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(CNPq) Brazil","award":["MR\/R020973\/1"],"award-info":[{"award-number":["MR\/R020973\/1"]}],"id":[{"id":"https:\/\/ror.org\/03swz6y49","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Council for Scientific and Technological Development (CNPq) Brazil","award":["MR\/X005895\/1"],"award-info":[{"award-number":["MR\/X005895\/1"]}],"id":[{"id":"https:\/\/ror.org\/03swz6y49","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Council for Scientific and Technological Development (CNPq) Brazil","award":["EP\/Y018842\/1"],"award-info":[{"award-number":["EP\/Y018842\/1"]}],"id":[{"id":"https:\/\/ror.org\/03swz6y49","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Council for Scientific and Technological Development (CNPq) Brazil","award":["2018\/18886-9"],"award-info":[{"award-number":["2018\/18886-9"]}],"id":[{"id":"https:\/\/ror.org\/03swz6y49","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Council for Scientific and Technological Development (CNPq) Brazil","award":["309482\/2022-4"],"award-info":[{"award-number":["309482\/2022-4"]}],"id":[{"id":"https:\/\/ror.org\/03swz6y49","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Council for Scientific and Technological Development (CNPq) Brazil","award":["102430\/2022-5"],"award-info":[{"award-number":["102430\/2022-5"]}],"id":[{"id":"https:\/\/ror.org\/03swz6y49","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Typhoid fever caused by Salmonella enterica serovar Typhi (S. typhi) continues to pose a significant risk to public health in developing countries, including Pakistan. This study investigated the epidemiological factors linked to suspected and confirmed S. typhi infections in Peshawar\u2019s hospital population. Methodology: A total of 5735 blood samples of patients with suspected enteric fever were collected from September 2022 to November 2023. S. typhi infection was confirmed using microbiological culture of blood samples, biochemical-based tests, and DNA-sequencing methods. Drug sensitivity testing on cultures was conducted as per the CLSI guidelines. Chi-square tests were used to analyze the clinical and epidemiologic characteristics of 5735 samples stratified by S. typhi infection status, and risk factors were assessed by applying logistic regression models to estimate odds ratios (ORs). Results: The number of confirmed typhoid fever cases in this hospital-based study population was 691 (\/5735, 12.0%), more prevalent in males (447\/3235 13.8%) and children (0\u201311 years) (429\/2747, 15.6%). Compared to children, the risk of S. typhi infection was lower in adolescence (adjusted OR = 0.52; 95% CI: 0.42\u20130.66), adulthood (19\u201359 years; aOR = 0.30; 95% CI: 0.25\u20130.38), and older adulthood (aOR = 0.08; 95% CI: 0.04\u20130.18) (p &lt; 0.001). Compared to males, the risk of S. typhi infection was lower in females (aOR = 0.67; 95% CI = 0.56\u20130.80; p = 0.002). Living in a rural residence (compared to urban) was associated with a higher risk of infection (aOR = 1.38; 95% CI: 1.16\u20131.63; p = 0.001), while access to a groundwater source (compared to municipal water supply) led to a lower risk (aOR = 0.56; 95% CI: 0.43\u20130.73; p = 0.002). Vaccination demonstrated a robust protective effect (aOR = 0.069; 95% CI = 0.04\u20130.11, p = 0.002). For those with typhoid infections, clinical biomarker analysis revealed the presence of leucopenia (65\/691, 9.4%), thrombocytopenia (130\/691, 18.8%), and elevated alanine aminotransferase (ALT) (402\/691, 58.2%) and C-reactive protein (CRP) (690\/691, 99.9%) levels. Worryingly, among the positive S. typhi isolates, there was a high prevalence of drug resistance (653\/691), including multidrug-resistant (MDR 82\/691, 11.9%) and extensively drug-resistant types (XDR, 571\/691, 82.6%). Conclusions: This study highlights the importance of age, sex, locality, water source, and vaccination status in shaping the epidemiological landscape of S. typhi in the Peshawar district. It implies that expanding vaccination coverage to the broader population of Khyber Pakhtunkhwa province, particularly in the district of Peshawar, would be beneficial.<\/jats:p>","DOI":"10.3390\/antibiotics13080765","type":"journal-article","created":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T05:23:27Z","timestamp":1723613007000},"page":"765","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Exploring the Antimicrobial Resistance Profile of Salmonella typhi and Its Clinical Burden"],"prefix":"10.3390","volume":"13","author":[{"given":"Muhammad","family":"Asghar","sequence":"first","affiliation":[{"name":"Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar 25120, Pakistan"},{"name":"Department of Pathology, Khyber Teaching Hospital, Khyber Medical College, Peshawar 25120, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taj Ali","family":"Khan","sequence":"additional","affiliation":[{"name":"Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar 25120, Pakistan"},{"name":"Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611, USA"},{"name":"Department of Medicine, Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Nancy","family":"S\u00e9raphin","sequence":"additional","affiliation":[{"name":"Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611, USA"},{"name":"Department of Medicine, Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5616-3410","authenticated-orcid":false,"given":"Lena F.","family":"Schimke","sequence":"additional","affiliation":[{"name":"Department of Immunology, Institute of Biomedical Sciences, University of S\u00e3o Paulo, S\u00e3o Paulo 05508-220, Brazil"},{"name":"Department of Medicine, Division of Molecular Medicine, University of S\u00e3o Paulo School of Medicine, S\u00e3o Paulo 05403-010, Brazil"},{"name":"Laboratory of Medical Investigation 29, University of S\u00e3o Paulo School of Medicine, S\u00e3o Paulo 05403-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otavio","family":"Cabral-Marques","sequence":"additional","affiliation":[{"name":"Department of Immunology, Institute of Biomedical Sciences, University of S\u00e3o Paulo, S\u00e3o Paulo 05508-220, Brazil"},{"name":"Department of Medicine, Division of Molecular Medicine, University of S\u00e3o Paulo School of Medicine, S\u00e3o Paulo 05403-010, Brazil"},{"name":"Laboratory of Medical Investigation 29, University of S\u00e3o Paulo School of Medicine, S\u00e3o Paulo 05403-010, Brazil"},{"name":"Network of Immunity in Infection, Malignancy, Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), S\u00e3o Paulo 05508-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0806-6907","authenticated-orcid":false,"given":"Ihtisham Ul","family":"Haq","sequence":"additional","affiliation":[{"name":"Department of Physical Chemistry and Technology of Polymers, Silesian University of Technology, M. Strzody 9, 44-100 Gliwice, Poland"},{"name":"Joint Doctoral School, Silesian University of Technology, M. Strzody 9, 44-100 Gliwice, Poland"},{"name":"Postgraduate Program in Technological Innovation, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zia-ur-Rehman","family":"Farooqi","sequence":"additional","affiliation":[{"name":"Khyber Medical University, Institute of Health Sciences, Swabi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Campino","sequence":"additional","affiliation":[{"name":"Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ihsan","family":"Ullah","sequence":"additional","affiliation":[{"name":"Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar 25120, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8985-9265","authenticated-orcid":false,"given":"Taane G.","family":"Clark","sequence":"additional","affiliation":[{"name":"Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK"},{"name":"Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"169","DOI":"10.3855\/jidc.12049","article-title":"Extended-spectrum beta-lactamases producing extensively drug-resistant Salmonella typhi in Punjab, Pakistan","volume":"14","author":"Saeed","year":"2020","journal-title":"J. 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