title: Laboratory-based surveillance of Salmonella serotype Typhi infections in the United States: antimicrobial resistance on the rise.
abstract: BACKGROUND
  Multidrug-resistant Salmonella serotype Typhi infections have been reported worldwide, but data on the incidence of resistant strains in the United States are lacking.
  
  
  OBJECTIVE
  To determine the incidence of antimicrobial-resistant Salmonella Typhi infections and to identify risk factors for infection.
  
  
  METHODS
  Cross-sectional laboratory-based surveillance study.
  
  
  METHODS
  A total of 293 persons with symptomatic typhoid fever who had Salmonella Typhi isolates and epidemiological information submitted to US public health departments and laboratories from June 1, 1996, to May 31, 1997.
  
  
  METHODS
  Proportion of Salmonella Typhi isolates demonstrating resistance to 12 antimicrobial agents; patient epidemiological factors associated with drug-resistant infections.
  
  
  RESULTS
  Median age was 21 years (range, 3 months to 84 years); 56% were male. Two hundred twenty-eight (80%) were hospitalized; 2 died. In the 6 weeks before illness onset, 81% of patients had traveled abroad. Seventy-four Salmonella Typhi isolates (25%) were resistant to 1 or more antimicrobial agent, and 51 (17%) were resistant to 5 or more agents, including ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug-resistant Salmonella Typhi [MDRST]). Although no resistance to ciprofloxacin or ceftriaxone was observed, 20 isolates (7%) were nalidixic acid-resistant (NARST). Patients with MDRST and NARST infections were more likely to report travel outside the United States, particularly to the Indian subcontinent (Bangladesh, India, and Pakistan) (odds ratio [OR], 29.3; 95% confidence interval [CI], 6.8-126.7; P<.001 and OR, 35.9; 95% CI, 3.4-377.3; P<.001, respectively).
  
  
  CONCLUSIONS
  Our data suggest that ciprofloxacin and ceftriaxone are appropriate empirical therapy for suspected typhoid fever; however, resistance may be anticipated. Continued monitoring of antimicrobial resistance among Salmonella Typhi strains will help determine vaccination and treatment policies. JAMA. 2000;283:2668-2673.
authors.affiliation: Epidemiology Branch, Division of HIV/AIDS, Mail Stop E-45, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Ackers
authors.forename: N D
authors.initials: ND
authors.lastname: Puhr
authors.forename: R V
authors.initials: RV
authors.lastname: Tauxe
authors.forename: E D
authors.initials: ED
authors.lastname: Mintz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007753:Laboratories; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D012485:Salmonella typhi / Q000187:drug effects*; D014195:Travel; D014435:Typhoid Fever / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D014481:United States / Q000453:epidemiology