title: Case Series of Imported Enteric Fever at a Referral Center in Tokyo, Japan: Antibiotic Susceptibility and Risk Factors for Relapse.
abstract: Owing to the increase in Salmonella strains with decreased fluoroquinolone susceptibility in the endemic areas, we have been treating enteric fever with intravenous ceftriaxone empirically since 2007. In this study, we reevaluated our treatment protocol. This retrospective cohort study was conducted at a single institute in Tokyo, Japan, between January 2006 and December 2013. Enteric fever was defined as isolation of Salmonella Typhi or Salmonella Paratyphi A, B, and C from the blood and/or stool of patients with fever. Of the 35 patients with imported enteric fever, 28 (80%) had returned from south Asia. Ciprofloxacin-susceptible strains were detected in only 12% of the cases. The isolates showed excellent susceptibility to ampicillin (91%), chloramphenicol (94%), ceftriaxone (97%), and azithromycin (97%). One case of Salmonella Paratyphi B was excluded, and of the remaining 34 patients, 56% were treated with ceftriaxone alone, 26% with ceftriaxone then fluoroquinolone, and 9% with levofloxacin alone. The overall relapse rate was 6.1%; however, among those receiving ceftriaxone monotherapy, the relapse rate was 11% (N = 2). The relapse group was characterized by longer times to treatment initiation (P = 0.035) and defervescence (> 7 days) after treatment initiation (P = 0.022). In such cases, we recommend that ceftriaxone treatment be continued for > 4 days after defervescence or be changed to fluoroquinolone if the strains are found to be susceptible to prevent relapse. Furthermore, ampicillin and chloramphenicol, which are no longer prescribed, may be reconsidered as treatment options in Asia.
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matono
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan. ykato@hosp.ncgm.go.jp.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Bacteriology I, National Institute of Infectious Diseases, Toyama, Shinjuku-ku, Tokyo, Japan.
authors.forename: Masatomo
authors.initials: M
authors.lastname: Morita
authors.affiliation: Department of Bacteriology I, National Institute of Infectious Diseases, Toyama, Shinjuku-ku, Tokyo, Japan.
authors.forename: Hidemasa
authors.initials: H
authors.lastname: Izumiya
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kutsuna
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Takeshita
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Hayakawa
authors.affiliation: Microbiology Laboratory, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Mezaki
authors.affiliation: Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Hyakunincho, Shinjuku-ku, Tokyo, Japan.
authors.forename: Maho
authors.initials: M
authors.lastname: Kawamura
authors.affiliation: Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Hyakunincho, Shinjuku-ku, Tokyo, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Konishi
authors.affiliation: Department of Infectious Diseases, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Mizuno
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan.
authors.forename: Shuzo
authors.initials: S
authors.lastname: Kanagawa
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Ohmagari
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012482:Salmonella paratyphi A / Q000187:drug effects / Q000302:isolation & purification; D012484:Salmonella paratyphi B / Q000187:drug effects / Q000302:isolation & purification; D012479:Salmonella paratyphi C / Q000187:drug effects / Q000302:isolation & purification; D055502:Secondary Prevention; D014041:Tokyo / Q000453:epidemiology; D014435:Typhoid Fever / Q000188:drug therapy* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents