Extended drug resistance in children with typhoid fever.

Abstract

In developing countries, typhoid fever is mostly seen due to poor public health and low socioeconomic indices. Currently Pakistan is going through the largest outbreak of XDR typhoid fever which has resulted in increased morbidity and mortality especially in pediatric population. Objectives: To see the pattern of extended drug resistant typhoid fever in different areas of Karachi. Study Design: Cross sectional study. Setting: Department of pediatrics, Ziauddin Hospital (KDLB, NORTH, CLIFTON campus). Period: 6 months from October 2018 till March 2019. Material & Methods: All patients who presented with history of fever for 3 or more days with signs and symptoms of typhoid fever were recruited. For data collection a self-structured questionnaire was used. Age, gender, socioeconomic status, personal hygiene, water supply and sanitation were taken into account. Blood samples were sent for cultures. Salmonella isolates were tested for antibiotic susceptibility. Tested antimicrobials were ampicillin, TMP/SMX, cefixime, ceftriaxone, aztreonam, ciprofloxacin, azithromycin, meropenem. For data analysis SPSS version 22 was used. Results: Out of 415 patients, 235 had culture proven typhoid fever. Salmonella typhi was isolated in 94.4%of the patients and salmonella paratyphi was isolated in 5.57%. Of the 235, Males were 62% and females were 42.4%. Major determinants associated with acquiring salmonella infection were young age (74%), male sex (62%), middle and low socioeconomic status (83.8%), living in west district of Karachi (54.9%) and drinking line water (79.2%). Extended drug resistance was encountered in 69.5%. Most of the isolates were sensitive to meropenem and azithromycin (96.7 %, and 95.5% respectively). Ceftriaxone resistance was prevelant in all three districts of Karachi (p value <0.001), in different age groups 1-6yrs (98%), 7-12 yrs(91%), 13-18 yrs (100%) and in males(58%) predominantly. Conclusion: Karachi is facing an outbreak of XDR typhoid fever. Risk of acquiring extended drug resistant typhoid fever is increased in younger age group 1-6 yrs, males, west district of Karachi and poor socioeconomic status. Drinking unboiled water is identified as one of the major culprits. Actions should be taken at all health care levels to monitor the judicious use of antibiotics, and preventive strategies like safe water supply, improved sanitation along with typhoid vaccination are suggested to overcome this outbreak.

Treatment of 21st-Century typhoid fever in children; open-label mono versus combination drug therapy: A multicenter randomized control study.

“…6.4% as compared to other studies. Similarly, Blumentrath et al in 2019 16 reported a case that was treated with meropenem and questioned its efficacy and reported other similar studies with inadequate response to meropenem monotherapy [30][31][32][33] . However, Tayyaba et al in 2020, reported 96.7 %, and 95.5% treatment response to meropenem and azithromycin respectively 32 , and a similar response was found by Qureshi et al 24 for XDR typhoid.…”

“…Similarly, Blumentrath et al in 2019 16 reported a case that was treated with meropenem and questioned its efficacy and reported other similar studies with inadequate response to meropenem monotherapy [30][31][32][33] . However, Tayyaba et al in 2020, reported 96.7 %, and 95.5% treatment response to meropenem and azithromycin respectively 32 , and a similar response was found by Qureshi et al 24 for XDR typhoid. Many models were proposed by the researchers to explain the lower efficacy of meropenum in multidrug strains including lower intracellular penetration of drug, short half-life which helps bacteria evolve tolerance or persistence of dormant bacteria in the body tissues.…”

A review of clinical profile, complications and antibiotic susceptibility pattern of extensively drug-resistant (XDR) Salmonella Typhi isolates in children in Karachi.

“…In our study, the most successful single drug was Azithromycin, which cured 78 cases (82%) followed by Meropenem, which cured 15 cases (16%). Tayyaba et al studied antibiotic susceptibility of XDR Enteric in Karachi and found equal susceptibility of XDR strains to both Azithromycin (95%) and Meropenem (97%) (23). Other studies also reported equal cure rates with both the drugs (24,25).…”

A review of clinical profile, complications and antibiotic susceptibility pattern of extensively drug-resistant (XDR) Salmonella Typhi isolates in children in Karachi

“…In our study, 76 (29%) children recovered on a combination of meropenem and azithromycin, 72 (27%) got cured on azithromycin alone, while 15 (6%) responded to meropenem alone. Tayyaba et al studied antibiotic susceptibility of XDR S.Typhi in Karachi and found equal susceptibility of XDR S.Typhi strains to both azithromycin (95%) and meropenem (97%) [22]. other studies also reported equal cure rates with both the drugs [23,24].…”

“…Tayyaba et al studied antibiotic susceptibility of XDR S.Typhi in Karachi and found equal susceptibility of XDR S.Typhi strains to both azithromycin (95%) and meropenem (97%) [ 22 ]. other studies also reported equal cure rates with both the drugs [ 23 , 24 ].…”