Journal Article

Trends in antimicrobial resistance amongst Salmonella Typhi in Bangladesh: A 24-year retrospective observational study (1999–2022)

Rahman, Hafizur, Sarkar, Anik, Islam, Nazrul, Hanif, Mohammed, Rahman, Md. Asadur, Luby, Stephen P., Tanmoy, Arif Mohammad, Garrett, Denise O., Sajib, Mohammad Saiful Islam, Shahidullah, Mohammod, Hooda, Yogesh, Saha, Senjuti, Das, Dipu, Kanon, Naito, Alam, Jahangir, Endtz, Hubert P., Amin, Md. Ruhul, Saha, Samir K.

2024

Overview

Rising antimicrobial resistance (AMR) in Salmonella Typhi restricts typhoid treatment options, heightening concerns for pan-oral drug-resistant outbreaks. However, lack of long-term temporal surveillance data on AMR in countries with high burden like Bangladesh is scarce. Our study explores the AMR trends of Salmonella Typhi isolates from Bangladesh, drawing comparisons with antibiotic consumption to optimize antibiotic stewardship strategies for the country. The typhoid fever surveillance from 1999 to 2022 included two pediatric hospitals and three private clinics in Dhaka, Bangladesh. Blood cultures were performed at treating physicians' discretion; cases were confirmed by microbiological, serological, and biochemical tests. Antibiotic susceptibility was determined following CLSI guidelines. National antibiotic consumption data for cotrimoxazole, ciprofloxacin, and azithromycin was obtained from IQVIA-MIDAS database for comparison. Over the 24 years of surveillance, we recorded 12,435 culture-confirmed typhoid cases and observed declining resistance to first-line drugs (amoxicillin, chloramphenicol, and cotrimoxazole); multidrug resistance (MDR) decreased from 38% in 1999 to 17% in 2022. Cotrimoxazole consumption dropped from 0.8 to 0.1 Daily defined doses (DDD)/1000/day (1999-2020). Ciprofloxacin non-susceptibility persisted at >90% with unchanged consumption (1.1-1.3 DDD/1000/day, 2002-2020). Low ceftriaxone resistance (<1%) was observed, with slightly rising MIC (0.03 to 0.12 mg/L, 1999-2019). Azithromycin consumption increased (0.1 to 3.8 DDD/1000/day, 1999-2020), but resistance remained ≤4%. Our study highlights declining MDR amongst Salmonella Typhi in Bangladesh; first-line antimicrobials could be reintroduced as empirical treatment options for typhoid fever if MDR rates further drops below 5%. The analysis also provides baseline data for monitoring the impact of future interventions like typhoid conjugate vaccines on typhoid burden and associated AMR.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Analysis / Anti-Bacterial Agents - pharmacology / Anti-Bacterial Agents - therapeutic use / Antibiotics / Antimicrobial agents / Antimicrobial resistance / Azithromycin / Azithromycin - pharmacology / Azithromycin - therapeutic use / Bangladesh - epidemiology / Baseline studies / Biochemical tests / Biology and Life Sciences / Blood / Ceftriaxone / Child / Child, Preschool / Childrens health / Chloramphenicol / Chloromycetin / Ciprofloxacin / Ciprofloxacin - pharmacology / Ciprofloxacin - therapeutic use / Cotrimoxazole / Disease / Drug resistance / Drug resistance in microorganisms / Drug Resistance, Bacterial / Drug Resistance, Multiple, Bacterial / Drug stores / Female / Fever / Health services / Hospitals / Humans / Laboratories / Male / Medical examination / Medicine and Health Sciences / Microbial Sensitivity Tests / Multidrug resistance / Observational studies / Oral administration / Pediatrics / People and Places / Prevention / Public health / Retrospective Studies / Risk factors / Salmonella / Salmonella Typhi / Salmonella typhi - drug effects / Stewardship / Surveillance / Time trends (Statistics) / Trends / Trimethoprim, Sulfamethoxazole Drug Combination - pharmacology / Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use / Typhoid / Typhoid fever / Typhoid Fever - drug therapy / Typhoid Fever - epidemiology / Typhoid Fever - microbiology / Vaccines / Waterborne diseases