Epidemiological and clinical characteristics of international travelers with enteric fever and antibiotic resistance profiles of their isolates: a GeoSentinel analysis

Stefan H. F. Hagmann; Kristina M. Angelo; Ralph Huits; Katherine Plewes; Gilles Eperon; Martin P. Grobusch; Anne McCarthy; Michael Libman; Eric Caumes; Daniel T. Leung; Hilmir Asgeirsson; Mogens Jensenius; Eli Schwartz; Adrian Sanchez-Montalva; Paul Kelly; Prativa Pandey; Karin Leder; Daniel L. Bourque; Yukihiro Yoshimura; Frank P. Mockenhaupt; Perry J. J. van Genderen; Silvia Odolini; Patricia Schlagenhauf; Bradley A. Connor; Davidson H. Hamer

doi:10.1128/AAC.01084-20

Epidemiological and clinical characteristics of international travelers with enteric fever and antibiotic resistance profiles of their isolates: a GeoSentinel analysis

Stefan H. F. Hagmann, Kristina M. Angelo, Ralph Huits, Katherine Plewes, Gilles Eperon, Martin P. Grobusch, Anne McCarthy, Michael Libman, Eric Caumes, Daniel T. Leung, Hilmir Asgeirsson, Mogens Jensenius, Eli Schwartz, Adrian Sanchez-Montalva, Paul Kelly, Prativa Pandey, Karin Leder, Daniel L. Bourque, Yukihiro Yoshimura, Frank P. MockenhauptPerry J. J. van Genderen, Silvia Odolini, Patricia Schlagenhauf, Bradley A. Connor, Davidson H. Hamer

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Abstract

Enteric fever, caused by Salmonella enterica serovar Typhi ( S Typhi) and S. enterica serovar Paratyphi ( S Paratyphi), is a common travel-related illness. Limited data are available on the antimicrobial resistance (AMR) patterns of these serovars among travelers. Records of travelers with a culture-confirmed diagnosis seen during or after travel from January 2007 to December 2018 were obtained from GeoSentinel. Traveler demographics and antimicrobial susceptibility data were analyzed. Isolates were classified as nonsusceptible if intermediate or resistant or as susceptible in accordance with the participating site's national guidelines. A total of 889 travelers ( S Typhi infections, n = 474; S Paratyphi infections, n = 414; coinfection, n = 1) were included; 114 (13%) were children of <18 years old. Most individuals (41%) traveled to visit friends and relatives (VFRs) and acquired the infection in South Asia (71%). Child travelers with S Typhi infection were most frequently VFRs (77%). The median trip duration was 31 days (interquartile range, 18 to 61 days), and 448 of 691 travelers (65%) had no pretravel consultation. Of 143 S Typhi and 75 S Paratyphi isolates for which there were susceptibility data, nonsusceptibility to antibiotics varied (fluoroquinolones, 65% and 56%, respectively; co-trimoxazole, 13% and 0%; macrolides, 8% and 16%). Two S Typhi isolates (1.5%) from India were nonsusceptible to third-generation cephalosporins. S Typhi fluoroquinolone nonsusceptibility was highest when infection was acquired in South Asia (70 of 90 isolates; 78%) and sub-Saharan Africa (6 of 10 isolates; 60%). Enteric fever is an important travel-associated illness complicated by AMR. Our data contribute to a better understanding of region-specific AMR, helping to inform empirical treatment options. Prevention measures need to focus on high-risk travelers including VFRs and children.

Original language	English
Article number	e01084-20
Journal	Antimicrobial Agents and Chemotherapy
Volume	64
Issue number	11
Number of pages	10
ISSN	0066-4804
DOIs	https://doi.org/10.1128/AAC.01084-20
Publication status	Published - 2020

Keywords

antimicrobial resistance
enteric fever
paratyphoid
travel
typhoid
UNITED-STATES
PARATYPHOID FEVER
VISITING FRIENDS
TYPHOID-FEVER
SURVEILLANCE
RELATIVES
VACCINES
ILLNESS
CARE

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2020aache01084Final published version, 418 KBLicence: Other

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Hagmann, S. H. F., Angelo, K. M., Huits, R., Plewes, K., Eperon, G., Grobusch, M. P., McCarthy, A., Libman, M., Caumes, E., Leung, D. T., Asgeirsson, H., Jensenius, M., Schwartz, E., Sanchez-Montalva, A., Kelly, P., Pandey, P., Leder, K., Bourque, D. L., Yoshimura, Y., ... Hamer, D. H. (2020). Epidemiological and clinical characteristics of international travelers with enteric fever and antibiotic resistance profiles of their isolates: a GeoSentinel analysis. Antimicrobial Agents and Chemotherapy, 64(11), Article e01084-20. https://doi.org/10.1128/AAC.01084-20

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title = "Epidemiological and clinical characteristics of international travelers with enteric fever and antibiotic resistance profiles of their isolates: a GeoSentinel analysis",

abstract = "Enteric fever, caused by Salmonella enterica serovar Typhi ( S Typhi) and S. enterica serovar Paratyphi ( S Paratyphi), is a common travel-related illness. Limited data are available on the antimicrobial resistance (AMR) patterns of these serovars among travelers. Records of travelers with a culture-confirmed diagnosis seen during or after travel from January 2007 to December 2018 were obtained from GeoSentinel. Traveler demographics and antimicrobial susceptibility data were analyzed. Isolates were classified as nonsusceptible if intermediate or resistant or as susceptible in accordance with the participating site's national guidelines. A total of 889 travelers ( S Typhi infections, n = 474; S Paratyphi infections, n = 414; coinfection, n = 1) were included; 114 (13%) were children of <18 years old. Most individuals (41%) traveled to visit friends and relatives (VFRs) and acquired the infection in South Asia (71%). Child travelers with S Typhi infection were most frequently VFRs (77%). The median trip duration was 31 days (interquartile range, 18 to 61 days), and 448 of 691 travelers (65%) had no pretravel consultation. Of 143 S Typhi and 75 S Paratyphi isolates for which there were susceptibility data, nonsusceptibility to antibiotics varied (fluoroquinolones, 65% and 56%, respectively; co-trimoxazole, 13% and 0%; macrolides, 8% and 16%). Two S Typhi isolates (1.5%) from India were nonsusceptible to third-generation cephalosporins. S Typhi fluoroquinolone nonsusceptibility was highest when infection was acquired in South Asia (70 of 90 isolates; 78%) and sub-Saharan Africa (6 of 10 isolates; 60%). Enteric fever is an important travel-associated illness complicated by AMR. Our data contribute to a better understanding of region-specific AMR, helping to inform empirical treatment options. Prevention measures need to focus on high-risk travelers including VFRs and children. ",

keywords = "antimicrobial resistance, enteric fever, paratyphoid, travel, typhoid, UNITED-STATES, PARATYPHOID FEVER, VISITING FRIENDS, TYPHOID-FEVER, SURVEILLANCE, RELATIVES, VACCINES, ILLNESS, CARE",

author = "Hagmann, {Stefan H. F.} and Angelo, {Kristina M.} and Ralph Huits and Katherine Plewes and Gilles Eperon and Grobusch, {Martin P.} and Anne McCarthy and Michael Libman and Eric Caumes and Leung, {Daniel T.} and Hilmir Asgeirsson and Mogens Jensenius and Eli Schwartz and Adrian Sanchez-Montalva and Paul Kelly and Prativa Pandey and Karin Leder and Bourque, {Daniel L.} and Yukihiro Yoshimura and Mockenhaupt, {Frank P.} and {van Genderen}, {Perry J. J.} and Silvia Odolini and Patricia Schlagenhauf and Connor, {Bradley A.} and Hamer, {Davidson H.}",

note = "FTX; CHECK: NOOA",

year = "2020",

doi = "10.1128/AAC.01084-20",

language = "English",

volume = "64",

journal = "Antimicrobial Agents and Chemotherapy",

issn = "0066-4804",

publisher = "American Society for Microbiology",

number = "11",

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Hagmann, SHF, Angelo, KM, Huits, R, Plewes, K, Eperon, G, Grobusch, MP, McCarthy, A, Libman, M, Caumes, E, Leung, DT, Asgeirsson, H, Jensenius, M, Schwartz, E, Sanchez-Montalva, A, Kelly, P, Pandey, P, Leder, K, Bourque, DL, Yoshimura, Y, Mockenhaupt, FP, van Genderen, PJJ, Odolini, S, Schlagenhauf, P, Connor, BA & Hamer, DH 2020, 'Epidemiological and clinical characteristics of international travelers with enteric fever and antibiotic resistance profiles of their isolates: a GeoSentinel analysis', Antimicrobial Agents and Chemotherapy, vol. 64, no. 11, e01084-20. https://doi.org/10.1128/AAC.01084-20

Epidemiological and clinical characteristics of international travelers with enteric fever and antibiotic resistance profiles of their isolates: a GeoSentinel analysis. / Hagmann, Stefan H. F.; Angelo, Kristina M.; Huits, Ralph et al.
In: Antimicrobial Agents and Chemotherapy, Vol. 64, No. 11, e01084-20, 2020.

Research output: Contribution to journal › A1: Web of Science-article › peer-review

TY - JOUR

T1 - Epidemiological and clinical characteristics of international travelers with enteric fever and antibiotic resistance profiles of their isolates: a GeoSentinel analysis

AU - Hagmann, Stefan H. F.

AU - Angelo, Kristina M.

AU - Huits, Ralph

AU - Plewes, Katherine

AU - Eperon, Gilles

AU - Grobusch, Martin P.

AU - McCarthy, Anne

AU - Libman, Michael

AU - Caumes, Eric

AU - Leung, Daniel T.

AU - Asgeirsson, Hilmir

AU - Jensenius, Mogens

AU - Schwartz, Eli

AU - Sanchez-Montalva, Adrian

AU - Kelly, Paul

AU - Pandey, Prativa

AU - Leder, Karin

AU - Bourque, Daniel L.

AU - Yoshimura, Yukihiro

AU - Mockenhaupt, Frank P.

AU - van Genderen, Perry J. J.

AU - Odolini, Silvia

AU - Schlagenhauf, Patricia

AU - Connor, Bradley A.

AU - Hamer, Davidson H.

N1 - FTX; CHECK: NOOA

PY - 2020

Y1 - 2020

N2 - Enteric fever, caused by Salmonella enterica serovar Typhi ( S Typhi) and S. enterica serovar Paratyphi ( S Paratyphi), is a common travel-related illness. Limited data are available on the antimicrobial resistance (AMR) patterns of these serovars among travelers. Records of travelers with a culture-confirmed diagnosis seen during or after travel from January 2007 to December 2018 were obtained from GeoSentinel. Traveler demographics and antimicrobial susceptibility data were analyzed. Isolates were classified as nonsusceptible if intermediate or resistant or as susceptible in accordance with the participating site's national guidelines. A total of 889 travelers ( S Typhi infections, n = 474; S Paratyphi infections, n = 414; coinfection, n = 1) were included; 114 (13%) were children of <18 years old. Most individuals (41%) traveled to visit friends and relatives (VFRs) and acquired the infection in South Asia (71%). Child travelers with S Typhi infection were most frequently VFRs (77%). The median trip duration was 31 days (interquartile range, 18 to 61 days), and 448 of 691 travelers (65%) had no pretravel consultation. Of 143 S Typhi and 75 S Paratyphi isolates for which there were susceptibility data, nonsusceptibility to antibiotics varied (fluoroquinolones, 65% and 56%, respectively; co-trimoxazole, 13% and 0%; macrolides, 8% and 16%). Two S Typhi isolates (1.5%) from India were nonsusceptible to third-generation cephalosporins. S Typhi fluoroquinolone nonsusceptibility was highest when infection was acquired in South Asia (70 of 90 isolates; 78%) and sub-Saharan Africa (6 of 10 isolates; 60%). Enteric fever is an important travel-associated illness complicated by AMR. Our data contribute to a better understanding of region-specific AMR, helping to inform empirical treatment options. Prevention measures need to focus on high-risk travelers including VFRs and children.

AB - Enteric fever, caused by Salmonella enterica serovar Typhi ( S Typhi) and S. enterica serovar Paratyphi ( S Paratyphi), is a common travel-related illness. Limited data are available on the antimicrobial resistance (AMR) patterns of these serovars among travelers. Records of travelers with a culture-confirmed diagnosis seen during or after travel from January 2007 to December 2018 were obtained from GeoSentinel. Traveler demographics and antimicrobial susceptibility data were analyzed. Isolates were classified as nonsusceptible if intermediate or resistant or as susceptible in accordance with the participating site's national guidelines. A total of 889 travelers ( S Typhi infections, n = 474; S Paratyphi infections, n = 414; coinfection, n = 1) were included; 114 (13%) were children of <18 years old. Most individuals (41%) traveled to visit friends and relatives (VFRs) and acquired the infection in South Asia (71%). Child travelers with S Typhi infection were most frequently VFRs (77%). The median trip duration was 31 days (interquartile range, 18 to 61 days), and 448 of 691 travelers (65%) had no pretravel consultation. Of 143 S Typhi and 75 S Paratyphi isolates for which there were susceptibility data, nonsusceptibility to antibiotics varied (fluoroquinolones, 65% and 56%, respectively; co-trimoxazole, 13% and 0%; macrolides, 8% and 16%). Two S Typhi isolates (1.5%) from India were nonsusceptible to third-generation cephalosporins. S Typhi fluoroquinolone nonsusceptibility was highest when infection was acquired in South Asia (70 of 90 isolates; 78%) and sub-Saharan Africa (6 of 10 isolates; 60%). Enteric fever is an important travel-associated illness complicated by AMR. Our data contribute to a better understanding of region-specific AMR, helping to inform empirical treatment options. Prevention measures need to focus on high-risk travelers including VFRs and children.

KW - antimicrobial resistance

KW - enteric fever

KW - paratyphoid

KW - travel

KW - typhoid

KW - UNITED-STATES

KW - PARATYPHOID FEVER

KW - VISITING FRIENDS

KW - TYPHOID-FEVER

KW - SURVEILLANCE

KW - RELATIVES

KW - VACCINES

KW - ILLNESS

KW - CARE

U2 - 10.1128/AAC.01084-20

DO - 10.1128/AAC.01084-20

M3 - A1: Web of Science-article

C2 - 32816733

SN - 0066-4804

VL - 64

JO - Antimicrobial Agents and Chemotherapy

JF - Antimicrobial Agents and Chemotherapy

IS - 11

M1 - e01084-20

ER -

Epidemiological and clinical characteristics of international travelers with enteric fever and antibiotic resistance profiles of their isolates: a GeoSentinel analysis

Abstract

Keywords

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