Evidence map›Paper›PMID 31898501›Full record

SynthesisBMC medicine2020

Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis.

Annie J Browne, Bahar H Kashef Hamadani, Emmanuelle A P Kumaran, Puja Rao, Joshua Longbottom, Eli Harriss, Catrin E Moore, Susanna Dunachie, Buddha Basnyat, Stephen Baker and 4 more

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 98 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
98citing papers in PubMed, 7 pooled it
52.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

98 citing papers in PubMed, 7 syntheses or guidelines pooled it, 402 citations in OpenAlex.

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  6. A Systematic Review on Antimicrobial Resistance amongThe American journal of tropical medicine and hygiene · 2020
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  19. Comparative genomics ofVirulence · 2025
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38 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 5 institutions in 6 countries.

Annie J BrowneBig Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
Bahar H Kashef HamadaniBig Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
Emmanuelle A P KumaranBig Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
Puja RaoInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Joshua LongbottomBig Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
Eli HarrissBodleian Health Care Libraries, University of Oxford, Oxford, UK.
Catrin E MooreBig Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
Susanna DunachieCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Buddha BasnyatCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Stephen BakerCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Alan D LopezBig Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
Nicholas P J DayCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Simon I HayInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Christiane DolecekCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. christiane.dolecek@ndm.ox.ac.uk.
University of Oxford · GBMahidol Oxford Tropical Medicine Research Unit · THInstitute for Health Metrics and Evaluation · USSeattle University · USUniversity of Melbourne · AU

Funding

Wellcome TrustWellcome Trust 209142/Z/17/Z
6 · The paper itself

Abstract

backgroundAntimicrobial 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.

methodsWe 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 I

findingsWe 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.

interpretationDrug-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.

trial registrationPROSPERO CRD42018029432.

Indexed as

Salmonella paratyphi ASalmonella typhiAnti-Bacterial AgentsAzithromycinDrug Resistance, BacterialGlobal HealthHumansParatyphoid FeverPrevalenceTyphoid FeverAnti-Bacterial AgentsAzithromycinAntimicrobial drug resistanceAzithromycin resistanceCeftriaxone resistanceDrug-resistant infectionsEnteric feverESBL-producingFluoroquinolone resistanceHarmonisation of breakpointsMeta-analysisMultidrug resistanceParatyphoid feverPrevalence of resistanceSalmonella Paratyphi ASalmonella TyphiTyphoid fever

Identifiers

PMID31898501
PMCPMC6941399
OpenAlexW2999170785

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.