ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021
Spontaneous Emergence of Azithromycin Resistance in Independent Lineages of Salmonella Typhi in Northern India.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 2 of them syntheses that pooled it.
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Who cites it
47 citing papers in PubMed, 2 syntheses or guidelines pooled it, 67 citations in OpenAlex.
- Burden of antimicrobial resistance in culture-confirmed Salmonella Typhi isolates in India from 1977 to 2024: A systematic review and meta-analysis.PLoS neglected tropical diseases · 2026Pooled it
- Pooled it
- Safety and Efficacy of a Typhoid Conjugate Vaccine in Malawian Children.The New England journal of medicine · 2021Trial
- Global trends and molecular epidemiology of Azithromycin-resistantOne health (Amsterdam, Netherlands) · 2026Article
- Azithromycin-resistantJAC-antimicrobial resistance · 2026Article
- Azithromycin Resistance in Salmonella Typhi and Paratyphi Across South Asia: A Systematic Review and Meta-Analysis.Open forum infectious diseases · 2026Review
- Azithromycin minimum inhibitory concentration (MIC) creep and clinical-microbiological profile of typhoidal and nontyphoidal Salmonella isolates from blood specimens at a tertiary care hospital in Pune, India.The Indian journal of medical research · 2026Article
- Evolution and rise of antimicrobial resistance in key public health bacteria within and across the One Health sectors.Future microbiology · 2026Review
- Integrative genomic and molecular dynamics characterisation ofFrontiers in microbiology · 2026Article
- ConfrontingInfection and drug resistance · 2026Review
- Emergence of azithromycin and ciprofloxacin non-susceptible genotype 4.2.2Antimicrobial agents and chemotherapy · 2025Article
- Azithromycin resistance inJAC-antimicrobial resistance · 2025Article
- Emergence of Azithromycin-resistant Salmonella Typhi in Southeast Asia: A systematic review.Pakistan journal of medical sciences · 2025Review
- Genomic insights into antibiotic-resistant non-typhoidal Salmonella isolates from outpatients in Minhang District in Shanghai.Communications medicine · 2025Article
- The TyphiNET data visualisation dashboard: unlocking Salmonella Typhi genomics data to support public health.Genome medicine · 2025Article
- Imported Typhoid Fever in Romania Between 2010 and 2024.Infectious disease reports · 2025Article
- Plasma concentration of azithromycin and correlation with clinical outcomes in patients with enteric fever.JAC-antimicrobial resistance · 2025Article
- Prevalence of azithromycin resistance after the COVID-19 era in clinical bacterial isolates from a tertiary care hospital in Gurugram, India.Frontiers in microbiology · 2025Article
- Emergence of carbapenem-resistantFrontiers in microbiology · 2025Article
- Azithromycin-resistant mph(A)-positive Salmonella enterica serovar Typhi in the United States.Journal of global antimicrobial resistance · 2024Article
Corrections and comments
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Authors and funding
14 authors at 4 institutions in 4 countries.
Funding
Abstract
backgroundThe emergence and spread of antimicrobial resistance (AMR) pose a major threat to the effective treatment and control of typhoid fever. The ongoing outbreak of extensively drug-resistant Salmonella Typhi (S. Typhi) in Pakistan has left azithromycin as the only remaining broadly efficacious oral antimicrobial for typhoid in South Asia. Ominously, azithromycin-resistant S. Typhi organisms have been subsequently reported in Bangladesh, Pakistan, and Nepal.
methodsHere, we aimed to understand the molecular basis of AMR in 66 S. Typhi organisms isolated in a cross-sectional study performed in a suburb of Chandigarh in Northern India using whole-genome sequencing and phylogenetic analysis.
resultsWe identified 7 S. Typhi organisms with the R717Q mutation in the acrB gene that was recently found to confer resistance to azithromycin in Bangladesh. Six out of the seven azithromycin-resistant S. Typhi isolates also exhibited triple mutations in gyrA (S83F and D87N) and parC (S80I) genes and were resistant to ciprofloxacin. These contemporary ciprofloxacin/azithromycin-resistant isolates were phylogenetically distinct from each other and from those reported from Bangladesh, Pakistan, and Nepal.
conclusionsThe independent emergence of azithromycin-resistant typhoid in Northern India reflects an emerging broader problem across South Asia and illustrates the urgent need for the introduction of typhoid conjugate vaccines in the region.
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Registered trials
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