title: Enteric fever in Barcelona: Changing patterns of importation and antibiotic resistance.
abstract: BACKGROUND
  Enteric fever's incidence is decreasing among residents of high-income countries, although it's rising in travelers coming from low-resource endemic settings. The study's aim is to describe epidemiological, clinical and laboratory features of patients with enteric fever.
  
  
  METHODS
  Retrospective descriptive study of enteric fever cases diagnosed at a Tropical Medicine Unit in Barcelona, 1993-2012.
  
  
  RESULTS
  Out of 40 patients, 31(77,5%) were returning travelers, and 70% of them had been in Southern Asia. In the rest of patients without an antecedent of a recent travel, the infection occurred mainly before year 2000. The more frequently reported symptoms were fever and diarrhea, lacking significant differences between S. typhi and S. paratyphi infections. Quinolones were used as empiric treatment in 47.2% of patients, 36.1% received 3rd generation cephalosporins, 2.78% azithromycin and 13.89% other combinations. Resistance to quinolones in the S. paratyphi group (66.7%) was significantly higher compared with the S. typhi group (20%) (p:0.02). 22.5% of patients had treatment failure and 23.6% patients presented complications, none of them had been previously vaccinated.
  
  
  CONCLUSIONS
  The diagnosis of enteric fever was more frequent among travelers coming from Southern-East Asia. Quinolone resistance is widely spread, particularly in S. paratyphi serotypes and should not be considered as first choice treatment anymore.
authors.affiliation: Barcelona Institute for Global Health, ISGlobal-CRESIB, Universitat de Barcelona, Spain. Electronic address: ana.requena@isglobal.org.
authors.forename: Ana
authors.initials: A
authors.lastname: Requena-Méndez
authors.affiliation: Barcelona Institute for Global Health, ISGlobal-CRESIB, Universitat de Barcelona, Spain.
authors.forename: Monica
authors.initials: M
authors.lastname: Berrocal
authors.affiliation: Department of Microbiology (CDB), Hospital Clínic, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Almela
authors.affiliation: Department of Infectious Diseases, Hospital Clinic, Barcelona, Spain.
authors.forename: Alex
authors.initials: A
authors.lastname: Soriano
authors.affiliation: Barcelona Institute for Global Health, ISGlobal-CRESIB, Universitat de Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gascón
authors.affiliation: Barcelona Institute for Global Health, ISGlobal-CRESIB, Universitat de Barcelona, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Muñoz
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001208:Asia / Q000453:epidemiology; D001210:Asia, Southeastern / Q000453:epidemiology; D017963:Azithromycin / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010284:Paratyphoid Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D015363:Quinolones / Q000627:therapeutic use; D012189:Retrospective Studies; D012482:Salmonella paratyphi A / Q000187:drug effects / Q000302:isolation & purification; D012485:Salmonella typhi / Q000187:drug effects / Q000302:isolation & purification; D014195:Travel; D014435:Typhoid Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000635:transmission; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D015363:Quinolones; D017963:Azithromycin
keywords: Azithromycin; Cephalosporins; Enteric fever; Paratyphoid fever; Quinolones; Salmonella paratyphi; Salmonella typhi; Typhoid fever