{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T05:00:02Z","timestamp":1791608402574,"version":"4.3.4"},"update-to":[{"DOI":"10.1371\/journal.pntd.0011723","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T00:00:00Z","timestamp":1700438400000}}],"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T00:00:00Z","timestamp":1699401600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001125","name":"GAVI Alliance","doi-asserted-by":"publisher","award":["PneumoADIP"],"award-info":[{"award-number":["PneumoADIP"]}],"id":[{"id":"10.13039\/100001125","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","award":["201588766"],"award-info":[{"award-number":["201588766"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","award":["201233523"],"award-info":[{"award-number":["201233523"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","award":["201022732"],"award-info":[{"award-number":["201022732"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","award":["200749550"],"award-info":[{"award-number":["200749550"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-008335"],"award-info":[{"award-number":["INV-008335"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Typhoid and paratyphoid remain common bloodstream infections in areas with suboptimal water and sanitation infrastructure. Paratyphoid, caused by <jats:italic>Salmonella<\/jats:italic> Paratyphi A, is less prevalent than typhoid and its antimicrobial resistance (AMR) trends are less documented. Empirical treatment for paratyphoid is commonly based on the knowledge of susceptibility of <jats:italic>Salmonella<\/jats:italic> Typhi, which causes typhoid. Hence, with rising drug resistance in <jats:italic>Salmonella<\/jats:italic> Typhi, last-line antibiotics like ceftriaxone and azithromycin are prescribed for both typhoid and paratyphoid. However, unlike for typhoid, there is no vaccine to prevent paratyphoid. Here, we report 23-year AMR trends of <jats:italic>Salmonella<\/jats:italic> Paratyphi A in Bangladesh.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>From 1999 to 2021, we conducted enteric fever surveillance in two major pediatric hospitals and three clinics in Dhaka, Bangladesh. Blood cultures were performed at the discretion of the treating physicians; cases were confirmed by culture, serological and biochemical tests. Antimicrobial susceptibility was determined following CLSI guidelines.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Over 23 years, we identified 2,725 blood culture-confirmed paratyphoid cases. Over 97% of the isolates were susceptible to ampicillin, chloramphenicol, and cotrimoxazole, and no isolate was resistant to all three. No resistance to ceftriaxone was recorded, and &gt;99% of the isolates were sensitive to azithromycin. A slight increase in minimum inhibitory concentration (MIC) is noticed for ceftriaxone but the current average MIC is 32-fold lower than the resistance cut-off. Over 99% of the isolates exhibited decreased susceptibility to ciprofloxacin.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p><jats:italic>Salmonella<\/jats:italic> Paratyphi A has remained susceptible to most antibiotics, unlike <jats:italic>Salmonella<\/jats:italic> Typhi, despite widespread usage of many antibiotics in Bangladesh. The data can guide evidence-based policy decisions for empirical treatment of paratyphoid fever, especially in the post typhoid vaccine era, and with the availability of new paratyphoid diagnostics.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0011723","type":"journal-article","created":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T18:49:50Z","timestamp":1699469390000},"page":"e0011723","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Trends in antimicrobial resistance amongst Salmonella Paratyphi A isolates in Bangladesh: 1999\u20132021"],"prefix":"10.1371","volume":"17","author":[{"given":"Mohammad S. 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Asadur","family":"Rahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazrul","family":"Islam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammod","family":"Shahidullah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Ruhul","family":"Amin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Jahangir","family":"Alam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Hanif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Luby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise O.","family":"Garrett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir K.","family":"Saha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6087-6766","authenticated-orcid":true,"given":"Senjuti","family":"Saha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,11,8]]},"reference":[{"key":"pntd.0011723.ref001","article-title":"The global burden of non-typhoidal salmonella invasive disease: a systematic analysis for the Global Burden of Disease Study 2017.","author":"JD Stanaway","journal-title":"Lancet Infect Dis. 2019"},{"key":"pntd.0011723.ref002","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1086\/649541","article-title":"Global trends in typhoid and paratyphoid Fever","volume":"50","author":"JA Crump","year":"2010","journal-title":"Clin Infect Dis"},{"key":"pntd.0011723.ref003","article-title":"Estimating the Burden of Paratyphoid A in Asia and Africa.","author":"MB Arndt","year":"2014","journal-title":"PLoS Negl Trop Dis."},{"key":"pntd.0011723.ref004","article-title":"Typhoid conjugate vaccine gets WHO prequalification","author":"T. Burki","year":"2018","journal-title":"The Lancet. 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enterica serovars Typhi and Paratyphi A in Pakistan.","volume":"8","author":"FN Qamar","year":"2014","journal-title":"J Infect Dev Ctries"},{"key":"pntd.0011723.ref033","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006051","article-title":"A 23-year retrospective investigation of Salmonella Typhi and Salmonella Paratyphi isolated in a tertiary Kathmandu hospital","author":"M Zellweger","year":"2017"},{"key":"pntd.0011723.ref034","article-title":"Paratype: a genotyping tool for Salmonella Paratyphi A reveals its global genomic diversity.","author":"AM Tanmoy","year":"2022","journal-title":"Nat Commun."},{"key":"pntd.0011723.ref035","article-title":"Evaluation of Antimicrobial Susceptibility Profile in Salmonella Typhi and Salmonella Paratyphi A: Presenting the Current Scenario in India and Strategy for Future Management","author":"B Veeraraghavan","year":"2021","journal-title":"J Infect Dis"},{"key":"pntd.0011723.ref036","article-title":"Genetic diversity of salmonella paratyphi a isolated from enteric fever patients in Bangladesh from 2008 to 2018.","author":"SIA Rahman","year":"2021","journal-title":"PLoS Negl Trop Dis."},{"key":"pntd.0011723.ref037","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006408","article-title":"Laboratory and molecular surveillance of paediatric typhoidal Salmonella in Nepal: Antimicrobial resistance and implications for vaccine policy","author":"CD Britto","year":"2018"},{"key":"pntd.0011723.ref038","article-title":"Phylogenomics and antimicrobial resistance of salmonella typhi and paratyphi a, b and c in england, 2016\u20132019","author":"MA Chattaway","year":"2021","journal-title":"Microb Genomics"},{"key":"pntd.0011723.ref039","article-title":"Typhoid Conjugate Vaccine: An Urgent Tool to Combat Typhoid and Tackle Antimicrobial Resistance","author":"SK Saha","year":"2021","journal-title":"J Infect Dis"},{"key":"pntd.0011723.ref040","article-title":"Genomic surveillance detects Salmonella enterica serovar Paratyphi A harbouring blaCTX-M-15 from a traveller returning from Bangladesh.","author":"S Nair","year":"2020","journal-title":"PLoS One."},{"key":"pntd.0011723.ref041","article-title":"Tracking the emergence of azithromycin resistance in multiple genotypes of typhoidal salmonella.","author":"MSI Sajib","year":"2021","journal-title":"MBio"},{"key":"pntd.0011723.ref042","article-title":"Changing trends of culture-positive typhoid fever and antimicrobial susceptibility in a tertiary care North Indian Hospital over the last decade","author":"P Sharma","year":"2018","journal-title":"Indian J Med Microbiol"},{"key":"pntd.0011723.ref043","article-title":"Trends in antibiotic susceptibility of enteric fever isolates from South India, 2002\u20132013.","author":"S Joshi","year":"2019","journal-title":"Med J Armed Forces India."},{"key":"pntd.0011723.ref044","article-title":"Renaissance of Conventional First-Line Antibiotics in Salmonella enterica Clinical Isolates: Assessment of MICs for Therapeutic Antimicrobials in Enteric Fever Cases from Nepal","author":"PR Khanal","year":"2017","journal-title":"Biomed Res Int"},{"key":"pntd.0011723.ref045","article-title":"Genomic analysis of Salmonella enterica serotype Paratyphi A during an outbreak in Cambodia, 2013\u20132015","author":"LMF Kuijpers","year":"2016","journal-title":"Microb genomics"},{"key":"pntd.0011723.ref046","article-title":"Characteristics of resistance mechanisms and molecular epidemiology of fluoroquinolone-nonsusceptible salmonella enterica serovar typhi and paratyphi a isolates from a tertiary hospital in Dhaka, Bangladesh","author":"T Okanda","year":"2018","journal-title":"Microb Drug Resist"},{"key":"pntd.0011723.ref047","article-title":"Estimating typhoid incidence from community-based serosurveys: a multicohort study","author":"K Aiemjoy","year":"2022","journal-title":"The Lancet Microbe"},{"key":"pntd.0011723.ref048","article-title":"What proportion of Salmonella Typhi cases are detected by blood 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A systematic literature review","author":"V Mogasale","year":"2016","journal-title":"Annals of Clinical Microbiology and Antimicrobials"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0011723","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T00:00:00Z","timestamp":1700438400000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0011723","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T18:47:50Z","timestamp":1700506070000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0011723"}},"subtitle":[],"editor":[{"given":"David Joseph","family":"Diemert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,11,8]]},"references-count":48,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0011723","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0011723","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,8]]}}}