A review of clinical profile, complications and antibiotic susceptibility pattern of extensively drug-resistant (XDR) Salmonella Typhi isolates in children in Karachi

Abstract

Background Enteric fever is a systemic infection caused by Salmonella enterica serovar Typhi and Salmonella enterica serovar Paratyphi A, B, and C. There is an emergence of Typhoid fever caused by extensively drug-resistant Salmonella Typhi strain called XDR S.Typhi. This strain is resistant to recommended first-line antibiotics and cephalosporins. WHO estimated 5274 cases of XDR S.Typhi in Karachi from November 2016 to December 2019. This study aims to determine clinical course, complications and response to treatment of XDR S.Typhi among the pediatric population coming to Indus Hospital. Method We reviewed the records of children who had culture-proven XDR S.Typhi infection at Indus Hospital from July 2017 to December 2018. A pre-designed data abstraction form was used to record information about seasonality, demographic details, clinical features and course, treatment, complications and outcomes of the cases of XDR S.Typhi. Results The records of 680 children were reviewed. The median (IQR) age of the patients was 5 (2–8) years. More than half (n = 391, 57.5%) of the patients were males. The outcomes were recorded in 270 (40%) patients. Out of these, 234 (86.7%) children got cured within 14 days, while a delayed response to antibiotics was noted in 32 (11.9%) children. Seventy-six (29%) children recovered on a combination of meropenem and azithromycin, 72 (27%) got cured on azithromycin alone, while 15 (6%) responded to meropenem alone. Conclusion Our review indicated that children under 5 years of age were affected more with XDR S.Typhi. Azithromycin alone or in combination with meropenem were effective antibiotics for treating XDR S.Typhi in children.

Extensively Drug-Resistant Salmonella typhi Infection: From Pill to Scalpel

“…The gastrointestinal manifestations of enteric fever include gastrointestinal ulcers leading to hemorrhage and perforation. Additionally, acute cholecystitis, acute pancreatitis, acute gastroenteritis, acute appendicitis, and post-infectious irritable bowel syndrome have been reported [ 10 , 13 ].…”

“…Gastrointestinal and hepatobiliary involvement in XDR S. typhi infection has been reported. Abscesses in various viscera like the spleen and infarcts in the spleen and kidneys caused by XDR S. typhi have been reported [ 10 - 11 ]. Similarly, hepatic involvement manifested by more than a three-fold elevation of alanine aminotransferase in 14% of cases of XDR S. typhi has been reported [ 10 ].…”

“…Abscesses in various viscera like the spleen and infarcts in the spleen and kidneys caused by XDR S. typhi have been reported [ 10 - 11 ]. Similarly, hepatic involvement manifested by more than a three-fold elevation of alanine aminotransferase in 14% of cases of XDR S. typhi has been reported [ 10 ]. During the course of our literature search, this is the first case of acute appendicitis caused by XDR S typhi.…”

“…Acute hepatitis, visceral abscesses in organs like the spleen and splenic and renal infarcts have been reported in association with XDR S. typhi [ 10 - 11 ]. During the course of our literature search, this is the first case report of acute appendicitis caused by XDR S. typhi.…”

Comparison of Single vs Combination Drug Therapy in Extensively Drug Resistant Salmonella typhi: An Observational Study from Pakistan

“…This has also been endorsed by many studies. 10 , 11 , 15 Azithromycin is effective since it can accumulate intracellularly more than 50 times that of blood, it has a long half-life, and it is rapidly absorbed from the gut. 13 , 14 Importantly, azithromycin retained sensitivity among XDR salmonella strains, and it can be safely used in these patients with good results.…”