Share sensitive information only on official, secure websites. Louise K. Appiah, MD 1 ; Cindy R. Meservey 1 ,9 ; Kaitlin A. Tagg, PhD 1 ,9 ; Jessica C. Before , no ceftriaxone-resistant Salmonella Typhi cases had been identified in the United States. Extensively drug-resistant Salmonella Typhi, susceptible only to azithromycin and carbapenems, has caused a typhoid fever outbreak in Pakistan since During February βAugust , 33 cases of ceftriaxone-resistant Salmonella Typhi were detected in the United States.
Whole genome sequencing of isolates identified two distinct clusters, associated with travel to Pakistan 30 cases and Iraq three. Vaccination and food and water precautions can help prevent typhoid fever. Clinicians and public health officials should remain vigilant for ceftriaxone-resistant Typhi in patients who have traveled to Pakistan, Iraq, or neighboring countries.
Ceftriaxone-resistant Salmonella enterica serotype Typhi Typhi , the bacterium that causes typhoid fever, is a growing public health threat. Extensively drug-resistant XDR Typhi is resistant to ceftriaxone and other antibiotics used for treatment, including ampicillin, chloramphenicol, ciprofloxacin, and trimethoprim-sulfamethoxazole 1.
These illnesses represented the first cases of ceftriaxone-resistant Typhi documented in the United States 3. This report provides an update on U. Travelers to areas with endemic Typhi should receive typhoid vaccination before traveling and adhere to safe food and water precautions 4. Treatment of patients with typhoid fever should be guided by antimicrobial susceptibility testing whenever possible 5 , and clinicians should consider travel history when selecting empiric therapy.
Typhi is transmitted through the fecal-oral route, usually by contaminated water or food. The incubation period of typhoid fever is typically 6β30 days. Ceftriaxone and ciprofloxacin are first-choice antibiotics, with ampicillin, azithromycin, or trimethoprim-sulfamethoxazole being alternative options 5.
