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

Abstract

Salmonella Typhi is a Gram-negative pathogen that causes typhoid fever in humans. The use of antibiotics to treat typhoid has considerably mitigated its fatality risk, but rising multidrug-resistant (MDR) and extensively drug-resistant (XDR) resistance in Pakistan threatens effective treatment. This study determined the prevalence of MDR and XDR S. Typhi at a local hospital in Lahore. Blood samples (n = 3000) were obtained and processed for bacterial identification. Antibiotic susceptibility test was performed using VITEK® 2 Compound 30 System. Statistical data analysis was performed using a Mann–Whitney U and Kruskal–Wallis H test, respectively. The results revealed 600 positive cultures, of which the majority were found to be XDR S. Typhi (46.1%) and MDR S. Typhi (24.5%) strains. The disease burden of resistant Salmonella strains was greater in males (60.67%) than females (39.33%), with the most affected age group being 0–10 years old (70.4 %). In both the outpatient department (OPD) and general ward, the prevalence of XDR S. Typhi cases was found to be alarmingly high (48.24%), followed by MDR S. Typhi (25.04 %). The results of the statistical analysis demonstrated that the incidence of resistance in MDR and XDR S. Typhi strains was not affected by the age as well as the gender of patients (p > 0.05). The occurrence of resistant strains against four tested antibiotics (azithromycin, ciprofloxacin, imipenem, and meropenem) was found to be similar in different wards and among hospitalized and OPD patients (p > 0.05). Maximum resistance was observed against chloramphenicol and ampicillin in the OPD and pediatric ward. Piperacillin/Tazobactam was observed to be the most effective antibiotic, followed by co-amoxiclav (p < 0.001). This study is effective in validating the existence of MDR and XDR S. Typhi in Lahore, where stringent methods should be applied for controlling its spread.

Antibacterial efficacy of indigenous Pakistani honey against extensively drug-resistant clinical isolates of Salmonella enterica serovar Typhi: an alternative option to combat antimicrobial resistance

“…Several studies have documented the spread of MDR and XDR S . Typhi pathogens in Pakistan and other parts of the world with a travel history to Pakistan [ 7 , 13 – 15 , 29 ]. MDR and XDR S .…”

“…Several S . Typhi pathogens are resistant to antibiotics normally recommended for the treatment of typhoid fever, including ampicillin, ceftriaxone, chloramphenicol, ciprofloxacin, and sulfamethoxazole/trimethoprim, and are only sensitive to azithromycin (oral antibiotic) and carbapenems (injectable antibiotic) [ 7 ]. However, even cases of azithromycin resistance have been reported from Bangladesh [ 8 ], Nepal [ 9 ], and India [ 10 ].…”

Molecular Characterization of Extensively Drug Resistant Salmonella Enterica Serovar Typhi Clinical Isolates from Lahore, Pakistan

“…Fearing its misuse in the current COVID-19 pandemic, acquiring a single resistance can change the treatment paradigm of typhoid fever from outpatient to hospitalization of every patient. 22 …”

“…Previous studies on Salmonella from Lahore, Pakistan only focus on epidemiology, antimicrobial susceptibility testing (AST), detection of ESBL and these are usually from single centers with a small number of samples 6 , 22 , 30 , 31 Here we extended our study with collection of samples from all the major tertiary care hospitals in Lahore. In addition to this we used standard broth microdilution method and E-strips for AST and all the 150 XDR S .…”

Prevalence and antimicrobial susceptibility pattern of Salmonella and Shigella in stool among patients presenting with diarrhea in a tertiary care centre in south India

“…Terfassa et al in her study reported that 10% and 33.3% of the isolates of Salmonella and Shigella respectively were multi drug resistant ( 9 ). Another concerning fact was the emergence of XDR (Extensively drug resistant) Salmonella in Pakistan ( 10 ).…”