Clinical Characteristics and Antibiotics Sensitivity of Culture Positive Typhoid Fever Patients in Baghdad Teaching Hospital - A Single Center Study

Abstract

BACKGROUND: Enteric fever caused by Salmonella Typhi is an endemic disease in Iraq. Variations in presentations make it a diagnostic challenge. If untreated or treated inappropriately then it is a serious disease with potentially life-threatening complications. The recent emergence of drug resistant strains of S. Typhi is a rising public health problem and a clinical concern to the physician. AIM: The objectives of the study were to assess and describe the patterns of antimicrobial resistance, clinical characteristics, epidemiological distribution, and complications of typhoid fever. PATIENTS AND METHODS: Fifty cases of typhoid fever (culture proven) were collected during the period from February 2019 to November 2019 in the medical wards of Baghdad Teaching Hospital. Detailed history, physical examination, and laboratory investigations were conducted and statistical analysis of the results was done, prospective observational study was conducted. RESULTS: During the study period, 50 cases of typhoid fever were documented, mean age of presentation was 30.7 ± 12.8, 60% of the cases were male gender, gastrointestinal complications were the most common (90%) followed by hematological complications (71%). Mortality of typhoid fever in our study was 2%. High percentage of resistance to third generation cephalosporins, ciprofloxacin, and azithromycin was found (96%, 56%, and 56%, respectively) while good sensitivity to trimethoprim and meropenem was found (94% and 76%, respectively). Significant association was also found between the development of typhoid fever complications and the presence of anemia, thrombocytopenia, lymphopenia, and eosinopenia. Significant association was also found between the complications and the infection with strains resistant to cephalosporins, ciprofloxacin, and azithromycin. CONCLUSIONS: There is a concerning increase in resistance toward cephalosporins, ciprofloxacin, and azithromycin while meropenem and trimethoprim are emerging as effective drugs. There was high incidence of complications found (84%).Lymphopenia, anemia, eosinopenia, and thrombocytopenia are independent risk factors for the development of complications of typhoid fever.

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“…The emerging multiple drug resistance (MDR) among the bacterial strains is on the rise, and becoming increasingly widespread, and also includes the resistance of older antimicrobials such as "Chloramphenicol", "Ampicillin", and "Trimethoprim-Sulfamethoxazole" (Co-Trimoxazole) has been existed for many years and this issue is considered as the first problem in holding typhoid fever. As a result, "Fluoroquinolone", as "Ciprofloxacin", has been chosen as the first-line antibiotic for therapy, particularly after the widespread rise of multidrug-resistant S. typhi isolates [2]. The transition to ciprofloxacin has resulted in a rise in the number of typhoidal Salmonellae resistant to the antimicrobial drug [3].…”

A Novel Algorithm for Predicting Antimicrobial Resistance in Unequal Groups of Bacterial Isolates

“…Previous studies on Salmonella-resistant typhoid cases in Iraq showed a diversity of resistance patterns S. typhi among different institutions and geographical locations. Furthermore, these studies were not limited to a pediatric age group [8][9][10].…”

“…In the context of existing data bias and distressing investigations of salmonella resistance and other bacterial isolates in Iraq [8,10,20], we designed this study to look for a valid method to deal with an unequal number of S. typhi isolates tested for different antibacterials to rank these groups according to best available evidence for drug resistance and sensitivity. This will fill the gap of knowledge in the unequal study groups, particularly among drug resistance isolates.…”