{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T11:59:26Z","timestamp":1773143966082,"version":"3.50.1"},"reference-count":31,"publisher":"Microbiology Society","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2007,4,1]]},"abstract":"<jats:p>A retrospective analysis of 135 typhoid cases was conducted to review the clinical, epidemiological and microbiological characteristics of enteric fever cases diagnosed and treated at the Infectious Diseases Hospital, Kuwait, from 2002 to 2005. Diagnosis of patients was based on clinical features, serology and blood culture. The susceptibility testing of the isolates to ampicillin, chloramphenicol, trimethoprim\u2013sulfamethoxazole, ceftriaxone, ciprofloxacin and nalidixic acid was performed by the disc diffusion method, and MICs of ceftriaxone and ciprofloxacin were determined by Etest. Of 135 typhoid fever patients, 108 (88\u200a%) were treated with ceftriaxone and 27 (20\u200a%) were treated with ciprofloxacin. The mean time for fever defervescence with ciprofloxacin therapy was 8 days and 6.3 days for those treated with ceftriaxone. Of the 135 <jats:italic>Salmonella enterica<\/jats:italic> serotypes Typhi and Paratyphi A isolated from patients, 50 (37\u200a%) were multidrug resistant (MDR) and 94 (69.6\u200a%) isolates of both serotypes were nalidixic acid resistant (NAR). Between 90 and 100\u200a% of MDR and NAR strains had decreased susceptibility to ciprofloxacin (0.125\u20131\u200a\u03bcg ml<jats:sup>\u22121<\/jats:sup>). Low-level resistance to ciprofloxacin (MIC 0.125\u22121\u200a\u03bcg ml<jats:sup>\u22121<\/jats:sup>) was also detected in 13.8 and 33.3\u200a% of nalidixic acid-susceptible isolates of <jats:italic>S. <\/jats:italic>Typhi and <jats:italic>S. <\/jats:italic>Paratyphi A, respectively. All isolates were susceptible to ceftriaxone. Two relapses occurred in the ciprofloxacin-treated group. MDR strains and strains resistant to ciprofloxacin and ceftriaxone are a major threat in the developing world. A situation is fast approaching where the emergence of highly resistant <jats:italic>Salmonella<\/jats:italic> isolates is quite likely. Proper steps must be taken to avoid a pandemic spread of MDR <jats:italic>S. <\/jats:italic>Typhi strains.<\/jats:p>","DOI":"10.1099\/jmm.0.46814-0","type":"journal-article","created":{"date-parts":[[2007,3,21]],"date-time":"2007-03-21T00:27:12Z","timestamp":1174436832000},"page":"538-544","source":"Crossref","is-referenced-by-count":15,"title":["Clinical and microbiological investigations of typhoid fever in an infectious disease hospital in Kuwait"],"prefix":"10.1099","volume":"56","author":[{"given":"Tsonyo","family":"Dimitrov","sequence":"first","affiliation":[{"name":"Department of Medical Laboratories, Microbiology Section, Infectious Diseases Hospital, PO Box 4710, Safat 13048, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eded E.","family":"Udo","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Kuwait University, PO Box 14923, Safat 13110, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ossama","family":"Albaksami","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Infectious Diseases Hospital, PO Box 4710, Safat 13048, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shehab","family":"Al-Shehab","sequence":"additional","affiliation":[{"name":"Department of Medicine, Infectious Diseases Hospital, PO Box 4710, Safat 13048, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdal","family":"Kilani","sequence":"additional","affiliation":[{"name":"Department of Medicine, Infectious Diseases Hospital, PO Box 4710, Safat 13048, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Medhat","family":"Shehab","sequence":"additional","affiliation":[{"name":"Department of Medicine, Infectious Diseases Hospital, PO Box 4710, Safat 13048, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aref","family":"Al-Nakkas","sequence":"additional","affiliation":[{"name":"Department of Medicine, Infectious Diseases Hospital, PO Box 4710, Safat 13048, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"345","reference":[{"key":"R1","doi-asserted-by":"crossref","first-page":"2668","DOI":"10.1001\/jama.283.20.2668","article-title":"Laboratory-based surveillance of Salmonella serotype Typhi infections in the United States: antimicrobial resistance on the rise","volume":"283","author":"Ackers","year":"2000","journal-title":"JAMA"},{"key":"R2","first-page":"484","article-title":"Typhoid fever due to chloramphenicol resistant Salmonella Typhi associated with R-plasmid","volume":"73","author":"Agarwal","year":"1981","journal-title":"Indian J Med Res"},{"key":"R3","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1136\/bmj.3.5822.329","article-title":"Chloramphenicol resistance in the typhoid bacillus","volume":"3","author":"Anderson","year":"1972","journal-title":"BMJ"},{"key":"R4","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1099\/jmm.0.46413-0","article-title":"Ciprofloxacin resistance in Salmonella enterica serotype Typhi\/Paratyphi and antimicrobial agent quality and bioavailability","volume":"55","author":"Arya","year":"2006","journal-title":"J Med Microbiol"},{"key":"R5","first-page":"69","article-title":"Quinolones: a practical review of clinical uses, dosing considerations and drug interactions","volume":"42","author":"Borcherding","year":"1996","journal-title":"J Fam Pract"},{"key":"R6","doi-asserted-by":"crossref","first-page":"420","DOI":"10.3201\/eid0604.000420","article-title":"Drug-resistant Salmonella enterica serotype Paratyphi A in India","volume":"6","author":"Chandel","year":"2000","journal-title":"Emerg Infect Dis"},{"key":"R7","doi-asserted-by":"crossref","first-page":"125","DOI":"10.4103\/0255-0857.16054","article-title":"Study of clinical profile and antibiotic response in Typhoid fever","volume":"23","author":"Chowta","year":"2005","journal-title":"Indian J Med Microbiol"},{"key":"R8","volume-title":"Methods for Disk Susceptibility Tests for Bacteria that Grow Aerobicall y","year":"2005"},{"key":"R9","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1159\/000088115","article-title":"Incidence of bloodstream infections in a specialty hospital in Kuwait: 8-years experience","volume":"14","author":"Dimitrov","year":"2005","journal-title":"Med Princ Pract"},{"key":"R10","doi-asserted-by":"crossref","first-page":"3572","DOI":"10.1128\/JCM.37.11.3572-3577.1999","article-title":"Detection of decreased fluoroquinolone susceptibility and validation of nalidixic acid screening test","volume":"37","author":"Hakanen","year":"1999","journal-title":"J Clin Microbiol"},{"key":"R11","doi-asserted-by":"crossref","first-page":"996","DOI":"10.3201\/eid0706.010613","article-title":"Reduced fluoroquinolone susceptibility in Salmonella enterica serotypes in travelers returning from Southeast Asia","volume":"7","author":"Hakanen","year":"2001","journal-title":"Emerg Infect Dis"},{"key":"R12","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/S0020-2452(97)81367-X","article-title":"Typhoid fever: continuing challenges from a resilient bacterial foe","volume":"95","author":"Ivanoff","year":"1997","journal-title":"Bull Inst Pasteur"},{"key":"R13","first-page":"247","article-title":"Trend of increasing levels of minimum inhibitory concentration of ciprofloxacin to Salmonella Typhi","volume":"103","author":"Jesudason","year":"1996","journal-title":"Indian J Med Res"},{"key":"R14","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1177\/004947559802800419","article-title":"Drug-resistant typhoid fever","volume":"28","author":"Khosla","year":"1998","journal-title":"Trop Doct"},{"key":"R15","first-page":"849","article-title":"Salmonella infection","volume-title":"In Manson\u2019s Tropical Diseases","author":"Mandal","year":"2001"},{"key":"R16","first-page":"10","article-title":"Incidence and multidrug-resistance in typhoid salmonellae in Bahawalpur Area","volume":"51","author":"Munir","year":"2001","journal-title":"Pak Armed Forces Med J"},{"key":"R17","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/S0140-6736(05)78338-0","article-title":"Epidemic ciprofloxacin-resistant Salmonella Typhi in Tajikista","volume":"351","author":"Murdoch","year":"1998","journal-title":"Lancet"},{"key":"R18","first-page":"12","article-title":"A profile of enteric fever in adults at Quetta","volume":"13","author":"Nadeem","year":"2002","journal-title":"Pakistan J Pathol"},{"key":"R19","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1159\/000072293","article-title":"Antimicrobial susceptibility, phage typing and plasmid profile of Salmonella enterica serotype Paratyphi A strains isolated in Kuwait","volume":"12","author":"Panigrahi","year":"2003","journal-title":"Med Princ Pract"},{"key":"R20","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1056\/NEJMra020201","article-title":"Typhoid fever","volume":"347","author":"Parry","year":"2002","journal-title":"N Engl J Med"},{"key":"R21","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/S0196-4399(03)80027-2","article-title":"Is it time to change fluoroquinolones MIC breakpoints for Salmonella spp.?","volume":"25","author":"Poutanen","year":"2003","journal-title":"Clin Microbiol Newsl"},{"key":"R22","first-page":"428","article-title":"Ciprofloxacin-resistant typhoid with incomplete response to cefotaxime","volume":"50","author":"Prabha Adhikari","year":"2002","journal-title":"J Assoc Physicians India"},{"key":"R23","first-page":"751","article-title":"Quinolone resistant enteric fever-problems and remedies","volume":"46","author":"Rodrigues","year":"1998a","journal-title":"J Assoc Physicians India"},{"key":"R24","first-page":"323","article-title":"Clinical resistance to ciprofloxacin in Salmonella Typhi","volume":"46","author":"Rodrigues","year":"1998b","journal-title":"J Assoc Physicians India"},{"key":"R25","first-page":"88","article-title":"Nalidixic acid resistant Salmonella Typhi in Mumbai","volume":"12","author":"Rodrigues","year":"1999","journal-title":"Natl Med J India"},{"key":"R26","doi-asserted-by":"crossref","first-page":"S106","DOI":"10.1093\/clinids\/24.Supplement_1.S106","article-title":"Multidrug-resistant Salmonella Typhi: a worldwide epidemic","volume":"24, Suppl. 1","author":"Rowe","year":"1997","journal-title":"Clin Infect Dis"},{"key":"R27","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1080\/02724936.1996.11747807","article-title":"Interpretation of the Widal test in the diagnosis of typhoid fever in Bangladeshi children","volume":"16","author":"Saha","year":"1996","journal-title":"Ann Trop Paediatr"},{"key":"R28","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/S0016-5085(19)32194-8","article-title":"Reassessment of the Widal test in the diagnosis of typhoid fever","volume":"73","author":"Senewiratne","year":"1977","journal-title":"Gastroenterology"},{"key":"R29","doi-asserted-by":"crossref","first-page":"448","DOI":"10.3201\/eid0703.017315","article-title":"Decreased susceptibility to ciprofloxacin in Salmonella enterica serotype Typhi, United Kingdom","volume":"7","author":"Threlfall","year":"2001","journal-title":"Emerg Infect Dis"},{"key":"R30","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1086\/516128","article-title":"Quinolone-resistant Salmonella Typhi in Viet Nam: molecular basis of resistance and clinical response to treatment","volume":"25","author":"Wain","year":"1997","journal-title":"Clin Infect Dis"},{"key":"R31","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1093\/clinids\/23.1.40","article-title":"Current blood culture methods and systems: clinical concepts, technology and interpretation of results","volume":"23","author":"Weinstein","year":"1996","journal-title":"Clin Infect Dis"}],"container-title":["Journal of Medical Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.microbiologyresearch.org\/content\/journal\/jmm\/10.1099\/jmm.0.46814-0?crawler=true","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T06:17:24Z","timestamp":1600841844000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.microbiologyresearch.org\/content\/journal\/jmm\/10.1099\/jmm.0.46814-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,4,1]]},"references-count":31,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2007,4,1]]}},"URL":"https:\/\/doi.org\/10.1099\/jmm.0.46814-0","relation":{},"ISSN":["0022-2615","1473-5644"],"issn-type":[{"value":"0022-2615","type":"print"},{"value":"1473-5644","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,4,1]]}}}