Antimicrobial Susceptibility Pattern of Salmonella spp. Isolated from Enteric Fever Patients in Nepal

Abstract

Introduction: Enteric fever, a systemic infection caused by Salmonella enterica Typhi and S. enterica Paratyphi is one of the most common infections in developing countries such as Nepal. Aside from irrational practices of antibiotic use, mutations in chromosomal genes encoding DNA gyrase and Topoisomerase IV and by plasmid mediated quinolone resistant (PMQR) genes are suggested mechanisms for the development of resistance to nalidixic acid and reduced susceptibility to ciprofloxacin. Regardless of high endemicity of enteric fever in Nepal, there is paucity of studies on prevalence and drug-resistance of the pathogen. Therefore, this study aimed to assess the antibiotic susceptibility pattern of Salmonella isolates and determine the minimum inhibitory concentration of ciprofloxacin. Methods: A total of 1298 blood samples were obtained from patients with suspected enteric fever, attending Sukraraj Tropical and Infectious Disease Hospital (STIDH) during March–August, 2019. Blood samples were inoculated immediately into BACTEC culture bottles and further processed for isolation and identification of Salmonella Typhi and S. Paratyphi. Axenic cultures of the isolates were further subjected to antimicrobial susceptibility testing (AST) by using the modified Kirby–Bauer disc diffusion method based on the guidelines by CLSI. The minimum inhibitory concentration (MIC) of ciprofloxacin was determined by agar-dilution method. Results: Out of 1298 blood cultures, 40 (3.1%) were positive for Salmonella spp. among which 29 (72.5%) isolates were S. Typhi and 11 (27.5%) isolates were S. Paratyphi A. In AST, 12.5% (5/40), 15% (6/40) and 20% (8/40) of the Salmonella isolates were susceptible to nalidixic acid, ofloxacin and levofloxacin, respectively, whereas none of the isolates were susceptible to ciprofloxacin. The MIC value for ciprofloxacin ranged from 0.06-16 µg/mL in which, respectively, 5% (2/40) and 52.5% (21/40) of the isolates were susceptible and resistant to ciprofloxacin. None of the isolates showed multidrug-resistance (MDR) in this study. Conclusion: This study showed high prevalence of quinolone-resistant Salmonella spp., while there was marked re-emergence of susceptibilities to traditional first option drugs. Hence, conventional first-line-drugs and third-generation cephalosporins may find potential usage as the empirical drugs for enteric fever. Although our reporting was free of MDR strains, extensive surveillance, augmentation of diagnostic facilities and treatment protocol aided by AST report are recommended for addressing the escalating drug-resistance in the country.

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

“…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. There are many possible explanations for these discrepancies, including differences in the source of isolates studied, the methods used to evaluate the antibiotic susceptibility, the presence or absence of antibiotic consumption surveillance programs, use of antibiotics in the food production and veterinary industries, and the types and races of the population studied.…”

Outer Membrane Proteins and Efflux Pumps Mediated Multi-Drug Resistance in Salmonella: Rising Threat to Antimicrobial Therapy

“…In the 21st century, azithromycin, ciprofloxacin, and ceftriaxone are the primary drugs used to treat typhoid fever. However, unrestricted and indiscriminate application of these antibiotics for common illnesses, including non-bacterial infections, overexploitation, and unregulated usage have led to the emergence of multi-drug resistance and/or extensive drug resistance, thereby increasing the mortality in typhoid fever significantly …”

Susceptibility to Fluoroquinolones among Salmonella Enterica Serovars in Blood Culture

“…However, the Salmonella enterica isolates reduced susceptibility to frequently used antibiotics are still a key issue for enteric fever operative remedy prolonging the fever duration and increasing risk for further complications [9]. Ofloxacin and ciprofloxacin like Fluoroquinolones is now a backbone for managing the Salmonella severe infections [10]. However, Salmonella straining increases resistance to fluoroquinolones as reported in various studies [11,12].…”