Salmonella Typhi and Salmonella Paratyphi prevalence, antimicrobial susceptibility profile and factors associated with enteric fever infection in Bahir Dar, Ethiopia

Abstract

Enteric fever (EF) is caused by Salmonella enterica serovars Typhi (S. Typhi) and Paratyphi (S. Paratyphi) causing significant health problems in developing countries including Ethiopia. Thus present study aimed to determine prevalence and antimicrobial resistance profile of S. Typhi and S. Paratyphi among EF suspected patients at Felege-Hiwot comprehensive specialized hospital, Bahir Dar, Ethiopia. Hospital based cross-sectional study was conducted from March-to-May 2020. Totally, 150 patients were included conveniently. Data were collected using questionnaires by face-to-face interview. Concurrently, venous blood and stool specimens were collected and processed following standard bacteriological technique. Antimicrobial susceptibility test (AST) was performed by disc diffusion method. Logistic regression was performed to identify factors associated with EF infection. The study indicated 5.3% EF prevalence where S. Typhi accounted 75%. S. Typhi and S. Paratyphi isolates were 100% sensitive to cephalosporins but at least 83.3% showed resistance against chloramphenicol and tetracycline. At least 66.7% of isolates were multidrug resistance (MDR). Using well water for drinking (AOR = 6.22, CI 1.4–27.5) and previous EF history (AOR = 10.74, CI 2.01–55.9) were significantly associated with EF infection. Thus high bacterial prevalence and MDR isolates was observed. Therefore, health professionals should consider AST and use antibiotics with cautions for EF patient management.

Emerging Trends of Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) Salmonella Typhi in a Tertiary Care Hospital of Lahore, Pakistan

“…As of recently, this number has been reported to increase drastically, with more than 20 million cases being reported every year globally. The global impact of typhoid fever is more pronounced due to the emergence of antimicrobial resistance, such as the prevalence of drug resistant S. Typhi in high-risk countries [21][22][23]. Moreover, the occurrence of MDR and XDR S. Typhi cases in Pakistan have also increased at an alarming rate, with an elevated risk of an infectious outbreak in the provinces of Punjab and Sindh [10].…”

Traditional Widal Agglutination Test Versus Rapid Immunochromatographic Test in the Diagnosis of Enteric Fever: A Prospective Study From South India

“…The drawback of low PPV includes false-positive diagnosis and unnecessary antibiotic therapy [15]. This could further put a financial burden on the patients and be responsible for the emergence of multi-drug resistance and further limit treatment options [16][17][18][19][20][21].…”

Prevalence and antimicrobial susceptibility level of typhoid fever in Ethiopia: A systematic review and meta-analysis

“…The sample size of the studies ranged from 95 in Southern Nations Nationalities of People’s Region (SNNPR) ( Ameya et al, 2017 ) to 4,872 in the capital city, Addis Ababa ( Weyessa, 2014 ). From the total of 15 articles, only 6 (40%) reported the prevalence of typhoid fever and the AMR level ( Habte et al, 2018 , Garedew et al, 2018 , Awol et al, 2021 , Zerfu et al, 2018 , Amsalu et al, 2021 , Ameya et al, 2017 , Weyessa, 2014 , Amsalu et al, 2021 , Teshome et al, 2019 , Feleke et al, 2015 , Tadesse and Tadesse, 2013 , Wlekidan et al, 2015 , Deksissa and Gebremedhin, 2019 , Andualem et al, 2014 , Birhanie et al, 2014 , Admassu et al, 2019 ). A total of 9,370 study participants were included.…”

“…Majority, (n = 7985/9,370; 85.22; ( Awol et al, 2021 , Zerfu et al, 2018 , Amsalu et al, 2021 , Weyessa, 2014 , Feleke et al, 2015 , Tadesse and Tadesse, 2013 , Wlekidan et al, 2015 , Deksissa and Gebremedhin, 2019 , Birhanie et al, 2014 , Admassu et al, 2019 ) participants were febrile patients and (1385/9,370, 14.78; ( Habte et al, 2018 , Garedew et al, 2018 , Ameya et al, 2017 , Andualem et al, 2014 ) were typhoid suspected cases. Most of the studies (n = 11/15; 73.3%) involved suspected typhoid patients who had some or all of the following symptoms (history of fever for ≥ 2 days, body temperature greater than 37.5 °C, abdominal pain, headache, constipation or diarrhea, fatigue, headache, joint, and back pain) ( Habte et al, 2018 , Awol et al, 2021 , Zerfu et al, 2018 , Amsalu et al, 2021 , Ameya et al, 2017 , Feleke et al, 2015 , Tadesse and Tadesse, 2013 , Wlekidan et al, 2015 , Deksissa and Gebremedhin, 2019 , Andualem et al, 2014 , Birhanie et al, 2014 ). Some of the studies (4/15) also considered taking antibiotic treatment for the last two weeks in average as inclusion) and exclusion criteria ( Ameya et al, 2017 , Wlekidan et al, 2015 , Deksissa and Gebremedhin, 2019 , Birhanie et al, 2014 ).…”

“…Antimicrobial resistance (AMR) is an emerging public health concern due to inappropriate use of antimicrobial agents, self-medication, and lack of clinical diagnostic tools to support antibiotic de-escalation in LMIC ( Bebell and Muiru, 2014 , Castro-Vargas et al, 2020 , Varma et al, 2018 ). AMR of Salmonella S. Typhi has initially emerged to the traditional first-line drugs such as chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole ( Crump, 2019 , Legese, et al, 2018 , Amsalu et al, 2021 ). A study conducted in sub-Saharan Africa (SSA) identified high incidences of MDR S. Typhi in children aged < 15 years ( Park et al, 2018 ) and similar report from Pakistan stated high multidrug-resistant (MDR) isolates,76% and significant Extensive drug resistance (XDR) Salmonella S. Typhi ( Dyson et al, 2019 , Hussain et al, 2019 ).…”