Enteric fever in a non-endemic setting: Review of cases over a 12-year period at University hospitals Birmingham, UK

Abstract

Objectives: Enteric fever remains a common diagnosis in returned travellers to the UK, the majority of which require hospital admission. Increased resistance to antibiotics has complicated the management and rates of vaccine uptake remain unclear. Methods: We performed a retrospective study of culture-confirmed cases of enteric fever from blood samples in patients admitted to University Hospitals Birmingham, UK, between January 2010 and June 2022 to assess antimicrobial susceptibility, treatment outcomes and vaccination uptake. Results: In total, 108 patients were identified during the time period (S.typhi n = 57 [53 %]; S.paratyphi n = 51 [47 %]). Nearly all (93 % [100/108]) had returned from South Asia. There was no evidence of typhoid vaccination pre-travel for most patients (n = 96 [89 %]) in both groups. Over half of patients with S.typhi had microbiologically positive stool samples compared to just over 20 % of the S. paratyphi group (20/36 [55 %] vs 5/23 [22 %], p = 0.015). Three cases of ceftriaxone resistant enteric fever occurred. Conclusion: Enteric fever remains a frequent presentation to a non-endemic setting with close links to high-endemic regions such as South Asia. Vaccination uptake among local populations could be improved. Few cases of ceftriaxone-resistant enteric fever were seen which is a consideration for improved antimicrobial stewardship.