Asghar Muhammad, Khan Taj Ali, Séraphin Marie Nancy, Schimke Lena F, Cabral-Marques Otavio, Haq Ihtisham Ul, Farooqi Zia-Ur-Rehman, Campino Susana, Ullah Ihsan, Clark Taane G
Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar 25120, Pakistan.
Department of Pathology, Khyber Teaching Hospital, Khyber Medical College, Peshawar 25120, Pakistan.
Antibiotics (Basel). 2024 Aug 14;13(8):765. doi: 10.3390/antibiotics13080765.
: Typhoid fever caused by serovar Typhi continues to pose a significant risk to public health in developing countries, including Pakistan. This study investigated the epidemiological factors linked to suspected and confirmed infections in Peshawar's hospital population. : A total of 5735 blood samples of patients with suspected enteric fever were collected from September 2022 to November 2023. infection was confirmed using microbiological culture of blood samples, biochemical-based tests, and DNA-sequencing methods. Drug sensitivity testing on cultures was conducted as per the CLSI guidelines. Chi-square tests were used to analyze the clinical and epidemiologic characteristics of 5735 samples stratified by infection status, and risk factors were assessed by applying logistic regression models to estimate odds ratios (ORs). : The number of confirmed typhoid fever cases in this hospital-based study population was 691 (/5735, 12.0%), more prevalent in males (447/3235 13.8%) and children (0-11 years) (429/2747, 15.6%). Compared to children, the risk of infection was lower in adolescence (adjusted OR = 0.52; 95% CI: 0.42-0.66), adulthood (19-59 years; aOR = 0.30; 95% CI: 0.25-0.38), and older adulthood (aOR = 0.08; 95% CI: 0.04-0.18) ( < 0.001). Compared to males, the risk of infection was lower in females (aOR = 0.67; 95% CI = 0.56-0.80; = 0.002). Living in a rural residence (compared to urban) was associated with a higher risk of infection (aOR = 1.38; 95% CI: 1.16-1.63; = 0.001), while access to a groundwater source (compared to municipal water supply) led to a lower risk (aOR = 0.56; 95% CI: 0.43-0.73; = 0.002). Vaccination demonstrated a robust protective effect (aOR = 0.069; 95% CI = 0.04-0.11, = 0.002). For those with typhoid infections, clinical biomarker analysis revealed the presence of leucopenia (65/691, 9.4%), thrombocytopenia (130/691, 18.8%), and elevated alanine aminotransferase (ALT) (402/691, 58.2%) and C-reactive protein (CRP) (690/691, 99.9%) levels. Worryingly, among the positive isolates, there was a high prevalence of drug resistance (653/691), including multidrug-resistant (MDR 82/691, 11.9%) and extensively drug-resistant types (XDR, 571/691, 82.6%). : This study highlights the importance of age, sex, locality, water source, and vaccination status in shaping the epidemiological landscape of in the Peshawar district. It implies that expanding vaccination coverage to the broader population of Khyber Pakhtunkhwa province, particularly in the district of Peshawar, would be beneficial.
伤寒杆菌血清型引起的伤寒热继续对包括巴基斯坦在内的发展中国家的公共卫生构成重大风险。本研究调查了白沙瓦医院人群中与疑似和确诊感染相关的流行病学因素。：2022年9月至2023年11月，共收集了5735份疑似肠热症患者的血样。通过血样的微生物培养、基于生化的检测和DNA测序方法确诊感染。根据CLSI指南对培养物进行药敏试验。采用卡方检验分析按感染状态分层的5735份样本的临床和流行病学特征，并应用逻辑回归模型评估风险因素以估计比值比（OR）。：在这个以医院为基础的研究人群中，确诊的伤寒热病例数为691例（/5735，12.0%），在男性（447/3235，13.8%）和儿童（0 - 11岁）（429/2747，15.6%）中更为普遍。与儿童相比，青少年（调整后的OR = 0.52；95% CI：0.42 - 0.66）、成年人（19 - 59岁；aOR = 0.30；95% CI：0.25 - 0.38）和老年人（aOR = 0.08；95% CI：0.04 - 0.18）感染的风险较低（<0.001）。与男性相比，女性感染的风险较低（aOR = 0.67；95% CI = 0.56 - 0.80； = 0.002）。居住在农村地区（与城市相比）感染风险较高（aOR = 1.38；95% CI：1.16 - 1.63； = 0.001），而使用地下水源（与市政供水相比）感染风险较低（aOR = 0.56；95% CI：0.43 - 0.73； = 0.002）。接种疫苗显示出强大的保护作用（aOR = 0.069；95% CI = 0.04 - 0.11， = 0.002）。对于伤寒感染患者，临床生物标志物分析显示存在白细胞减少（65/691，9.4%）、血小板减少（130/691，18.8%）以及丙氨酸转氨酶（ALT）升高（402/691，58.2%）和C反应蛋白（CRP）升高（690/691，99.9%）。令人担忧的是，在阳性分离株中，耐药性普遍存在（653/691），包括多重耐药（MDR 82/691，11.9%）和广泛耐药类型（XDR，571/691，82.6%）。：本研究强调了年龄、性别、地点、水源和疫苗接种状况在塑造白沙瓦地区伤寒流行病学格局中的重要性。这意味着将疫苗接种覆盖范围扩大到开伯尔 - 普赫图赫瓦省更广泛的人群，特别是在白沙瓦地区，将是有益的。
