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

Abstract

Background Enteric fever is a serious public health problem in Pakistan. Growing problem of drug-resistant Salmonella strains and outbreak of ceftriaxone-resistant Salmonella typhi in Hyderabad during 2016-2017 is concerning. This study aimed to determine the antibiogram profile of Salmonella typhi and Salmonella paratyphi isolated from blood cultures of patients presenting in Pakistan Institute of Medical Sciences (PIMS), Islamabad. Materials and methods A retrospective cross-sectional study conducted in PIMS. A case of enteric fever was defined as a patient with blood culture positive for either S. typhi or S. paratyphi. Demographics and antibiogram profile of the 664 cases who presented during 2012-2018 were included in this study. Results Out of 664 cases, S. typhi was isolated from 528 and S. paratyphi was isolated from 136 cases. Males accounted for the majority of the cases (n = 440, 66.3%). Clustering of the cases was observed in young adults (18-25 years). Incidence was highest during months of summer and monsoon (May-September). Most of the S. typhi isolates were resistant to the first-line antibiotics (amoxicillin 57.6%, co-trimoxazole 61.4%, chloramphenicol 46.9%) and ciprofloxacin (62.7%). Antibiotic resistance rates were lowest for imipenem (3.8%) and ceftriaxone (4.4%). Among S. typhi isolates tested for all first-line antibiotics, 44.6% (149/334) were multidrug-resistant (MDR). In contrast, only 12.2% (11/90) of the S. paratyphi isolates were MDR. 0.7% (2/283) of the tested S. typhi isolates were extensively drug-resistant (XDR). XDR strains were sensitive to imipenem. There was an overall reduction in first-line antibiotic resistance rates from 2012 to 2018.

High Resistance of Salmonella spp. and Shigella spp. in Blood and Stool Cultures from the Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, Nepal, 2015−2019

“…among males. This finding is consistent with the studies done by Joshi et al and Umair and Siddiqui and likely reflects increased risk for this population, perhaps related to lapses in hygiene, particularly in lower age groups [ 10 , 23 ].…”

Extended-spectrum beta-lactamases encoding genes among <i>salmonella enterica</i> serovar typhi Isolates in patients with typhoid fever from four Academic Medical Centers in Lagos, Nigeria

“…In this study, the resistance rates against amoxicillinclavulanate, gentamicin, and ciprofloxacin were 18.5%, 22.2%, and 33.3%, respectively. Umair and Siddiqui 27 from Pakistan (62.7%) and Katiyar et al, 28 from India (96.9%), reported higher resistance rates for ciprofloxacin compared to the current research. However, Katiyar et al 28 from India and Maharjan et al 29 The results of antibiotic resistance for Salmonella isolates are different in various countries, even in the diverse regions of the same country.…”

Salmonella paratyphi-induced splenic vein thrombosis: A case report on infrequent cause of acute abdomen

“…S. typhi and Paratyphi strains are usually sensitive to third generation of cephalosporins but resistance is not uncommon. A study on enteric fever by Umair and Siddiqui[ 15 ] suggested that S. Paratyphi has less resistance pattern than S. typhi . The research also described that ceftriaxone and imipenem had lower chances of resistance, and the second one, respectively, is the most useful antibiotic in cases with resistant strains.…”