no vaccine to prevent paratyphoid. Here, we report 23-year AMR trends of Salmonella Paratyphi A in Bangladesh.<h4>Methods</h4>From 1999 to 2021, we conducted enteric fever surveillance in two major pediatric hospitals and three clinics in Dhaka, Bangladesh. Blood cultures were performed at the discretion of the treating physicians; cases were confirmed by culture, serological and biochemical tests. Antimicrobial susceptibility was determined following CLSI guidelines.<h4>Results</h4>Over 23 years, we identified 2,725 blood culture-confirmed paratyphoid cases. Over 97% of the isolates were susceptible to ampicillin, chloramphenicol, and cotrimoxazole, and no isolate was resistant to all three. No resistance to ceftriaxone was recorded, and >99% of the isolates were sensitive to azithromycin. A slight increase in minimum inhibitory concentration (MIC) is noticed for ceftriaxone but the current average MIC is 32-fold lower than the resistance cut-off. Over 99% of the isolates exhibited decreased susceptibility to ciprofloxacin.<h4>Conclusions</h4>Salmonella Paratyphi A has remained susceptible to most antibiotics, unlike Salmonella Typhi, despite widespread usage of many antibiotics in Bangladesh. The data can guide evidence-based policy decisions for empirical treatment of paratyphoid fever, especially in the post typhoid vaccine era, and with the availability of new paratyphoid diagnostics.https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0011723&type=printable |
| spellingShingle | Mohammad S I Sajib Arif M Tanmoy Yogesh Hooda Hafizur Rahman Sira J Munira Anik Sarkar Dipu Das Md Asadur Rahman Nazrul Islam Mohammod Shahidullah Md Ruhul Amin Md Jahangir Alam Mohammed Hanif Stephen P Luby Denise O Garrett Samir K Saha Senjuti Saha Trends in antimicrobial resistance amongst Salmonella Paratyphi A isolates in Bangladesh: 1999-2021. PLoS Neglected Tropical Diseases |
| title | Trends in antimicrobial resistance amongst Salmonella Paratyphi A isolates in Bangladesh: 1999-2021. |
| title_full | Trends in antimicrobial resistance amongst Salmonella Paratyphi A isolates in Bangladesh: 1999-2021. |
| title_fullStr | Trends in antimicrobial resistance amongst Salmonella Paratyphi A isolates in Bangladesh: 1999-2021. |
| title_full_unstemmed | Trends in antimicrobial resistance amongst Salmonella Paratyphi A isolates in Bangladesh: 1999-2021. |
| title_short | Trends in antimicrobial resistance amongst Salmonella Paratyphi A isolates in Bangladesh: 1999-2021. |
| title_sort | trends in antimicrobial resistance amongst salmonella paratyphi a isolates in bangladesh 1999 2021 |
| url | https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0011723&type=printable |
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