Antibiotic Susceptibility Pattern and the Indicator of Decreased Ciprofloxacin Susceptibility of Salmonella enterica Serovar Typhi Isolated from Dhulikhel Hospital, Nepal

Khadka

J Nepal Health Res Council

et al. 2018

Background: For diagnosis of enteric fever, the culture of the organism from different body fluids is the gold standard. After diagnosis, it is important to treat with the right antibiotic before any complications can occur. The retrospective study is designed to explore the antibiotic sensitivity trend in blood culture positive typhoid fever cases and the extent of drug resistance before treatment is administered. Methods:A retrospective study was carried out for culture isolated enteric fever patients admitted in Kathmandu Model Hospital. The discharged records from January 2012 to December 2016 were analyzed. The patients above 15 years and with culture isolated enteric fever were included in the study. Results:One hundred fifty-nine strains of Salmonella typhi and paratyphi were isolated from Jan 2012 to Dec 2016 at Kathmandu Model Hospital. Out of 159 isolated, 125 (78.6%) were Salmonella typhi and 34 (21.4%) were paratyphi. Among them co-trimoxazole, chloramphenicol, ceftriaxone, cefotaxime, cefixime, and ofloxacin demonstrated 100% sensitivity. Similarly, amoxicillin sensitivity was 98.1% (n=156) while ciprofloxacin was sensitive in 6.3% (n=10), intermediately sensitive in 49.1% (n=78) and resistance in 44.7% (n=71).The newer quinolone levofloxacin showed 78.5% (n=11) sensitivity. Azithromycin was sensitive in 99.2% (n=132) of total isolated Salmonella species both typhi and paratyphi. Conclusions:A high degree of sensitivity was noted to chloramphenicol and co-trimoxazole, showing sensitivity has returned to conventional antibiotics. The drug-like ofloxacin is still the best responding drug in our contest whereas ciprofloxacin resistance is still high, but five years patterns show a trend of rollback of sensitivity.

Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 52%

Antimicrobial Sensitivity Trend in Blood Culture Positive Enteric Fever at Kathmandu Model Hospital

Khadka

J Nepal Health Res Council

et al. 2018

“…Salmonella spp is the most common isolate indicating that enteric fever is endemic in various parts of Nepal. 2,4,5,15 All the cases of enteric fever were community acquired. An experiment on 112 cases of typhoid fever in out-patients at Dhulikhel Hospital in 2004 showed a higher percentage of infection in males than in females with a ratio of 3:1.…”

Section: Discussionmentioning

confidence: 99%

“…17 In recent years many case studies has shown failure in the treatment of enteric fever with isolates susceptible to fl uoroquinolones and resistant to Nalidixic acid. 2,18 Hence routine testing of resistance to Nalidixic acid can serve as a useful screening test for fl uoroquinolones. 18 The increase in the resistivity of the antibiotics like Ciprofl oxacin from 0 % in 2005 to 33.33 % in 2013 might have occurred due to the long-term use of the drugs or the misuse of the drugs by the patients.…”

Section: Discussionmentioning

confidence: 99%

“…1 There are approximately 21.6 million cases of typhoid fever resulting in 200,000 death every year. 2 In developing countries like Nepal where the annual incidence ranges from 12 to 622 per 100,000, Salmonella Typhi is reported as major cause of bacteremia followed by Salmonella Paratyphi A. 3 Primary infections, of the respiratory tract, urinary tract and gastro-intestinal tract, often result in bloodstream infections and may cause fever.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Etiology of bloodstream infection and antibiotic susceptibility pattern of the isolates

et al. 2015

Background: Bloodstream infection (BSI) is a signifi cant cause of morbidity and mortality. In Nepal, very few studies on BSIs have restricted the understanding of their cause, prevention and treatment. This cross-sectional study was conducted to isolate BSIs causing pathogens and determine their antibiotic susceptibility pattern in patients visiting Kathmandu Model Hospital during December 2012 to May 2013. Materials and Methods: Standard laboratory procedure was used to screen, isolate and identify the bacteria from 1,205 patients. The antibiotic susceptibility pattern (AST) was analyzed by modifi ed Kirby Bauer technique and data were analyzed using SPSS version-16. Results: Out of 1,205 blood samples, 186 (15.4 %) were culture positive. The most common bacteria isolated were: Salmonella spp., Escherichia coli, Klebsiella pneumoniae and CoNS. Gram-negative bacteria were the predominant causes of BSIs. Salmonella Typhi was isolated in 71 % cases of bloodstream infection followed by Salmonella Paratyphi A in 16 %, Escherichia coli in 5.3 % and Klebsiella pneumoniae in 0.5 %. The gram-positive organism responsible for causing BSI was coagulase-negative staphylococcus in 7 % cases. There was no signifi cant association between bacteremia and gender of the patients. During ASTs, Gram-negative bacteria were sensitive to Chloramphenicol with only 0.5 % resistivity. Salmonella Typhi (85.6 % of isolates) showed resistance to Nalidixic acid. Gram-positive bacteria showed 100 % sensitivity towards Chloramphenicol and Gentamicin and were least sensitive to Amoxicillin. Conclusion: Salmonella spp., was major cause of BSIs. Increase in antibiotic resistivity for BSI causing pathogens has necessitated continuous monitoring of the susceptibility of organisms towards antibiotics.

Clinical Infectious Diseases

Trends of Etiology and Drug Resistance in Enteric Fever in the Last Two Decades in Nepal: A Systematic Review and Meta-analysis

Karki

Shakya²,

Cheng

et al. 2013

Prospective time-trend analyses on shifting etiology and trends of drug resistance in enteric fever are scarce. Using published and unpublished datasets from Nepal, we performed a systematic review and meta-analysis to understand the trends in etiology and resistance to antimicrobials that have occurred since 1993. Thirty-two studies involving 21 067 Salmonella enterica serotype Typhi (ST) and S. enterica serotype Paratyphi A (SPA) isolates were included. There was an increasing trend in enteric fever caused by SPA during the last 2 decades (P < .01). We observed sharply increasing trends in resistance to nalidixic acid and ciprofloxacin for both ST and SPA. In contrast, multi-drug resistance (MDR), resistance to traditional first-line antibiotics such as chloramphenicol and co-trimoxazole have significantly decreased for both organisms. The resistance to ceftriaxone has remained low, suggesting it is likely to remain useful as a reserve antibiotic for treatment. Trends in decreasing resistance to traditional first-line antibiotics and decreasing MDR provide an opportunity to reconsider these first-line antimicrobials as therapeutic options.