Pattern of Anti-microbial Drug Resistance in Childhood Typhoid Fever in a Selected Hospital in Karachi, Pakistan

Abstract

Introduction: Typhoid fever is a major public health issue in Pakistan. Variations in clinical manifestations make diagnosis a challenging task. Over use of antibiotics make the organism resistant. Antibiotic resistance is currently the most threatening issue as regards to infection control and our study would be helpful in the understanding of this feature of the microbes. The main purpose of this study was to determine the antimicrobial drug resistance and sensitivity pattern in Salmonella typhi and S. paratyphi.
 Methods: This is a descriptive study carried out in a private hospital in Karachi, Pakistan. One hundred consecutive patients, children from age one day till 12 years admitted in the hospital with the history of fever and had positive blood culture for Salmonella typhi and S.paratyphi were included, 9 antimicrobial drugs were taken into account to check their sensitivity. Statistical analysis was performed using SPSS (IBM SPSS Statistics 20.0). Data was expressed in frequencies and percentages.
 Results: Most of the children belong to middle class 58% with 62% male and common age group (40%) was 1 day to 4 years. Nearly half of them drinking un-boiled water and had ladder pattern of high grade fever. Most pronounced symptoms were abdominal pain, nausea and anorexia. Resistance pattern was ciprofloxacin 100%, chloramphenicol 89.1%, Ampicillin 87.1% Ceftriaxone 76.2%, Cefixime 75.2%, Amoxicillin 65.3%.
 Conclusion: Typhoid fever is most commonly observed with unhygienic practices, eating of unhealthy outside food and contaminated water. Pattern of anti microbial resistance gives us a little choice to select antibiotic for typhoid fever. Typhoid fever still remains the commonest bacteraemic illness in Pakistan with children being especially susceptible. Antimicrobial non-susceptibility continues to complicate management.

NTDs in the age of urbanization, climate change, and conflict: Karachi, Pakistan as a case study

“…A 2019 study conducted at a private hospital in Karachi found that over two-thirds of patients with a positive blood culture for S. typhi and S. paratyphi yielded multidrug resistant (MDR) isolates [65]. This study confirms previous findings of a high degree of MDR S. typhi and S. paratyphi in Karachi, particularly among children in urban squatter settlements [46,65,66,68].…”

“…Furthermore, antimicrobial drug resistance remains one of the most critical public health challenges faced by Pakistan, resulting in increasingly severe infections and complications, longer hospital stays, and increased mortality rates [67]. In Karachi, the development of antimicrobial drug resistance in Salmonella typhi and Salmonella paratyphi has presented major obstacles in terms of effectively treating typhoid patients, as local physicians often have very limited options for typhoid drug prescription [65,66]. A 2019 study conducted at a private hospital in Karachi found that over two-thirds of patients with a positive blood culture for S. typhi and S. paratyphi yielded multidrug resistant (MDR) isolates [65].…”

“…In Karachi, the development of antimicrobial drug resistance in Salmonella typhi and Salmonella paratyphi has presented major obstacles in terms of effectively treating typhoid patients, as local physicians often have very limited options for typhoid drug prescription [65,66]. A 2019 study conducted at a private hospital in Karachi found that over two-thirds of patients with a positive blood culture for S. typhi and S. paratyphi yielded multidrug resistant (MDR) isolates [65]. This study confirms previous findings of a high degree of MDR S. typhi and S. paratyphi in Karachi, particularly among children in urban squatter settlements [46,65,66,68].…”

“…Typhoid and paratyphoid fevers are some of the most studied NTDs present in Karachi, with some studies linking the emergence of these conditions to consumption of contaminated street food and water supplies, both of which are common practices throughout the city [ 46 , 65 , 66 ]. Low-income communities in Karachi typically lack access to piped water supplies, and these same communities often face the issue of improper drainage of sewage [ 46 ].…”

“…typhi and S . paratyphi yielded multidrug resistant (MDR) isolates [ 65 ]. This study confirms previous findings of a high degree of MDR S .…”