title: Trends of etiology and drug resistance in enteric fever in the last two decades in Nepal: a systematic review and meta-analysis.
abstract: Prospective time-trend analyses on shifting etiology and trends of drug resistance in enteric fever are scarce. Using published and unpublished datasets from Nepal, we performed a systematic review and meta-analysis to understand the trends in etiology and resistance to antimicrobials that have occurred since 1993. Thirty-two studies involving 21 067 Salmonella enterica serotype Typhi (ST) and S. enterica serotype Paratyphi A (SPA) isolates were included. There was an increasing trend in enteric fever caused by SPA during the last 2 decades (P < .01). We observed sharply increasing trends in resistance to nalidixic acid and ciprofloxacin for both ST and SPA. In contrast, multi-drug resistance (MDR), resistance to traditional first-line antibiotics such as chloramphenicol and co-trimoxazole have significantly decreased for both organisms. The resistance to ceftriaxone has remained low, suggesting it is likely to remain useful as a reserve antibiotic for treatment. Trends in decreasing resistance to traditional first-line antibiotics and decreasing MDR provide an opportunity to reconsider these first-line antimicrobials as therapeutic options.
authors.affiliation: Infectious Disease Epidemiology Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Surendra
authors.initials: S
authors.lastname: Karki
authors.forename: Prabin
authors.initials: P
authors.lastname: Shakya
authors.forename: Allen C
authors.initials: AC
authors.lastname: Cheng
authors.forename: Shyam Prakash
authors.initials: SP
authors.lastname: Dumre
authors.forename: Karin
authors.initials: K
authors.lastname: Leder
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D006801:Humans; D009390:Nepal / Q000453:epidemiology; D012480:Salmonella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D019779:Salmonella enterica / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents
keywords: antimicrobial; enteric fever; paratyphoid; resistance; typhoid