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Twenty‐six years of enteric fever in Australia: an epidemiological analysis of antibiotic resistance
Author(s) -
Commons Robert J,
McBryde Emma,
Valcanis Mary,
Powling Joan,
Street Alan,
Hogg Geoff
Publication year - 2012
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja12.10082
Subject(s) - nalidixic acid , typhoid fever , antibiotic resistance , ciprofloxacin , multiple drug resistance , paratyphoid fever , incidence (geometry) , drug resistance , ampicillin , medicine , veterinary medicine , microbiology and biotechnology , antibiotics , biology , physics , optics
Objectives: To determine incidence and trends in antibiotic resistance in Australian Salmonella enterica subspecies enterica serovars Typhi ( S . Typhi) and Paratyphi ( S. Paratyphi) isolates over the past 26 years. Design: A retrospective analysis of consecutive microbiologically confirmed enteric fever isolates. Participants and setting: All S. Typhi and S . Paratyphi isolates from patients diagnosed with enteric fever in Australia between 1985 and 2010. Main outcome measures: Incidence and variation in antibiotic resistance over time and according to country of origin. Results: We analysed 2551 isolates, which originated from 74 countries or regions, mainly India (33%) and Indonesia (22%). The incidence among Australian residents increased from four to five before 2003 to seven cases per million person‐years after 2003. Multidrug resistance (chloramphenicol, ampicillin, trimethoprim) and nalidixic acid resistance emerged rapidly from the early 1990s, with nalidixic acid resistance increasing to 70% in 2009–2010, while multidrug resistance was relatively stable at between 4% and 11%. Nalidixic acid and multidrug resistance rates are highest in isolates from the Indian subcontinent. Some countries in South‐East Asia, such as Indonesia, had very low rates of resistance; however, this varied across the region. Conclusions: Nalidixic acid resistance has become widespread in enteric fever isolates from the Indian subcontinent and some parts of South‐East Asia, justifying the use of ceftriaxone or azithromycin rather than ciprofloxacin as first‐line treatment. However, resistance in some countries remains rare, potentially allowing treatment to be adjusted according to country of origin.