Translational Health Science and Technology Institute, Faridabad, India.
Sabin Vaccine Institute, Washington, D. C., Georgia.
J Infect Dis. 2018 Nov 10;218(suppl_4):S206-S213. doi: 10.1093/infdis/jiy502.
Enteric fever remains a threat to many countries with minimal access to clean water and poor sanitation infrastructure. As part of a multisite surveillance study, we conducted a retrospective review of records in 5 hospitals across India to gather evidence on the burden of enteric fever.
We examined hospital records (laboratory and surgical registers) from 5 hospitals across India for laboratory-confirmed Salmonella Typhi or Salmonella Paratyphi cases and intestinal perforations from 2014-2015. Clinical data were obtained where available. For laboratory-confirmed infections, we compared differences in disease burden, age, sex, clinical presentation, and antimicrobial resistance.
Of 267536 blood cultures, 1418 (0.53%) were positive for S. Typhi or S. Paratyphi. Clinical data were available for 429 cases (72%); a higher proportion of participants with S. Typhi infection were hospitalized, compared with those with S. Paratyphi infection (44% vs 35%). We observed resistance to quinolones among 82% of isolates, with cases of cephalosporin resistance (1%) and macrolide resistance (9%) detected. Of 94 participants with intestinal perforations, 16 (17%) had a provisional, final, or laboratory-confirmed diagnosis of enteric fever.
Data show a moderate burden of enteric fever in India. Enteric fever data should be systematically collected to facilitate evidence-based decision-making by countries for typhoid conjugate vaccines.
在那些难以获得清洁用水和卫生基础设施较差的国家，肠热病仍然是一个威胁。作为多地点监测研究的一部分，我们对印度 5 家医院的记录进行了回顾性审查，以收集有关肠热病负担的证据。
我们检查了印度 5 家医院的医院记录（实验室和外科登记册），以寻找 2014 年至 2015 年间实验室确诊的伤寒沙门氏菌或副伤寒沙门氏菌病例和肠穿孔病例。在有临床数据的情况下，我们获得了临床数据。对于实验室确诊的感染，我们比较了疾病负担、年龄、性别、临床表现和抗生素耐药性方面的差异。
在 267536 份血培养中，有 1418 份（0.53%）为伤寒沙门氏菌或副伤寒沙门氏菌阳性。有 429 例（72%）的临床数据可用；与副伤寒沙门氏菌感染相比，伤寒沙门氏菌感染的患者住院比例更高（44%对 35%）。我们观察到 82%的分离株对喹诺酮类药物耐药，检测到头孢菌素耐药（1%）和大环内酯类耐药（9%）。在 94 例肠穿孔患者中，有 16 例（17%）初步、最终或实验室确诊为肠热病。
数据显示印度肠热病的负担适中。应系统收集肠热病数据，以促进各国对伤寒结合疫苗的循证决策。
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