Risk Factors of Extensively Drug Resistant Typhoid Fever Among Children in Karachi: Case-Control Study (Preprint)-Reference-Cited by-同舟云学术

Risk Factors of Extensively Drug Resistant Typhoid Fever Among Children in Karachi: Case-Control Study (Preprint)

Published:2021-01-19 Issue: Volume: Page:
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Author:

Vighio Anum^ORCID,Syed Muhammad Asif^ORCID,Hussain Ishfaque^ORCID,Zia Syed Masroor^ORCID,Fatima Munaza^ORCID,Masood Naveed^ORCID,Chaudry Ambreen^ORCID,Hussain Zakir^ORCID,Iqbal Baig Mirza Zeeshan^ORCID,Baig Mirza Amir^ORCID,Ikram Aamer^ORCID,S Khader Yousef^ORCID

Abstract

BACKGROUND

Extensively drug resistant typhoid fever (XDR-TF) has been responsible for an ongoing outbreak in Pakistan, which began in November 2016.

OBJECTIVE

This study aimed to determine the risk factors associated with XDR-TF.

METHODS

This age- and sex-matched case-control study was conducted during May-October 2018 in Karachi. All patients with XDR-TF were identified from the laboratory-based surveillance system data. Cases included patients aged <15 years living in Karachi with culture-positive <i>Salmonella enterica</i> serovar Typhi with resistance to chloramphenicol, ampicillin, trimethoprim/sulfamethoxazole, fluoroquinolones, and third-generation cephalosporins. Age- and sex-matched controls included children free from the symptoms of TF, aged under 15 years, and residing in Karachi. All controls were recruited from among those who attended outpatient clinics.

RESULTS

A total of 75 cases and 75 controls were included in this study. On univariate analysis, the odds of having XDR-TF were 13-fold higher among participants who used piped municipal water than among those who did not (odds ratio [OR] 12.6, 95% CI 4.1-38.6). The use of bore water was significantly associated with XDR-TF (OR 5.1, 95% CI 1.4-19.0). Cases were more likely to report eating French fries with sauce (OR 13.5, 95% CI 3.9-47.0) and poppadum (OR 3.4, 95% CI 1.7-6.7) from street vendors than controls. Boiling water at home was negatively associated with XDR-TF (OR 0.3, 95% CI 0.2-0.7). On multivariate analysis, 2 factors were independently associated with XDR-TF. Using piped municipal water (OR 10.3, 95% CI 3.4-30.4) and eating French fries with sauce from street vendors (OR 8.8, 95% CI 2.1-36.2) were significantly associated with an increased odds of XDR-TF.

CONCLUSIONS

Community water supply and street food eating habits were implicated in the spread of the superbug <i>S</i> typhi outbreak, which continues to grow in Karachi. Therefore, it is recommended to improve the community water supply to meet recommended standards and to develop a policy to improve the safety of street food. In addition, health authorities are required to conduct mass vaccination for TF among high-risk groups.

Publisher

JMIR Publications Inc.

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