Extended-spectrum beta-lactamases producing extensively drug-resistant Salmonella Typhi in Punjab, Pakistan

Abstract

Introduction: The multidrug-resistant (MDR) Salmonella enterica serovar Typhi isolates have been increasingly reported from the Asian and African countries. The emergence of isolates with decreased susceptibility to fluoroquinolones and cephalosporins has worsened the situation. Recently, an outbreak from Sindh, Pakistan was reported caused by extensively drug-resistant (XDR) S. Typhi strains.
 Methodology: In the present study, a total of 82 cases of typhoid have been investigated during 2018 from the febrile children referred to a tertiary care hospital in the population-wise largest province (Punjab) of Pakistan. S. Typhi was identified by standard microbiological techniques and isolates were characterized for antimicrobial resistance profiling and minimum inhibitory concentrations were determined. The presence of various ESBL genes in S. Typhi was confirmed by the PCR.
 Results: Out of the 82 isolates tested, 35 (43%) were found to be XDR; resistant to the first-line drugs. The resistance to third-generation cephalosporins was mainly mediated by extended-spectrum beta-lactamases i.e. blaTEM and blaCTX-M genes.
 Conclusions: The higher prevalence of ESBL producing Salmonella typhi clinical strains raises the concern about transmission prevention and infection management in the community as well as clinical settings. Moreover, the study highlights the problem concerning the declining antibiotic arsenal for the therapeutic management of typhoid fever and the emergence and spread of XDR strains in Pakistan.

Extended-spectrum beta-lactamases encoding genes among <i>salmonella enterica</i> serovar typhi Isolates in patients with typhoid fever from four Academic Medical Centers in Lagos, Nigeria

“…The emergence of MDR and extensively drug-resistant Salmonella strains is a critical health issue that suggests that treatment of typhoid fever may become economically and practically challenging in the near future, especially in developing countries 7 . One of the causes of this high level of resistance is the transfer of antibiotic resistance genes including ESBLs among different species of Gram-negative bacteria, especially Enterobacteriaceae.…”

“…Until the 1970s, effective first-line therapies included betalactams such as ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole. However, the emergence of multidrug-resistant (MDR) isolates has increasingly reduced the efficacy of these drugs 7,8 . In recent years, third-generation cephalosporins have been used in the treatment of typhoid fever, especially in cases when there are no other options available.…”

“…In recent years, third-generation cephalosporins have been used in the treatment of typhoid fever, especially in cases when there are no other options available. Yet, outbreaks of cephalosporin-resistant S. Typhi have also been reported 7,8 .…”

Transcriptional Response of Multidrug-Resistant Klebsiella pneumoniae Clinical Isolates to Ciprofloxacin Stress

“…The mutation in QRDR, i.e., gyrA and parC genes, is a key player responsible for quinolone resistance. Mutation in QRDR causes structural modifications in enzymes such as DNA gyrase/topoisomerase IV, which decreases the quinolone affinity [ 17 , 18 ].…”

Bacteriophage Proteome: Insights and Potentials of an Alternate to Antibiotics

“…The stay of patients suffering from such resistant infections is approximately 13 days, which costs about $29,000/patient treated with such resistant bacterial infections. In this regard, a total annual economic loss (productivity loss) of about $35 billion has been reported [1][2][3][4]. The global nature of this issue emphasizes the need to control the antibiotic resistance crisis [1,5].…”