Institution
Patan Academy of Health Sciences
Education•Patan, Nepal•
About: Patan Academy of Health Sciences is a education organization based out in Patan, Nepal. It is known for research contribution in the topics: Population & Health care. The organization has 587 authors who have published 766 publications receiving 7539 citations.
Topics: Population, Health care, Typhoid fever, Salmonella typhi, Medicine
Papers
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TL;DR: In this paper, the authors proposed a framework to combat the threat to human health and biosecurity from antimicrobial resistance, an understanding of its mechanisms and drivers is needed.
1,428 citations
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Wellcome Trust Sanger Institute1, Cambridge University Hospitals NHS Foundation Trust2, University of Oxford3, University of London4, University College London5, Liverpool School of Tropical Medicine6, Quadram Institute7, Pasteur Institute8, University of Melbourne9, University of Birmingham10, Emory University11, Centers for Disease Control and Prevention12, Kenya Medical Research Institute13, University of Liverpool14, University of Malawi15, Institute of Tropical Medicine Antwerp16, Katholieke Universiteit Leuven17, University of the Republic18, International Vaccine Institute19, Novartis20, University of the Witwatersrand21, Nagasaki University22, Patan Academy of Health Sciences23, World Health Organization24, Hasanuddin University25, Mahosot Hospital26, Mahidol University27, University of Otago28, Public Health England29, Angkor Hospital for Children30
TL;DR: This whole-genome sequence analysis of Salmonella enterica serovar Typhi identifies a single dominant MDR lineage, H58, that has emerged and spread throughout Asia and Africa over the last 30 years, and identifies numerous transmissions of H58.
Abstract: The emergence of multidrug-resistant (MDR) typhoid is a major global health threat affecting many countries where the disease is endemic. Here whole-genome sequence analysis of 1,832 Salmonella enterica serovar Typhi (S. Typhi) identifies a single dominant MDR lineage, H58, that has emerged and spread throughout Asia and Africa over the last 30 years. Our analysis identifies numerous transmissions of H58, including multiple transfers from Asia to Africa and an ongoing, unrecognized MDR epidemic within Africa itself. Notably, our analysis indicates that H58 lineages are displacing antibiotic-sensitive isolates, transforming the global population structure of this pathogen. H58 isolates can harbor a complex MDR element residing either on transmissible IncHI1 plasmids or within multiple chromosomal integration sites. We also identify new mutations that define the H58 lineage. This phylogeographical analysis provides a framework to facilitate global management of MDR typhoid and is applicable to similar MDR lineages emerging in other bacterial species.
383 citations
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TL;DR: Assessment of the prevalence and geographic distribution of AMR in Salmonella enterica serovars Typhi and Paratyphi A infections globally and a descriptive analysis of ceftriaxone and azithromycin resistance found drug-resistant enteric fever widespread in low- and middle-income countries.
Abstract: Antimicrobial resistance (AMR) is an increasing threat to global health. There are > 14 million cases of enteric fever every year and > 135,000 deaths. The disease is primarily controlled by antimicrobial treatment, but this is becoming increasingly difficult due to AMR. Our objectives were to assess the prevalence and geographic distribution of AMR in Salmonella enterica serovars Typhi and Paratyphi A infections globally, to evaluate the extent of the problem, and to facilitate the creation of geospatial maps of AMR prevalence to help targeted public health intervention. We performed a systematic review of the literature by searching seven databases for studies published between 1990 and 2018. We recategorised isolates to allow the analysis of fluoroquinolone resistance trends over the study period. The prevalence of multidrug resistance (MDR) and fluoroquinolone non-susceptibility (FQNS) in individual studies was illustrated by forest plots, and a random effects meta-analysis was performed, stratified by Global Burden of Disease (GBD) region and 5-year time period. Heterogeneity was assessed using the I2 statistics. We present a descriptive analysis of ceftriaxone and azithromycin resistance. We identified 4557 articles, of which 384, comprising 124,347 isolates (94,616 S. Typhi and 29,731 S. Paratyphi A) met the pre-specified inclusion criteria. The majority (276/384; 72%) of studies were from South Asia; 40 (10%) articles were identified from Sub-Saharan Africa. With the exception of MDR S. Typhi in South Asia, which declined between 1990 and 2018, and MDR S. Paratyphi A, which remained at low levels, resistance trends worsened for all antimicrobials in all regions. We identified several data gaps in Africa and the Middle East. Incomplete reporting of antimicrobial susceptibility testing (AST) and lack of quality assurance were identified. Drug-resistant enteric fever is widespread in low- and middle-income countries, and the situation is worsening. It is essential that public health and clinical measures, which include improvements in water quality and sanitation, the deployment of S. Typhi vaccination, and an informed choice of treatment are implemented. However, there is no licenced vaccine for S. Paratyphi A. The standardised reporting of AST data and rollout of external quality control assessment are urgently needed to facilitate evidence-based policy and practice. PROSPERO CRD42018029432.
248 citations
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TL;DR: Understanding of the molecular mechanisms that catalyze carriage, as well as the ability to reliably identify and treat the Salmonella carrier state, have only recently begun to advance.
205 citations
Authors
Showing all 590 results
Name | H-index | Papers | Citations |
---|---|---|---|
Gordon Dougan | 114 | 715 | 55037 |
Jeremy Farrar | 107 | 484 | 51520 |
Andrew J. Pollard | 79 | 673 | 26295 |
Buddha Basnyat | 49 | 316 | 8596 |
Christiane Dolecek | 43 | 87 | 6793 |
Patrick Webb | 42 | 208 | 11579 |
Rakesh K. Singh | 37 | 176 | 5812 |
Dominic F. Kelly | 30 | 109 | 2907 |
Anil Shrestha | 30 | 183 | 2848 |
Abhilasha Karkey | 27 | 73 | 3151 |
Sabina Dongol | 26 | 61 | 2155 |
Amit Arjyal | 24 | 43 | 1714 |
Pawan Sharma | 16 | 73 | 784 |
Reena Amatya Shrestha | 15 | 44 | 519 |
Sarah Hanieh | 14 | 43 | 751 |