title: Emerging trends in enteric fever in Nepal: 9124 cases confirmed by blood culture 1993-2003.
abstract: This was a retrospective study in an urban hospital in Kathmandu, Nepal to determine the changing burden of salmonella septicaemia, the proportion of Salmonella paratyphi A, and the emergence of drug-resistant organisms. The participants were outpatients and inpatients over the period 1993-2003, and the main outcome measures were blood culture isolates and antibiotic sensitivity testing. The results showed that of 82467 blood cultures performed, a bacterium was isolated from 12252. Salmonella accounted for 9124 (74.5%) of the positive blood cultures: 6447 (70.7%) were Salmonella enterica serotype Typhi (S. typhi) and 2677 (29.3%) were Paratyphi A (S. paratyphi A). In comparing the period 1997-2000 to the period 2001-2003, we found that, as a proportion of total blood cultures taken, salmonella septicaemia more than doubled, from 6.2 to 13.6% (P<0.001). From the first half of the study (1993-1998) to the second half (1999-2003), S. paratyphi A as a proportion of all salmonella isolates rose from 23 to 34% (P<0.001), which paralleled its increased resistance to ciprofloxacin. Despite the introduction of new antibiotics, enteric fever continues to grow as a cause for hospital presentation in Nepal. Salmonella paratyphi A contributes an increasingly large proportion of cases, and ciprofloxacin resistance is also emerging more rapidly in S. paratyphi A.
authors.affiliation: Patan Hospital, GPO Box 252, Kathmandu, Nepal.
authors.forename: Ashish P
authors.initials: AP
authors.lastname: Maskey
authors.forename: Buddha
authors.initials: B
authors.lastname: Basnyat
authors.forename: Guy E
authors.initials: GE
authors.lastname: Thwaites
authors.forename: James I
authors.initials: JI
authors.lastname: Campbell
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Farrar
authors.forename: Mark D
authors.initials: MD
authors.lastname: Zimmerman
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D003906:Developing Countries; D024881:Drug Resistance, Bacterial; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D008826:Microbial Sensitivity Tests; D009390:Nepal / Q000453:epidemiology; D012189:Retrospective Studies; D012485:Salmonella typhi / Q000187:drug effects / Q000302:isolation & purification; D014435:Typhoid Fever / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D002939:Ciprofloxacin