Drug resistance in Salmonella Typhi: implications for South Asia and travel

Abstract

Purpose of review Recent attempts at mapping Typhoid epidemiology have revealed an enormous burden of disease in developing countries. Countries hitherto believed to have a low incidence, such as the African subcontinent, on accurate mapping were found to have a significant burden of disease. Drug resistance, because of rampant overuse of antibiotics, has driven selection pressure to extensively drug-resistant typhoid becoming a reality in the Indian subcontinent. With widespread travel, importation of this variety of typhoid to nonendemic countries is likely to lead to outbreaks in a nonimmune population. Recent findings A strain of extensively drug-resistant Salmonella Typhi isolated in Pakistan in 2016 has been responsible for multiple outbreaks in Pakistan and multiple travel-related cases all over the world in United States, UK, and Australia. This novel strain belongs to H58 lineage harbouring a plasmid encoding additional resistance elements like blaCTX-M-15 and a qnrS fluoroquinolone resistance gene. This resistance pattern has rendered many therapeutic options like Ceftriaxone and Fluoroquinolones clinically inactive impacting care in endemic and traveller populations alike. Summary Changing epidemiology and drug resistance in typhoid indicates that it may be prudent to vaccinate nonimmune travellers travelling to typhoid endemic areas, especially the Indian subcontinent.

Clinical and Laboratory Features of Enteric Fever in Children and Antibiotic Sensitivity Pattern in a Tertiary Care Hospital of a Low- and Middle-Income Country

“…However, a decline in MDR strains of EF has been demonstrated in India and Bangladesh; nevertheless, fluoroquinolone resistance patterns were steadily increasing. In contrast, there is a preponderance of MDR strains in Pakistan and Nepal and evolving extensively drug-resistant (XDR) strains in Pakistan [ 68 ].…”

Antibiotic Resistance in Salmonella typhi Strains Isolated From Patients in Pakistan: A Hospital Database Study

“…Many studies point to the lack of access to healthcare services along with the increased supply of over-the-counter (OTC) drugs as one of the main contributors to antibiotic resistance in lower-middle-income countries [ 5 ]. In 2016, extensively drug-resistant Salmonella Typhi was isolated in Pakistan and has been responsible for multiple outbreaks in Pakistan and many travel-related cases all over the world [ 6 ]. In this study, we have observed the rate of resistance and sensitivity of various antibiotics in the case of Salmonella Typhi.…”

“…In recent years, healthcare professionals have witnessed the rapid rise of multi-drug resistant (MDR) and extensive drug-resistant (XDR) Salmonella enterica serotype Typhi [ 5 ][ 6 ]. Typhoid fever that is resistant to traditional first-line antibiotics including ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole is regarded as MDR typhoid [ 2 ].…”

Antibacterial effect of eucalyptus (Melaleuca leucadendra) ecoenzyme produced by Lamongan’s MSMEs against Salmonella Typhi

“…Various resistance mechanisms make many Salmonella Typhi bacteria fall into the category of Multi-Drug Resistant (MDR), resistant to antibiotics like ampicillin, chloramphenicol, and cotrimoxazole. Some even reach the Extensively Drug-Resistant (XDR) category, showing resistance to fluoroquinolone and third-generation cephalosporin antibiotics [12]. These findings highlight the highly complex and potent resistance capabilities of Salmonella Typhi against various antibacterial agents.…”

“…Globally, Salmonella Typhi has shown resistance to Ampicillin, Chloramphenicol, Trimethoprimsulfamethoxazole, Nalixylic Acid, Ciprofloxacin, Ceftriaxone, and Azithromycin [11]. This bacterium has even shown multi-drug resistance (MDR) in South Asian countries, namely India, Pakistan, and Bangladesh [12].…”