Cotrimoxazole treats fluoroquinolone-resistant<i>Salmonella typhi</i>H58 infection

Karki, Manan; Pandit, Sarbagya; Baker, Stephen; Basnyat, Buddha

doi:10.1136/bcr-2016-217223

Cited by 9 publications

(9 citation statements)

References 8 publications

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“…Single drug therapy (monotherapy) has been common practice in the treatment of typhoid, and monotherapy with former first-line antimicrobials may be a reasonable option in Asia. A single report from Nepal suggests that monotherapy with co-trimoxazole results in complete remission of typhoid fever caused by H58 which was fluoroquinolone-resistant but not MDR[ 43 ]. However, a more astute approach in Asia might involve combination therapy with a first-line antimicrobial and perhaps azithromycin.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of antimicrobial resistance in Salmonella enterica serovar Typhi, the etiological agent of typhoid

et al. 2018

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BackgroundThe temporal and spatial change in trends of antimicrobial resistance (AMR) in typhoid have not been systematically studied, and such information will be critical for defining intervention, as well as planning sustainable prevention strategies.Methodology and findingsTo identify the phenotypic trends in AMR, 13,833 individual S. Typhi isolates, reported from 1973 to 2018 in 62 publications, were analysed to determine the AMR preponderance over time. Separate analyses of molecular resistance determinants present in over 4,000 isolates reported in 61 publications were also conducted. Multi-drug resistant (MDR) typhoid is in decline in Asia in a setting of high fluoroquinolone resistance while it is on the increase in Africa. Mutations in QRDRs in gyrA (S83F, D87N) and parC (S80I) are the most common mechanisms responsible for fluoroquinolone resistance. Cephalosporin resistant S. Typhi, dubbed extensively drug-resistant (XDR) is a real threat and underscores the urgency in deploying the Vi-conjugate vaccines.ConclusionFrom these observations, it appears that AMR in S. Typhi will continue to emerge leading to treatment failure, changes in antimicrobial policy and further resistance developing in S. Typhi isolates and other Gram-negative bacteria in endemic regions. The deployment of typhoid conjugate vaccines to control the disease in endemic regions may be the best defence.

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Section: Discussionmentioning

confidence: 99%

A systematic review of antimicrobial resistance in Salmonella enterica serovar Typhi, the etiological agent of typhoid

et al. 2018

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“…Given the re-emergence of antimicrobial sensitivity to chloramphenicol and co-trimoxazole as evidenced in this study, it may be logical to shift to these first-line drugs for treating enteric fever; indeed there has already been a case report demonstrating efficacy of co-trimoxazole treatment in the treatment of fluoroquinolone resistant H58 S . Typhi in this setting[ 53 ]. We acknowledge the possibility that typhoidal Salmonella strains will acquire resistance to these antibiotics when re-introduced and the cycling of antimicrobials is seldom sufficient to effectively prevent MDR in the long-term.…”

Section: Discussionmentioning

confidence: 99%

Laboratory and molecular surveillance of paediatric typhoidal Salmonella in Nepal: Antimicrobial resistance and implications for vaccine policy

et al. 2018

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BackgroundChildren are substantially affected by enteric fever in most settings with a high burden of the disease, including Nepal. However pathogen population structure and transmission dynamics are poorly delineated in young children, the proposed target group for immunization programs. Here we present whole genome sequencing and antimicrobial susceptibility data on 198 S. Typhi and 66 S. Paratyphi A isolated from children aged 2 months to 15 years of age during blood culture surveillance at Patan Hospital, Nepal, 2008–2016.Principal findingsS. Typhi was the dominant agent and comprised several distinct genotypes, dominated by 4.3.1 (H58). The heterogeneity of genotypes in children under five was reduced compared to data from 2005–2006, attributable to ongoing clonal expansion of H58. Most isolates (86%) were non-susceptible to fluoroquinolones, associated mainly with S. Typhi H58 lineage II and S. Paratyphi A harbouring mutations in the quinolone resistance-determining region (QRDR); non-susceptible strains from these groups accounted for 50% and 25% of all isolates. Multi-drug resistance (MDR) was rare (3.5% of S. Typhi, 0 S. Paratyphi A) and restricted to chromosomal insertions of resistance genes in H58 lineage I strains. Temporal analyses revealed a shift in dominance from H58 Lineage I to H58 Lineage II, with the latter being significantly more common after 2010. Comparison to global data sets showed the local S. Typhi and S. Paratyphi A strains had close genetic relatives in other South Asian countries, indicating regional strain circulation. Multiple imports from India of ciprofloxacin-resistant H58 lineage II strains were identified, but these were rare and showed no evidence of clonal replacement of local S. Typhi.SignificanceThese data indicate that enteric fever in Nepal continues to be a major public health issue with ongoing inter- and intra-country transmission, and highlights the need for regional coordination of intervention strategies. The absence of a S. Paratyphi A vaccine is cause for concern, given its prevalence as a fluoroquinolone resistant enteric fever agent in this setting.

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“…These isolates had a composite transposon as described above and an additional IncY plasmid containing bla CTX-M15 and qnrS genes77, conferring resistance to the first-line antimicrobials, FQs and third-generation cephalosporins. Cephalosporins were the most commonly used antimicrobial in India followed by broad-spectrum penicillins, FQs and macrolides as per a 2014 report78 and more recently by a 2018 report79. This indirectly portrays the antimicrobial pressure exerted by the use of cephalosporins, which has consequently led to the production of ESBLs by Gram-negative bacteria, including S. Typhi596667.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of antimicrobial resistance of typhoidal Salmonella in India

et al. 2019

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Background & objectives: The temporal trends in the development of antimicrobial resistance (AMR) among Salmonella Typhi and Salmonella Paratyphi in India have not been systematically reported. We aimed to systematically review the temporal AMR trends (phenotypic and molecular mechanisms) in bacterial isolates from patients with enteric fever over two decades in India. Methods: To identify trends in AMR in India, resistance patterns among 4611 individual S . Typhi isolates and 800 S. Paratyphi A isolates, reported from 1992 to 2017 in 40 publications, were analysed. Molecular resistance determinants were extracted from 22 publications and also reviewed in accordance with the PRISMA guidelines. Articles were sourced using a predefined search strategy from different databases. Results: The analyses suggested that multidrug-resistant (MDR) enteric fever was declining in India and being replaced by fluoroquinolone (FQ) resistance. Mutations in gyrA and parC were key mechanisms responsible for FQ resistance, whereas MDR was largely driven by resistance determinants encoded on mobile genetic elements (plasmids, transposons). Interpretation & conclusions: The results reflect the effect of antimicrobial pressure which has been driving AMR in typhoidal Salmonella in India. Understanding these trends is important in planning future approaches to therapy, which serve as a baseline for assessment of the impact of new typhoid conjugate vaccines against these resistant organisms.

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Cotrimoxazole treats fluoroquinolone-resistantSalmonella typhiH58 infection

Cited by 9 publications

References 8 publications

A systematic review of antimicrobial resistance in Salmonella enterica serovar Typhi, the etiological agent of typhoid

A systematic review of antimicrobial resistance in Salmonella enterica serovar Typhi, the etiological agent of typhoid

Laboratory and molecular surveillance of paediatric typhoidal Salmonella in Nepal: Antimicrobial resistance and implications for vaccine policy

A systematic review of antimicrobial resistance of typhoidal Salmonella in India

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