Azithromycin-resistant mph(A)-positive Salmonella enterica serovar Typhi in the United States

IF 3.7 3区 医学 Q2 INFECTIOUS DISEASES Journal of global antimicrobial resistance Pub Date : 2024-08-20 DOI:10.1016/j.jgar.2024.08.005
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Abstract

Objectives

The United States Centers for Disease Control and Prevention (CDC) conducts active surveillance for typhoid fever cases caused by Salmonella enterica serovar Typhi (Typhi). Here we describe the characteristics of the first two cases of mph(A)-positive azithromycin-resistant Typhi identified through US surveillance.

Methods

Isolates were submitted to public health laboratories, sequenced, and screened for antimicrobial resistance determinants and plasmids, as part of CDC PulseNet's routine genomic surveillance. Antimicrobial susceptibility testing and long-read sequencing were also performed. Basic case information (age, sex, travel, outcome) was collected through routine questionnaires; additional epidemiological data was requested through follow-up patient interviews.

Results

The patients are related and both reported travel to India (overlapping travel dates) before illness onset. Both Typhi genomes belong to the GenoTyphi lineage 4.3.1.1 and carry the azithromycin-resistance gene mph(A) on a PTU-FE (IncFIA/FIB/FII) plasmid. These strains differ genetically from mph(A)-positive Typhi genomes recently reported from Pakistan, suggesting independent emergence of azithromycin resistance in India.

Conclusions

Cases of typhoid fever caused by Typhi strains resistant to all available oral treatment options are cause for concern and support the need for vaccination of travellers to Typhi endemic regions. US genomic surveillance serves as an important global sentinel for detection of strains with known and emerging antimicrobial resistance profiles, including strains from areas where routine surveillance is not conducted.

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美国对阿奇霉素耐药的 mph(A)阳性肠炎沙门氏菌。
目标:.美国疾病控制和预防中心(CDC)对由伤寒沙门氏菌引起的伤寒病例进行积极监测。在此,我们描述了通过美国监测发现的头两例对阿奇霉素耐药的 mph(A) 阳性 Typhi 的特征。作为美国疾病预防控制中心(CDC)PulseNet 常规基因组监测的一部分,分离物被提交给公共卫生实验室、进行测序并筛查抗菌药耐药性决定簇和质粒。此外,还进行了抗菌药物药敏试验和长序列测序。通过常规问卷调查收集了病例的基本信息(年龄、性别、旅行、结果),并通过对患者的随访获得了其他流行病学数据。结果:这两名患者有亲属关系,均报告在发病前曾前往印度(旅行日期重叠)。两株 Typhi 的基因组均属于 GenoTyphi 4.3.1.1 系,并在 PTU-FE (IncFIA/FIB/FII) 质粒上携带阿奇霉素抗性基因 mph(A)。这些菌株在基因上与巴基斯坦最近报道的 mph(A) 阳性 Typhi 基因组不同,表明印度独立出现了阿奇霉素耐药性。由对所有可用口服治疗方案耐药的伤寒菌株引起的伤寒病例令人担忧,这也支持了为前往伤寒流行地区的旅行者接种疫苗的必要性。美国的基因组监测是检测具有已知和新出现的抗菌药耐药性菌株(包括来自未开展常规监测地区的菌株)的重要全球哨点。
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来源期刊
Journal of global antimicrobial resistance
Journal of global antimicrobial resistance INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY
CiteScore
8.70
自引率
2.20%
发文量
285
审稿时长
34 weeks
期刊介绍: The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes. JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR). Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.
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