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. 2021 Nov 16;8(12):ofab572.
doi: 10.1093/ofid/ofab572. eCollection 2021 Dec.

Extensively Drug-Resistant Typhoid Fever in the United States

Michael J Hughes  1 , Meseret G Birhane  1 , Layne Dorough  1   2 , Jared L Reynolds  1 , Hayat Caidi  1 , Kaitlin A Tagg  1   3 , Caroline M Snyder  1   2 , Alexander T Yu  4 , Shana M Altman  5 , Michelle M Boyle  6 , Deepam Thomas  7 , Amy E Robbins  8 , HaeNa A Waechter  9 , Irina Cody  10 , Eric D Mintz  1 , Bruce Gutelius  1 , Gayle Langley  1 , Louise K Francois Watkins  1
Affiliations

Extensively Drug-Resistant Typhoid Fever in the United States

Michael J Hughes et al. Open Forum Infect Dis. .

Abstract

Cases of extensively drug-resistant (XDR) typhoid fever have been reported in the United States among patients who did not travel internationally. Clinicians should consider if and where the patient traveled when selecting empiric treatment for typhoid fever. XDR typhoid fever should be treated with a carbapenem, azithromycin, or both.

Keywords: Pakistan; Salmonella Typhi infection; drug resistance; enteric fever; microbial; treatment.

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Figures

Figure 1.
Figure 1.
Extensively drug-resistant (XDR)a and XDR variantbSalmonella Typhi cases by month of first positive culture and travel history—United States, January 2018–April 2020 (n=76)c. an = 71. Isolates were considered XDR if they were resistant to ampicillin, ceftriaxone, chloramphenicol, and trimethoprim-sulfamethoxazole and were resistant or intermediate to ciprofloxacin. bn = 5. Isolates were considered XDR variants if they were highly related to XDR isolates by whole-genome sequencing and were resistant to ceftriaxone and at least 2 additional antibiotic classes. All 5 patients with Typhi isolates that were XDR variants reported travel to Pakistan. cResistance was determined by antimicrobial susceptibility testing for 72 isolates and predicted based on whole-genome sequencing for 4 isolates.
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