An Overview of Extensively Drug-resistant Salmonella Typhi from a Tertiary Care Hospital in Pakistan

Abstract

Introduction: Since 2016, the province of Sindh is in the limelight because of its association with the emergence and spread of extensively drug-resistant Salmonella typhi (XDR S. typhi). Although its global spread has been proven in several studies, our information regarding its countrywide existence is still insufficient. In the last four years, few cases of XDR S. typhi were identified at the Shifa International Hospital (SIH), Islamabad, Pakistan. This article aims to report demographic patterns, clinical presentations, and treatment outcome of these cases. Materials and methods: This study was conducted at SIH, Islamabad, on blood culture-proven XDR S. typhi cases from January 2015 to December 2018. The data were retrieved from the hospital's record system. Patient demographic details, clinical presentations, management, and disease outcomes were evaluated and statistical analysis was performed through IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, NY). Results: A total of 30 blood culture-proven XDR S. typhi cases were identified and 80% (24) of them were reported in 2018. The mean age at presentation was 12.8±9.6 years. Twelve (40%) patients came from Islamabad, nine (30%) from Rawalpindi, and eight (26.6%) from Khyber Pakhtunkhwa (KPK). All patients, except one, were prescribed meropenem and azithromycin. Three patients developed complications but no mortality was documented. Over four years, these XDR S. typhi cases contributed 5.01% to the total S. typhi isolates. Conclusion: This study validates the existence of XDR S. typhi all over Pakistan. It stresses upon the fact that more stringent methods should be adopted for its identification and control.

Antibiotic Susceptibility Patterns of Salmonella Typhi and Salmonella Paratyphi in a Tertiary Care Hospital in Islamabad

“…Antibiotic resistance is a major problem in the management of enteric fever. MDR and XDR cases of enteric fever have been reported [5,11,12]. The largest outbreak of ceftriaxone-resistant S. typhi was reported in Pakistan during 2017-2018 [12].…”

“…One of these cases was tested for and found to be sensitive to azithromycin as well. A study conducted on XDR S. typhi in Northern Pakistan reported antibiotic sensitivity only to azithromycin and meropenem [11]. Yousafzai et al investigated the outbreak of ceftriaxone-resistant S. typhi in Hyderabad during 2016-2017 and reported a similar antibiotic sensitivity profile, that is, azithromycin, imipenem and meropenem [12].…”

X-DR (Drug Resistant) typhoid fever in children.

“…6 But recent reports of XDR (chloramphenicol, amoxicillin, TMP, fluroquinolones and ceftriaxone) strains of Salmonella in areas of Sindh (Pakistan) have been alarming. 7,9,10 International Surveillance has also identified XDR strains in patients in UK, USA and Canada with all of them having travelled to Pakistan in recent past. 8,9 Pakistan health authorities have reported an outbreak of extensively (XDR) typhoid fever that begin in Hyderabad district of Sindh province in November, 2016.…”

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

“…An investigation of XDR enteric fever in Hyderabad (7) and in Islamabad (14) revealed that 56% and 33% affected children were under 5 years of age. This nding is consistent with our study, since we found that the median age of affected children was 5 years (IQR: 2-8 years).…”