Laboratory-based surveillance of paratyphoid fever in the United States: Travel and antimicrobial resistance
Laboratory-based surveillance of paratyphoid fever in the United States: Travel and antimicrobial resistance
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DOI：
10.1086/587894
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发表时间：
2008-06-01
影响因子：
11.8
通讯作者：
Mintz, Eric D.
中科院分区：
文献类型：
--
作者：
Gupta, Sundeep K.;Medalla, Felicita;Mintz, Eric D.
背景。副伤寒的发病率，包括抗菌素耐药菌株引起的副伤寒，正在全球范围内增加。然而，对美国副伤寒的流行病学和实验室特征尚未进行研究。我们试图访问2005年4月1日至2006年3月31日期间在美国收集标本的所有感染实验室确认的甲型副伤寒、乙型副伤寒或丙型副伤寒沙门氏菌血清型的患者。在疾病控制和预防中心（CDC），分离株进行了血清型确认、抗菌药物敏感性测试和脉冲场凝胶电泳分型。在149例甲型副伤寒沙门氏菌感染患者中，我们获得了89例（60%）的流行病学信息；86例中有55例（62%）住院。85名患者（96%）报告曾出国旅行，80名患者（90%）曾前往南亚。在疾控中心收到的146株分离株中，127株（87%）耐钠地酸；耐萘啶酸与南亚旅行相关（优势比为17.0；95%可信区间为3.8-75.9）。所有耐钠地酸菌株对环丙沙星的敏感性均降低（最低抑菌浓度>= 0.12 μ g/mL）。在49名感染了B型副伤寒沙门氏菌的患者中，只有12名（24%）在疾病预防控制中心检测时被确认患有B型副伤寒。6名患者中有4名（67%）住院，5名（83%）报告旅行（4名前往南美洲安第斯地区）。报告了一名前往西非的旅行者尿路感染的C型副伤寒沙门氏菌感染病例。鉴于甲型副伤寒沙门氏菌的广泛耐药性，医生应意识到感染发生率的增加和治疗选择。目前迫切需要副伤寒疫苗。对副伤寒的持续监测将有助于指导今后的预防和治疗建议。
Background. The incidence of paratyphoid fever, including paratyphoid fever caused by antimicrobial-resistant strains, is increasing globally. However, the epidemiologic and laboratory characteristics of paratyphoid fever in the United States have never been studied.Methods. We attempted to interview all patients who had been infected with laboratory-confirmed Salmonella serotypes Paratyphi A, Paratyphi B, or Paratyphi C in the United States with specimens collected from 1 April 2005 through 31 March 2006. At the Centers for Disease Control and Prevention (CDC), isolates underwent serotype confirmation, antimicrobial susceptibility testing, and pulsed-field gel electrophoresis typing.Results. Of 149 patients infected with Salmonella Paratyphi A, we obtained epidemiologic information for 89 (60%); 55 (62%) of 86 were hospitalized. Eighty-five patients (96%) reported having travel internationally, and 80 (90%) had traveled to South Asia. Of the 146 isolates received at the CDC, 127 (87%) were nalidixic acid resistant; nalidixic acid resistance was associated with travel to South Asia (odds ratio, 17.0; 95% confidence interval, 3.8-75.9). All nalidixic acid-resistant isolates showed decreased susceptibility to ciprofloxacin (minimum inhibitory concentration, >= 0.12 mu g/mL). Of 49 patients infected with Salmonella Paratyphi B, only 12 (24%) were confirmed to have Paratyphi B when tested at the CDC. Four (67%) of 6 patients were hospitalized, and 5 (83%) reported travel (4 to the Andean region of South America). One case of Salmonella Paratyphi C infection was reported in a traveler to West Africa with a urinary tract infection.Conclusions. Physicians should be aware of the increasing incidence of infection due to Salmonella Paratyphi A and treatment options given its widespread antimicrobial resistance. A paratyphoid fever vaccine is urgently needed. Continued surveillance for paratyphoid fever will help guide future prevention and treatment recommendations.