{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:26:58Z","timestamp":1787077618224,"version":"build-2736575974"},"reference-count":42,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foodborne Pathogens and Disease"],"abstract":"<jats:p>\n                    Antimicrobial-resistant enteric infections may be difficult to treat, associated with severe outcomes, and costly. To determine if resistant enteric infections are more costly, we described direct hospitalization costs for hospital admissions for typhoid fever, salmonellosis, and shigellosis infections by resistance status. We included all inpatient admissions with culture-confirmed infections from approximately 300 hospitals in the Premier Healthcare database during 2012\u20132019. We classified typhoid fever, salmonellosis, and shigellosis infections as clinically resistant if laboratory testing found resistance to \u22651 antibiotic class recommended for treatment. We examined patient demographic characteristics and underlying chronic conditions. We used the Wilcoxon rank sum test to assess the difference in median hospitalization cost for each patient admission by resistance status. We estimated adjusted cost and length of stay (LOS) using multivariable linear regression, adjusting for host and health care provider characteristics. Among 67 inpatient admissions for typhoid fever, 3421 for salmonellosis, and 619 for shigellosis, 33% of typhoid fever, 13% of salmonellosis, and 82% of shigellosis infections were clinically resistant. The unadjusted median costs for resistant salmonellosis were higher than susceptible infection-related costs ($7,753 vs. $6,909,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.002). The unadjusted costs for resistant versus susceptible typhoid fever ($13,709 vs. $9,254,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.111) and shigellosis were similar ($5,365 vs. $5,777,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.167). For all three pathogens, the adjusted mean hospitalization costs were not statistically different for resistant and susceptible infections. Adjusted mean LOS was significantly longer for resistant typhoid fever compared with susceptible infections (6.50 days vs. 4.35 days,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.001). Although adjusted cost differences for resistant infections were not significant, we observed differences by host factors including age and comorbidities, suggesting patient demographic characteristics for resistant infections are impactful on cost. These findings support the premise that public health interventions to limit the spread of resistant infections, particularly among individuals at higher risk for severe illness, could reduce hospitalization costs.\n                  <\/jats:p>","DOI":"10.1177\/15353141261479162","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T06:33:27Z","timestamp":1786948407000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Direct Hospitalization Costs Associated with Resistant and Susceptible\n                    <i>Salmonella<\/i>\n                    and\n                    <i>Shigella<\/i>\n                    Infections in the United States, 2012\u20132019"],"prefix":"10.1177","author":[{"given":"Farrell A.","family":"Tobolowsky","sequence":"first","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6253-9672","authenticated-orcid":false,"given":"Laura","family":"Ford","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab","family":"Salah","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunkyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Baggs","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babatunde","family":"Olubajo","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaohui","family":"Cui","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"II","given":"R. Douglas","family":"Scott","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Wolford","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"McCarthy","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicita","family":"Medalla","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Francois Watkins","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,16]]},"reference":[{"key":"e_1_3_2_2_1","unstructured":"Agency for Healthcare Research and Quality (AHRQ). 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Available from: https:\/\/www.cdc.gov\/salmonella\/about\/index.html [Last accessed: September20 2025]."},{"key":"e_1_3_2_8_1","unstructured":"Centers for Disease Control and Prevention (CDC). Antibiotic resistance threats in the United States. CDC: Atlanta GA; 2019. Available from: https:\/\/www.cdc.gov\/drugresistance\/pdf\/threats-report\/2019-ar-threats-report-508.pdf"},{"key":"e_1_3_2_9_1","unstructured":"Centers for Disease Control and Prevention (CDC). Antimicrobial Resistance and Shigella Infections. CDC: Atlanta GA; 2024b. Available from: https:\/\/www.cdc.gov\/shigella\/treatment\/antimicrobial-resistance-and-shigella-infections.html [Last accessed: January8 2025]."},{"key":"e_1_3_2_10_1","unstructured":"Centers for Disease Control and Prevention (CDC). BEAM Dashboard. CDC: Atlanta GA; 2025. Available from: https:\/\/www.cdc.gov\/ncezid\/dfwed\/beam-dashboard.html [Last accessed: December8 2025]."},{"key":"e_1_3_2_11_1","unstructured":"Centers for Disease Control and Prevention (CDC). Extensively Drug-Resistant Salmonella Typhi Infections Among U.S. Residents Without International Travel. CDC: Atlanta GA; 2021. Available from: https:\/\/archive.cdc.gov\/emergency_cdc_gov\/han\/2021\/han00439.asp [Last accessed: December8 2025]."},{"key":"e_1_3_2_12_1","unstructured":"Centers for Disease Control and Prevention (CDC). FoodNet Fast. CDC: Atlanta GA; 2023a. Available from: https:\/\/wwwn.cdc.gov\/foodnetfast\/ [Last accessed: September20 2025]."},{"key":"e_1_3_2_13_1","unstructured":"Centers for Disease Control and Prevention (CDC). How Shigella Spreads. CDC: Atlanta GA; 2024c. Available from: https:\/\/www.cdc.gov\/shigella\/causes\/index.html [Last accessed: September20 2025]."},{"key":"e_1_3_2_14_1","unstructured":"Centers for Disease Control and Prevention (CDC). Increase in Extensively Drug-Resistant Shigellosis in the United States. CDC: Atlanta GA; 2023b. Available from: https:\/\/www.cdc.gov\/han\/2023\/han00486.html [Last accessed: December8 2025]."},{"key":"e_1_3_2_15_1","unstructured":"Centers for Disease Control and Prevention (CDC). National Typhoid and Paratyphoid Fever Surveillance. CDC: Atlanta GA; 2024d. Available from: https:\/\/www.cdc.gov\/typhoid-fever\/php\/surveillance\/index.html#cdc_survey_profile_key_findings-key-findings [Last accessed: September20 2025]."},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6801a3"},{"key":"e_1_3_2_17_1","volume-title":"Performance Standards for Antimicrobial Susceptibility Testing. CLSI M100","author":"Clinical and Laboratory Standards Institute (CLSI)","year":"2019","unstructured":"Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing. CLSI M100, 29th ed. CLSI: Wayne, PA; 2019.","edition":"29"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.1086\/375602"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1089\/fpd.2015.1969"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199801000-00004"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad631"},{"key":"e_1_3_2_22_1","volume-title":"CDC Yellow Book 2026: Health Information for International Travel","author":"Francois Watkins LK","year":"2025","unstructured":"Francois Watkins LK, , Shih DC, , Dorough L. Typhoid and Paratyphoid Fever. In: CDC Yellow Book 2026: Health Information for International Travel. CDC: Atlanta, GA; 2025. Available from: https:\/\/www.cdc.gov\/yellow-book\/hcp\/travel-associated-infections-diseases\/typhoid-and-paratyphoid-fever.html"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.21105\/joss.00648"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(19)30418-9"},{"key":"e_1_3_2_25_1","volume-title":"User Guide: Elixhauser Comorbidity Software Refined for ICD-10-CM Diagnoses, v2025.1","author":"Healthcare Cost and Utilization Project (HCUP)","year":"2024","unstructured":"Healthcare Cost and Utilization Project (HCUP). User Guide: Elixhauser Comorbidity Software Refined for ICD-10-CM Diagnoses, v2025.1. 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Harmonizing specimen source categorization across the Enteric Diseases Epidemiology Branch (EDEB) surveillance systems. Division of Foodborne, Waterborne, and Environmental Diseases, CDC: Atlanta, GA; 2016."},{"key":"e_1_3_2_41_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.1153"},{"key":"e_1_3_2_42_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwf155"},{"key":"e_1_3_2_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2022.100521"}],"container-title":["Foodborne Pathogens and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15353141261479162","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15353141261479162","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15353141261479162","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T17:48:08Z","timestamp":1787075288000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15353141261479162"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,16]]},"references-count":42,"alternative-id":["10.1177\/15353141261479162"],"URL":"https:\/\/doi.org\/10.1177\/15353141261479162","relation":{},"ISSN":["1535-3141","1556-7125"],"issn-type":[{"value":"1535-3141","type":"print"},{"value":"1556-7125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,16]]},"article-number":"15353141261479162"}}