Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Bangladesh.
Bangladesh Institute of Child Health, Dhaka Shishu (Children) Hospital, Bangladesh.
J Infect Dis. 2018 Nov 10;218(suppl_4):S227-S231. doi: 10.1093/infdis/jiy191.
Designing comprehensive surveillance to generate credible burden estimates of enteric fever in an endemic country can be challenging because care-seeking behavior is complex and surveillance in different healthcare facilities may lead to documentation of different epidemiological characteristics.
We conducted retrospective surveillance in 3 healthcare facilities to identify culture-confirmed enteric fever cases in Dhaka, Bangladesh, from January 2012 through December 2016. The study settings included (1) hospital in-patient department (IPD), (2) hospital out-patient department (OPD), and (3) private consultation center OPD. We analyzed the cases to understand their distribution, age ranges, and antibiotic susceptibility patterns across the settings.
Of the 1837 culture-confirmed enteric fever cases, 59% (1079 of 1837) were OPD cases. Children with enteric fever hospitalized in the IPDs were younger than children seeking care at the hospital OPD (median age: 45 vs 60 months) or private OPD (median age: 45 vs 72 months). Multidrug resistance rates were slightly higher in hospital IPD cases than in private OPD cases (26% vs 24%).
In each facility, we identified different epidemiological characteristics, and lack of consideration of any of these may result in misinterpretation of disease burden, identification of different age groups, and/or antibiotic susceptibility patterns.
在一个地方性流行国家设计全面监测以生成肠热病负担的可信估计可能具有挑战性，因为求医行为复杂，不同医疗机构的监测可能导致记录不同的流行病学特征。
我们在孟加拉国达卡的 3 家医疗机构进行了回顾性监测，以确定 2012 年 1 月至 2016 年 12 月期间经培养确诊的肠热病病例。研究场所包括（1）医院住院部（IPD），（2）医院门诊部（OPD）和（3）私人咨询中心 OPD。我们分析了这些病例，以了解它们在不同环境中的分布、年龄范围和抗生素敏感性模式。
在 1837 例经培养确诊的肠热病病例中，59%（1079/1837）为 OPD 病例。在 IPD 住院的肠热病患儿比在医院 OPD（中位数年龄：45 岁与 60 岁）或私人 OPD（中位数年龄：45 岁与 72 岁）就诊的儿童年龄更小。医院 IPD 病例的多药耐药率略高于私人 OPD 病例（26%比 24%）。
在每个医疗机构中，我们都确定了不同的流行病学特征，如果不考虑这些特征，可能会导致对疾病负担的误解，以及不同年龄组和/或抗生素敏感性模式的识别。
