Emerging multidrug-resistant H58 typhoid strain highlights need for antibiotic stewardship

A new study revealing the rise of a multidrug-resistant typhoid strain called H58, has emphasized the need for antibiotic stewardship.

A large international study, published in Nature Genetics, found that the H58 “superbug” version, which is resistant to multiple types of antibiotics, is now a major global health threat affecting many countries, including Asia and Africa, where typhoid is endemic.

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The typhoid epidemic is worldwide and causes about 20 to 30 million cases annually. In the United States, about 6,000 cases occur annually, three-quarters of which are travel-related.

“Antibiotic resistance has been steadily on the increase and has influenced treatment regimens,” said Amesh Adalja, MD, an Infectious Diseases Society of America spokesperson. “A new strain of typhoid H58 is increasing in prevalence and, because it is resistant to multiple antibiotics, is very alarming.”

According to the Centers for Disease Control and Prevention, typhoid is contracted by drinking contaminated water or food and is characterized by fever, headache, constipation, malaise, chills, and myalgia with few clinical features that reliably distinguish it from a variety of other infectious diseases. Diarrhea is uncommon, and vomiting is not usually severe. Confusion, delirium, intestinal perforation, and death may occur in severe cases.

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Many US hospitals will not see typhoid cases. However, formulary managers should ensure ready availability of multiple antibiotics that could see use against typhoid, according to Dr Adalja.

“Hospital formulary managers and managed care organization managers should be concerned because the threat of antibiotic resistance could lead to the end of the antibiotic age and modern medicine would come to a sudden halt,” said Dr Adalja. “Specifically, these individuals should keep abreast of resistance rates and new antibiotics, ensuring the latter are quickly added to formularies.

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“The rise of antibiotic resistance is a public health emergency of the highest order and should be a concern for everyone from the general public to policymakers,” he continued. “Formulary managers are the individuals who bring the tools, which are dwindling, physicians need to combat these infections. Ensuring that when new antibiotics are released that they are rapidly added to formularies and adequately stocked is essential.”

The chief issue with typhoid in the United States is being able to suspect this infection, which is fairly rare, according to Dr Adalja. “Once diagnosed, antibiotic treatment-with agents the causative bacteria is susceptible to-is essential,” he said.