XDR typhoid in Pakistan: A threat to global health security and a wake-up call for antimicrobial stewardship.

IF 3.4 2区 医学 Q1 PARASITOLOGY
PLoS Neglected Tropical Diseases Pub Date : 2025-05-12 eCollection Date: 2025-05-01 DOI:10.1371/journal.pntd.0013067
Muhammad Ahmed Abdullah, Babar Tasneem Shaikh, Maryam Ashraf, Shahzad Ali Khan
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引用次数: 0

Abstract

Extensively drug-resistant (XDR) typhoid, caused by Salmonella enterica serotype Typhi, has emerged as a critical global health security threat, with Pakistan, particularly Sindh province, at its epicenter. The misuse of antibiotics, inadequate diagnostic tools, and poor water and sanitation infrastructure have created ideal conditions for the rise of antimicrobial resistance (AMR). XDR typhoid strains resistant to multiple first-line antibiotics have been linked to environmental contamination, with urban areas like Karachi demonstrating high rates of waterborne transmission. International travel has amplified this threat, exporting cases to countries including the United States, the United Kingdom, and Canada, thus highlighting its global implications. This commentary examines the historical context of typhoid treatment, the drivers of AMR in Pakistan, and the critical role of antimicrobial stewardship in combating XDR typhoid. It advocates for an integrated approach that would encompass improvements in water quality, expanded vaccination coverage with typhoid conjugate vaccines (TCVs), and stringent audit of antibiotic prescription practices. Immediate local and global action is needed to contain this public health crisis and prevent the resurgence of typhoid as a largely untreatable disease. This situation underscores the urgency of addressing AMR to safeguard global health security.

巴基斯坦的广泛耐药伤寒:对全球卫生安全的威胁和对抗菌药物管理的警钟。
由肠炎沙门氏菌血清型伤寒引起的广泛耐药伤寒已成为严重的全球卫生安全威胁,巴基斯坦,特别是信德省是其中心。滥用抗生素、诊断工具不足以及水和卫生基础设施差,为抗菌素耐药性的上升创造了理想条件。对多种一线抗生素具有耐药性的广泛耐药伤寒菌株与环境污染有关,卡拉奇等城市地区的水媒传播率很高。国际旅行放大了这一威胁,将病例输出到美国、英国和加拿大等国家,从而凸显了其全球影响。本评论探讨了伤寒治疗的历史背景、巴基斯坦抗菌素耐药性的驱动因素以及抗菌素管理在抗击广泛耐药伤寒方面的关键作用。它倡导一种综合方法,包括改善水质、扩大伤寒结合疫苗的接种覆盖率,以及严格审查抗生素处方做法。需要立即采取地方和全球行动,遏制这一公共卫生危机,防止伤寒作为一种基本上无法治愈的疾病死灰复燃。这一形势凸显了解决抗生素耐药性问题以维护全球卫生安全的紧迫性。
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来源期刊
PLoS Neglected Tropical Diseases
PLoS Neglected Tropical Diseases PARASITOLOGY-TROPICAL MEDICINE
自引率
10.50%
发文量
723
期刊介绍: PLOS Neglected Tropical Diseases publishes research devoted to the pathology, epidemiology, prevention, treatment and control of the neglected tropical diseases (NTDs), as well as relevant public policy. The NTDs are defined as a group of poverty-promoting chronic infectious diseases, which primarily occur in rural areas and poor urban areas of low-income and middle-income countries. Their impact on child health and development, pregnancy, and worker productivity, as well as their stigmatizing features limit economic stability. All aspects of these diseases are considered, including: Pathogenesis Clinical features Pharmacology and treatment Diagnosis Epidemiology Vector biology Vaccinology and prevention Demographic, ecological and social determinants Public health and policy aspects (including cost-effectiveness analyses).
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