Drug Resistant XDR Typhoid in Children Admitted in a Tertiary Care Hospital

Abstract

Objective: To evaluate the prevalence and patterns of drug-resistant typhoid fever, including extensively drug-resistant (XDR) and multidrug-resistant (MDR) strains, among children admitted to a tertiary care Hospital. Methodology: This descriptive observational study was done at Paediatric department of LUMHS from May 2022-november 2022. Children aged 1-12 years, both gender and with confirmed diagnosis of typhoid fever based on positive blood cultures were included. Blood culture samples were collected from pediatric patients presenting with suspected typhoid fever are processed according to standard microbiological techniques. Isolation and identification of Salmonella Typhi are performed using appropriate culture media and biochemical tests. Antimicrobial susceptibility testing was conducted using standardized methods. Drug resistance patterns, including multidrug resistance (MDR) and extensively drug-resistant (XDR) phenotypes, are determined based on susceptibility testing results. MDR was defined as resistance to at least three classes of antibiotics commonly used for typhoid fever treatment, while XDR indicates additional resistance to fluoroquinolones and third-generation cephalosporins, which are frontline treatment options for typhoid fever. Data was entered and analyzed using SPSS version 26. Results: A total of 43 patients were studied, their mean age was 5.91 years. Boys were 72.15 and girls were 27.9%. Most of the cases 65.1% were consuming tap water. MDR resistance was observed in 9.4% of the cases, while XDR resistance was highly frequent among 83.7% of the patients. Very few cases 16.3% had history of typhoid vaccination. However, MDR and XDR resistance were statistically insignificant according to type of water consumption (p->0.05). Conclusion: In conclusion, the study revealed alarmingly high prevalence rates of extensively drug-resistant (XDR) typhoid with multidrug-resistant (MDR) strains observed in 9.4% of cases. These findings emphasize the urgent need for comprehensive strategies that address both antimicrobial resistance and vaccination efforts to combat the increasing burden of XDR typhoid in children.