Case Series of Imported Enteric Fever at a Referral Center in Tokyo, Japan: Antibiotic Susceptibility and Risk Factors for Relapse

Abstract

Abstract. Owing to the increase in Salmonella strains with decreased fluoroquinolone susceptibility in the endemic areas, we have been treating enteric fever with intravenous ceftriaxone empirically since 2007. In this study, we reevaluated our treatment protocol. This retrospective cohort study was conducted at a single institute in Tokyo, Japan, between January 2006 and December 2013. Enteric fever was defined as isolation of Salmonella Typhi or Salmonella Paratyphi A, B, and C from the blood and/or stool of patients with fever. Of the 35 patients with imported enteric fever, 28 (80%) had returned from south Asia. Ciprofloxacin-susceptible strains were detected in only 12% of the cases. The isolates showed excellent susceptibility to ampicillin (91%), chloramphenicol (94%), ceftriaxone (97%), and azithromycin (97%). One case of Salmonella Paratyphi B was excluded, and of the remaining 34 patients, 56% were treated with ceftriaxone alone, 26% with ceftriaxone then fluoroquinolone, and 9% with levofloxacin alone. The overall relapse rate was 6.1%; however, among those receiving ceftriaxone monotherapy, the relapse rate was 11% (N = 2). The relapse group was characterized by longer times to treatment initiation (P = 0.035) and defervescence (> 7 days) after treatment initiation (P = 0.022). In such cases, we recommend that ceftriaxone treatment be continued for > 4 days after defervescence or be changed to fluoroquinolone if the strains are found to be susceptible to prevent relapse. Furthermore, ampicillin and chloramphenicol, which are no longer prescribed, may be reconsidered as treatment options in Asia.

Multi-drug resistant Salmonella enterica serovar Typhi isolates with reduced susceptibility to ciprofloxacin in Kenya

“…Contrary to the current research on antibiogram of S . Typhi, the bacterium is showing full sensitivity to these antibiotics since they had not been used for a long time to treatment typhoid fever [ 21 ]. A study in Nepal reported an increased susceptibility rate of chloramphenicol, co-trimoxazole, and ampicillin as 98.8, 98.8, and 97.6% respectively [ 22 ].…”

Quantitative Antibiotic Use Profile in Typhoid

“…The delay in starting typhoid fever treatment and the longer the time to decrease body temperature (> 7 days) can affect patient recurrence and will lead to increased treatment costs due to the longer hospitalization time. 14,15 The condition of the patients when they left the hospital did not die or go home at their own request, but with the condition of outpatient treatment with the approval of the doctor. Typhoid fever patients who are declared cured or improved must perform a bacteriological examination at least once a month to detect Salmonella typhi bacteria because these bacteria can still be excreted by the body within 3 months or more than a year.…”

“…Typhoid fever patients who are declared cured or improved must perform a bacteriological examination at least once a month to detect Salmonella typhi bacteria because these bacteria can still be excreted by the body within 3 months or more than a year. 15 The fluoroquinolone class of antibiotics (ciprofloxacin, levofloxacin, pefloxacin and ofloxacin) is an effective therapy for typhoid fever in isolates that are not resistant to fluoroquinolones. This class of antibiotics has a clinical cure rate of up to 98%, a recurrence rate and fecal career of less than 2%, and a fever reduction time of 4 days.…”

“…Ceftriaxone antibiotics should be given for 10-14 days (APhA, 2013), whereas in this study there were 8 prescriptions for ceftriaxone that were given less than 10 days. 15 Long duration of treatment is associated with the development of antibiotic resistance. Administration of antibiotics that are too short or too long can affect the outcome of treatment and will have an impact on morbidity, mortality, bacterial resistance and very high economic and social disadvantages.…”

Affinity of cefotiam for the alternative penicillin binding protein PBP3SAL used by Salmonella inside host eukaryotic cells

“…In this scenario, it is alarming that relapse caused by drug-susceptible isolates is reported in the order of 5%–15% by many studies. 7 , 8 Intracellularity as a lifestyle therefore impacts the antimicrobial chemotherapy of S. enterica infections.…”