A pattern of antibiotic drug resistance of Salmonella Typhi and Salmonella Paratyphi among children with enteric fever in a tertiary care hospital in Lahore, Pakistan

Abstract

Aim To establish the pattern of antibiotic resistance and assess the frequency of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Salmonella Typhi and Salmonella Paratyphi among children with enteric fever. Methods This cross-sectional study was carried out in the Department of Pediatrics, Sharif Medical City Hospital, Lahore, from July 2020 to January 2021. The study involved patients aged between 0 to 15 years who attended our outpatient department or were admitted to the ward with the suspicion of typhoid fever. A convenience sample of patients with blood cultures positive for S . Typhi and S . Paratyphi was enrolled. Results Of the 105 participants, 70 (66.7%) were male. The mean age was 8.48 ± 4.18 years, and the most affected age group was 6-10 years (n = 46, 43.8%). Among the cultured organisms, 95 (90.5%) isolates were S . Typhi and 10 (9.5%) were S . Paratyphi A. Antibiotic resistance was highest against ampicillin (n = 91, 86.7%), and all of the isolates were sensitive to imipenem and meropenem. Twenty-three (21.9%) cultured organisms were MDR and 54 (56.8%) were XDR. Conclusion An alarming antibiotic drug resistance pattern was observed among children with enteric fever in Lahore. The lowest resistance was noted for azithromycin, meropenem, and imipenem. Our findings warrant the immediate implementation of tailored antibiotic stewardship and infection control strategies.

Drug Resistant XDR Typhoid in Children Admitted in a Tertiary Care Hospital

“…However, the rise of resistant bacterial strains has rendered these drugs ineffective. 9 Furthermore, their use has contributed to the emergence of a multidrug-resistant (MDR) strain, which is no longer susceptible to the aforementioned medications.…”

“…Consequently, there has been a shift in prescription patterns towards quinolones and cephalosporins, that worked effectively until an extensively drug-resistant (XDR) strain that was resistant to both medication classes emerged. 9,10 In 2016, Hyderabad had the first outbreak of XDR typhoid, which quickly expanded to surrounding cities in the province of Sindh. Since then, Pakistan alone has reported over 10,000 cases in 2016 by WHO, highlighting the alarming extent of dissemination of this highly resistant strain.…”

“…Since then, Pakistan alone has reported over 10,000 cases in 2016 by WHO, highlighting the alarming extent of dissemination of this highly resistant strain. 9,11 The emergence of multidrugresistant (MDR) and extensively drug-resistant (XDR) strains in numerous countries worldwide has sparked significant apprehension regarding the escalation of antibiotic resistance among pathogens like S. Typhi. 11 Tackling the ongoing progression of antimicrobial drug resistance in Sindh represents a critical public health challenge that requires immediate attention to prevent its local containment and potential spread to urban centers in other provinces of Pakistan.…”