title: Epidemiology, antibiotic resistance trends and the cost of enteric fever in East London, 2005-2010.
abstract: BACKGROUND
  Enteric fever seen in the UK has usually been acquired abroad. The cost to the NHS of treating enteric fever cases is not known. Data on the epidemiology of enteric fever, inpatient treatment costs and the public health management is needed to make decisions regarding the cost benefit considerations of introducing targeted prevention strategies.
  
  
  METHODS
  A retrospective study of laboratory confirmed enteric fever cases was conducted to estimate the cost of inpatient treatment and to determine antimicrobial resistance patterns at two hospitals in East London between January 2005 and the end of August 2010.
  
  
  RESULTS
  138 cases of enteric fever were identified during the study period (90 S.ser.Typhi and 48 S. ser. Paratyphi). 92% had a recent history of foreign travel, 57% had travelled to visit friends and relatives (VFRs), 26% sought pre-travel health advice and 26% of patients had received typhoid vaccination. The inpatient treatment cost of 138 cases to the NHS was £272,747. The proportion of isolates with high level ciprofloxacin resistance (MICs>1 mg/L) has increased from 10% in 2006 to 30% in 2010. Our data also shows the emergence of isolates with high azithromycin MICs (>32 mg/L); 60% (six out of ten) isolates tested in July-August 2010.
  
  
  CONCLUSIONS
  There is a significant direct cost of treating enteric fever cases on the NHS. Cost reduction measures are confined due to the lack of effective oral antibiotics following the emergence of high level resistance to ciprofloxacin and azithromycin. Outpatient parenteral antibiotic therapy service and improved preventative public health measures aimed at VFR travellers in particular may be helpful in reducing costs.
authors.affiliation: Department of Microbiology, Barts and The London NHS Trust, 3rd Floor, Pathology and Pharmacy Building, 80 Newark St., London E1 2ES, United Kingdom. drsrinivasulu63@yahoo.com
authors.forename: Srinivasulu
authors.initials: S
authors.lastname: Reddy
authors.forename: Jayakeerthi
authors.initials: J
authors.lastname: Rangaiah
authors.forename: Sarah
authors.initials: S
authors.lastname: Addiman
authors.forename: David
authors.initials: D
authors.lastname: Wareham
authors.forename: Peter
authors.initials: P
authors.lastname: Wilson
authors.forename: Armine
authors.initials: A
authors.lastname: Sefton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D008131:London; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012485:Salmonella typhi / Q000187:drug effects; D014435:Typhoid Fever / Q000191:economics / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents