Association of extensively drug resistant salmonella infection in children with typhoid fever

Abstract

Objectives: In resource limited countries facing a huge burden of multidrug resistant and extensively drug resistant (XDR) enteric fever, treatment is a great challenge on the part of a patient as well as a health care professional. This study was conducted to determine the association of XDR enteric fever with various studied factors among hospitalized culture-positive pediatric patients in a tertiary care hospital setup.
 Methods: We conducted a descriptive observational study at The Karachi Adventist Hospital from July 01, 2019, to March 31, 2020 on 143 hospitalized children with culture proven enteric fever who were already on empirical antibiotics. Depending on the variability of the course of illness and clinical responses to given antibiotics, the data was gathered on a structured data sheet. Association of various study parameters and their significance in relation to XDR salmonella infection was analyzed and studied.
 Results: The age group highly affected was 5-7.5 years, with a male preponderance of 61.5%. Majority were from urban slums areas of Karachi (53.8%) and 52% were admitted between 7 to 14 days of fever onset. XDR salmonella infection was observed in 79% of blood culture isolates. None of the XDR patients were consuming boiled water and neither of these infected children were vaccinated against salmonella typhi. Duration of fever before hospitalization, non-consumption of boiled or mineral water, ciprofloxacin use and lack of typhoid vaccination showed statistically strong association with XDR enteric fever (p<0.01).
 Conclusion: Prehospitalization fever duration, use of boiled/mineral water, ciprofloxacin use and typhoid vaccine status showed strong association with XDR salmonella infection. Prioritizing the focus on healthcare awareness, early access to proper health care facility, discouraging over-the-counter drugs and enforcement of immunization will help decline the dissemination of this dreadful disease.
 doi: https://doi.org/10.12669/pjms.38.7.5868
 How to cite this:Memon H, Saeed F, Iqbal M, Saboohi E, Hanif S, Mallick AHH. Association of extensively drug resistant salmonella infection in children with typhoid fever. Pak J Med Sci. 2022;38(7):---------. doi: https://doi.org/10.12669/pjms.38.7.5868
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Hematological Manifestations of Dengue, Malaria and Enteric Fever in Children Presenting To a Tertiary Care Hospital, Pakistan

“…Most of the patients in our sample population were male in all three disease groups. Same finding is reported by other researchers from Pakistan for all three diseases [9][10][11] . The age group of our patients was 4, 5 and 6 years for enteric fever, malaria and dengue fever respectively.…”

The frightening disease burden of blood culture proven XDR Typhoidal isolates in pediatric population in a tertiary care hospital in Islamabad; Time to implement a holistic approach countrywide

“…21 Study done by Memon et al in Karachi also showed a male preponderance of 61.5%. 17 Moreover, there was male predominance with 56.4% boys and 43.6% girls in study done by Gul et al in Lahore that also corresponds to our findings. 22 On contrary, Mubashir et al reported that 54.9% cases out of all blood culture positive patients were females and 28 (55.1%) were males which is in contrast to our findings.…”

“…16 Another study done by Memon et al in Karachi in 2019-2020 reported that the age bracket mainly affected was 5-7.5 years which is also similar to our findings. 17 During another study conducted by Fivizia and colleagues in Karachi in 2017-2018, it was observed that the predominant age range in children was 5-6 years. 18 In a study by Gul et al in Lahore, most children were between 4-8 years of age i.e 44.8%.…”

Pattern of Antibiotic Sensitivity in Typhoid Fever Patients With Positive Blood Culture: An Observational Study

“…The observed antibiotic resistance patterns among Salmonella typhi isolates in this study reveal a concerning trend, echoing global challenges in combating infectious diseases. The World Health Organization (WHO) underscores the threat of antibiotic resistance in enteric fever, particularly to commonly prescribed drugs like ampicillin and chloramphenicol, which is consistent with the findings of this study (Memon et al, 2022). The emergence of multi-drug resistant (MDR) and extensively drug-resistant (XDR) strains, seen in 68.80% of cases, aligns with global trends reported by the Centers for Disease Control and Prevention (CDC) (Ombelet et al, 2022).…”