Erschienen:
Public Library of Science (PLoS), 2024
Erschienen in:PLOS Neglected Tropical Diseases
Sprache:
Englisch
DOI:
10.1371/journal.pntd.0012132
ISSN:
1935-2735
Entstehung:
Anmerkungen:
Beschreibung:
<jats:sec id="sec001">
<jats:title>Background</jats:title>
<jats:p>Typhoid fever is a common cause of febrile illness in low- and middle-income countries. While multidrug-resistant (MDR) <jats:italic>Salmonella</jats:italic> Typhi (<jats:italic>S</jats:italic>. Typhi) has spread globally, fluoroquinolone resistance has mainly affected Asia.</jats:p>
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<jats:sec id="sec002">
<jats:title>Methods</jats:title>
<jats:p>Consecutively, 1038 blood cultures were obtained from patients of all age groups with fever and/or suspicion of serious systemic infection admitted at Mnazi Mmoja Hospital, Zanzibar in 2015–2016. <jats:italic>S</jats:italic>. Typhi were analyzed with antimicrobial susceptibility testing and with short read (61 strains) and long read (9 strains) whole genome sequencing, including three <jats:italic>S</jats:italic>. Typhi strains isolated in a pilot study 2012–2013.</jats:p>
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<jats:sec id="sec003">
<jats:title>Results</jats:title>
<jats:p>Sixty-three <jats:italic>S</jats:italic>. Typhi isolates (98%) were MDR carrying <jats:italic>bla</jats:italic><jats:sub>TEM-1B</jats:sub>, <jats:italic>sul1</jats:italic> and <jats:italic>sul2</jats:italic>, <jats:italic>dfrA7</jats:italic> and <jats:italic>catA1</jats:italic> genes. Low-level ciprofloxacin resistance was detected in 69% (43/62), with a single gyrase mutation <jats:italic>gyrA</jats:italic>-D87G in 41 strains, and a single <jats:italic>gyrA-</jats:italic>S83F mutation in the non-MDR strain. All isolates were susceptible to ceftriaxone and azithromycin. All MDR isolates belonged to genotype 4.3.1 lineage I (4.3.1.1), with the antimicrobial resistance determinants located on a composite transposon integrated into the chromosome. Phylogenetically, the MDR subgroup with ciprofloxacin resistance clusters together with two external isolates.</jats:p>
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<jats:sec id="sec004">
<jats:title>Conclusions</jats:title>
<jats:p>We report a high rate of MDR and low-level ciprofloxacin resistant <jats:italic>S</jats:italic>. Typhi circulating in Zanzibar, belonging to genotype 4.3.1.1, which is widespread in Southeast Asia and African countries and associated with low-level ciprofloxacin resistance. Few therapeutic options are available for treatment of typhoid fever in the study setting. Surveillance of the prevalence, spread and antimicrobial susceptibility of <jats:italic>S</jats:italic>. Typhi can guide treatment and control efforts.</jats:p>
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