ArticleThe Lancet. Microbe2022
The international and intercontinental spread and expansion of antimicrobial-resistant Salmonella Typhi: a genomic epidemiology study.
Article in The Lancet. Microbe, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 2 of them syntheses that pooled it.
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Who cites it
68 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- 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
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- Efficacy of typhoid conjugate vaccine: final analysis of a 4-year, phase 3, randomised controlled trial in Malawian children.Lancet (London, England) · 2024Trial
- Population genomics reveals a long-term increase in azole resistance associated with the emerging cluster AZR amongEmerging microbes & infections · 2026Article
- Azithromycin-resistantJAC-antimicrobial resistance · 2026Article
- Presence of globally prominent multidrug-resistant genotypes ofMicrobial genomics · 2026Article
- Molecular detection of antimicrobial resistance genes and virulence-associated protein expression profiling in multidrug-resistant Salmonella enterica serovar typhi clinical isolates.Molecular biology reports · 2026Article
- Article
- Evolution and rise of antimicrobial resistance in key public health bacteria within and across the One Health sectors.Future microbiology · 2026Review
- Compartmentalization and Aggregation of Biomolecular Condensates in Crowded Hydrogels for Enhanced Nucleic Acid Diagnosis.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- ConfrontingInfection and drug resistance · 2026Review
- Revolutionizing Antibiotic Delivery: Harnessing 3D-Printing Technology to Combat Bacterial Resistance.Current pharmaceutical design · 2026Review
- Laboratory epidemiology ofOne health (Amsterdam, Netherlands) · 2025Article
- Typhi Mykrobe: fast and accurate lineage identification and antimicrobial resistance genotyping directly from sequence reads for the typhoid fever agent Salmonella Typhi.Genome medicine · 2025Article
- Article
- Leveraging illumina iSeq100 for whole genome sequencing of Salmonella Typhi for a resource-limited setting.Scientific reports · 2025Article
- Whole-Genome Sequencing Analysis of Drug-ResistantPathogens (Basel, Switzerland) · 2025Article
- The global burden of typhoid and paratyphoid fever from 1990 to 2021 and the impact on prevention and control.BMC infectious diseases · 2025Article
- Determining genotype and antimicrobial resistance of Salmonella Typhi in environmental samples by amplicon sequencing.PLoS neglected tropical diseases · 2025Article
- Article
8 more citing papers are in PubMed but not listed here.
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Authors and funding
28 authors.
Funding
Abstract
backgroundThe emergence of increasingly antimicrobial-resistant Salmonella enterica serovar Typhi (S Typhi) threatens to undermine effective treatment and control. Understanding where antimicrobial resistance in S Typhi is emerging and spreading is crucial towards formulating effective control strategies.
methodsIn this genomic epidemiology study, we sequenced the genomes of 3489 S Typhi strains isolated from prospective enteric fever surveillance studies in Nepal, Bangladesh, Pakistan, and India (between 2014 and 2019), and combined these with a global collection of 4169 S Typhi genome sequences isolated between 1905 and 2018 to investigate the temporal and geographical patterns of emergence and spread of antimicrobial-resistant S Typhi. We performed non-parametric phylodynamic analyses to characterise changes in the effective population size of fluoroquinolone-resistant, extensively drug-resistant (XDR), and azithromycin-resistant S Typhi over time. We inferred timed phylogenies for the major S Typhi sublineages and used ancestral state reconstruction methods to estimate the frequency and timing of international and intercontinental transfers.
findingsOur analysis revealed a declining trend of multidrug resistant typhoid in south Asia, except for Pakistan, where XDR S Typhi emerged in 2016 and rapidly replaced less-resistant strains. Mutations in the quinolone-resistance determining region (QRDR) of S Typhi have independently arisen and propagated on at least 94 occasions, nearly all occurring in south Asia. Strains with multiple QRDR mutations, including triple mutants with high-level fluoroquinolone resistance, have been increasing in frequency and displacing strains with fewer mutations. Strains containing acrB mutations, conferring azithromycin resistance, emerged in Bangladesh around 2013 and effective population size of these strains has been steadily increasing. We found evidence of frequent international (n=138) and intercontinental transfers (n=59) of antimicrobial-resistant S Typhi, followed by local expansion and replacement of drug-susceptible clades.
interpretationIndependent acquisition of plasmids and homoplastic mutations conferring antimicrobial resistance have occurred repeatedly in multiple lineages of S Typhi, predominantly arising in south Asia before spreading to other regions.
fundingBill & Melinda Gates Foundation.
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