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. 2018 Sep;99(3_Suppl):48-54.
doi: 10.4269/ajtmh.18-0145. Epub 2018 Jul 24.

Trends, Associations, and Antimicrobial Resistance of Salmonella Typhi and Paratyphi in Pakistan

Jai K Das  1 , Rumina Hasan  2 , Afia Zafar  2 , Imran Ahmed  1 , Aamer Ikram  3 , Summiya Nizamuddin  4 , Saleel Fatima  1 , Nauman Akbar  3 , Faisal Sultan  5 , Zulfiqar A Bhutta  6   7   6
Affiliations

Trends, Associations, and Antimicrobial Resistance of Salmonella Typhi and Paratyphi in Pakistan

Jai K Das et al. Am J Trop Med Hyg. 2018 Sep.

Abstract

Typhoid remains a major cause of morbidity and mortality in endemic countries. This review analyzed typhoid burden changes in Pakistan and its association with contextual factors. A retrospective cohort study on blood culture-positive typhoid and antibiotic resistance was conducted from three tertiary hospitals and contextual factor data obtained from primary household surveys. Salmonella Typhi/Paratyphi positivity rates were estimated and trend analysis was carried out using positive cases out of total number of blood cultures performed. Contextual factors' associations were determined through bivariate correlation analysis, using STATA (SataCorp, College Station, TX). We report a total of 17,387 S. Typhi-positive and 8,286 S. Paratyphi A and B-positive specimens from 798,137 blood cultures performed. The results suggest an overall decline in typhoid incidence as S. Typhi positivity rates declined from 6.42% in 1992 to 1.32% in 2015 and S. Paratyphi (A and B) from 1.29% to 0.39%. Subgroup analysis suggests higher S. Typhi prevalence in adults older than 18 years, whereas S. Paratyphi is greater in children aged 5-18 years. The relative contribution of S. Paratyphi to overall confirmed cases increased from 16.8% in 1992 to 23% in 2015. The analysis suggests high burden of fluoroquinolone resistance and multidrug-resistant S. Typhi strains. Statistically significant associations of water, sanitation indicators, and literacy rates were observed with typhoid positivity. Despite some progress, typhoid remains endemic and a strong political will is required for targeted typhoid control strategies. A multipronged approach of improving water, sanitation and hygiene in combination with large-scale immunization in endemic settings of Pakistan could help reduce burden and prevent epidemics.

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Figures

Figure 1.
Figure 1.
Positivity rates for Salmonella Typhi.
Figure 2.
Figure 2.
Positivity rates for Salmonella Paratyphi (A and B).
Figure 3.
Figure 3.
Data for antimicrobial resistance patterns from 1992 to 2015 at The Aga Khan University.
Figure 4.
Figure 4.
Trends in contextual factors in Pakistan from 1992 to 2015.
See this image and copyright information in PMC

References

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