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Browne, Annie J, Chipeta, Michael G, Fell, Frederick J, Haines-Woodhouse, Georgina, Kashef Hamadani, Bahar H, Kumaran, Emmanuelle A P, Robles Aguilar, Gisela, McManigal, Barney, Andrews, Jason R, Ashley, Elizabeth A, Audi, Allan, Baker, Stephen, Banda, Happy C, Basnyat, Buddha, Bigogo, Godfrey, Ngoun, Chanpheaktra, Chansamouth, Vilada, Chunga, Angeziwa, Clemens, John D, Davong, Viengmon, Dougan, Gordon, Dunachie, Susanna J, Feasey, Nicholas 
ORCID: https://orcid.org/0000-0003-4041-1405, Garrett, Denise O, Gordon, Melita A, Hasan, Rumina, Haselbeck, Andrea H, Henry, Nathaniel J, Heyderman, Robert S, Holm, Marianne, Jeon, Hyon Jin, Karkey, Abhilasha, Khanam, Farhana, Luby, Stephen P, Malik, Faisal Riaz, Marks, Florian, Mayxay, Mayfong, Meiring, James E, Moore, Catrin E, Munywoki, Patrick K, Musicha, Patrick, Newton, Paul N, Pak, Gideok, Phommasone, Koukeo, Pokharel, Sunil, Pollard, Andrew J, Qadri, Firdausi, Qamar, Farah N, Rattanavong, Sayaphet, Reiner, Bobby, Roberts, Tamalee, Saha, Samir, Saha, Senjuti, Shakoor, Sadia, Shakya, Mila, Simpson, Andrew J, Stanaway, Jeff, Turner, Claudia, Turner, Paul, Verani, Jennifer R, Vongsouvath, Manivanh, Day, Nicholas P J, Naghavi, Mohsen, Hay, Simon I, Sartorius, Benn and Dolecek, Christiane
(2024)
'Estimating the subnational prevalence of antimicrobial resistant Salmonella enterica serovars Typhi and Paratyphi A infections in 75 endemic countries, 1990–2019: a modelling study'. Lancet Global Health, Vol 12, Issue 3, e406-e418.
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Abstract
Background
Enteric fever, a systemic infection caused by Salmonella enterica serovars Typhi and Paratyphi A, remains a major cause of morbidity and mortality in low-income and middle-income countries. Enteric fever is preventable through the provision of clean water and adequate sanitation and can be successfully treated with antibiotics.
However, high levels of antimicrobial resistance (AMR) compromise the effectiveness of treatment. We provide estimates of the prevalence of AMR S Typhi and S Paratyphi A in 75 endemic countries, including 30 locations without data.
Methods
We used a Bayesian spatiotemporal modelling framework to estimate the percentage of multidrug resistance (MDR), fluoroquinolone non-susceptibility (FQNS), and third-generation cephalosporin resistance in S Typhi and S Paratyphi A infections for 1403 administrative level one districts in 75 endemic countries from
1990 to 2019. We incorporated data from a comprehensive systematic review, public health surveillance networks, and large multicountry studies on enteric fever. Estimates of the prevalence of AMR and the number of AMR infections (based on enteric fever incidence estimates by the Global Burden of Diseases study) were produced at the country, super-region, and total endemic area level for each year of the study.
Findings
We collated data from 601 sources, comprising 184225 isolates of S Typhi and S Paratyphi A, covering 45 countries over 30 years. We identified a decline of MDR S Typhi in south Asia and southeast Asia, whereas in sub-Saharan Africa, the overall prevalence increased from 6·0% (95% uncertainty interval 4·3–8·0) in 1990 to
72·7% (67·7–77·3) in 2019. Starting from low levels in 1990, the prevalence of FQNS S Typhi increased rapidly, reaching 95·2% (91·4–97·7) in south Asia in 2019. This corresponded to 2·5 million (1·5–3·8) MDR S Typhi infections and 7·4 million (4·7–11·3) FQNS S Typhi infections in endemic countries in 2019. The prevalence of third-generation cephalosporin-resistant S Typhi remained low across the whole endemic area over the study period, except for Pakistan where prevalence of third-generation cephalosporin resistance in S Typhi reached 61·0% (58·0–63·8) in 2019. For S Paratyphi A, we estimated low prevalence of MDR and third-generation cephalosporin resistance in all endemic countries, but a drastic increase of FQNS, which reached 95·0% (93·7–96·1; 3·5 million [2·2–5·6] infections)
in 2019.
Interpretation
This study provides a comprehensive and detailed analysis of the prevalence of MDR, FQNS, and third-generation cephalosporin resistance in S Typhi and S Paratyphi A infections in endemic countries, spanning the last 30 years. Our analysis highlights the increasing levels of AMR in this preventable infection and serves as a resource to guide urgently needed public health interventions, such as improvements in water, sanitation, and hygiene and typhoid fever vaccination campaigns
| Item Type: | Article |
|---|---|
| Subjects: | QW Microbiology and Immunology > QW 45 Microbial drug resistance. General or not elsewhere classified. QW Microbiology and Immunology > QW 50 Bacteria (General). Bacteriology. Archaea WC Communicable Diseases > Infection. Bacterial Infections > Enteric Infections > WC 269 Salmonella infections |
| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1016/s2214-109x(23)00585-5 |
| Depositing User: | Mary Creegan |
| Date Deposited: | 17 Dec 2024 15:09 |
| Last Modified: | 17 Dec 2024 15:09 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/25768 |
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