背景:伤寒沙门氏菌引起的伤寒(S.typhi)继续对发展中国家的公共卫生构成重大风险,包括巴基斯坦。这项研究调查了白沙瓦医院人群中与怀疑和确认的伤寒沙门氏菌感染相关的流行病学因素。方法:从2022年9月至2023年11月共收集5735例疑似肠热患者的血液样本。使用血液样本的微生物培养证实了伤寒S.基于生化的测试,和DNA测序方法。根据CLSI指南对培养物进行药物敏感性测试。采用卡方检验对5735份样本按伤寒沙门氏菌感染状况分层进行临床和流行病学分析,和危险因素通过应用逻辑回归模型评估比值比(ORs).结果:本院研究人群确诊伤寒病例为691例(/5735,12.0%),男性(447/323513.8%)和儿童(0-11岁)(429/274715.6%)。与孩子相比,青少年伤寒沙门氏菌感染的风险较低(校正后OR=0.52;95%CI:0.42-0.66),成年期(19-59岁;aOR=0.30;95%CI:0.25-0.38),和老年成年期(aOR=0.08;95%CI:0.04-0.18)(p<0.001)。与男性相比,女性伤寒沙门氏菌感染风险较低(aOR=0.67;95%CI=0.56-0.80;p=0.002).居住在农村(与城市相比)与更高的感染风险相关(aOR=1.38;95%CI:1.16-1.63;p=0.001),而获得地下水源(与市政供水相比)的风险较低(aOR=0.56;95%CI:0.43-0.73;p=0.002)。疫苗接种显示出强大的保护作用(aOR=0.069;95%CI=0.04-0.11,p=0.002)。对于那些伤寒感染的人来说,临床生物标志物分析显示存在白细胞减少症(65/691,9.4%),血小板减少症(130/691,18.8%),丙氨酸转氨酶(ALT)(402/691,58.2%)和C反应蛋白(CRP)(690/691,99.9%)水平升高。令人担忧的是,在阳性的伤寒沙门氏菌中,耐药率很高(653/691),包括多重耐药(MDR82/691,11.9%)和广泛耐药类型(XDR,571/691,82.6%)。结论:本研究强调了年龄的重要性,性别,局部性,水源,和疫苗接种状况在塑造白沙瓦地区伤寒沙门氏菌的流行病学景观中。这意味着将疫苗接种覆盖面扩大到开伯尔-普赫图赫瓦省更广泛的人口,特别是在白沙瓦地区,将是有益的。
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\'s 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 (0-11 years) (429/2747, 15.6%). Compared to children, the risk of S. typhi infection was lower in adolescence (adjusted OR = 0.52; 95% CI: 0.42-0.66), adulthood (19-59 years; aOR = 0.30; 95% CI: 0.25-0.38), and older adulthood (aOR = 0.08; 95% CI: 0.04-0.18) (p < 0.001). Compared to males, the risk of S. typhi infection was lower in females (aOR = 0.67; 95% CI = 0.56-0.80; p = 0.002). Living in a rural residence (compared to urban) was associated with a higher risk of infection (aOR = 1.38; 95% CI: 1.16-1.63; p = 0.001), while access to a groundwater source (compared to municipal water supply) led to a lower risk (aOR = 0.56; 95% CI: 0.43-0.73; p = 0.002). Vaccination demonstrated a robust protective effect (aOR = 0.069; 95% CI = 0.04-0.11, 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.