Prevalence of Salmonella enterica serovar Typhi infection, its associated factors and antimicrobial susceptibility patterns among febrile patients at Adare general hospital, Hawassa, southern Ethiopia

Abstract

Background Salmonellas enterica serovar Typhi (S.typhi) causes typhoid fever and is a global health problem, especially in developing countries like Ethiopia. But there is a little information about prevalence and factors association with S.typhi and its antimicrobial susceptibility pattern in Ethiopia especially in the study area. The aim of this study was to determine the prevalence of S.typhi infection, its associated factors and antimicrobial susceptibility pattern among patient with a febrile illness at Adare General Hospital, Hawassa, Southern Ethiopia. Methods Hospital based cross sectional study was conducted among 422 febrile patients from May 23, 2018 to October 20, 2018. A 5 ml venous blood was collected from each febrile patient. Culture and biochemical test were performed for each isolate. Antimicrobial susceptibility testing was performed for each isolate using modified Kirby-Bauer disk diffusion techniques. Result In this study, the prevalence of S.typhi among febrile illness patients at Adare General Hospital was 1.6% [95% confidence interval (CI): 0.5–2.9]. The age of the study subjects were ranged from 15 to 65 years (mean age 32 years). It was observed that participants who came from rural area had 8 times (AOR 8.27: 95% CI: 1.33, 51.55) more likely to had S. typhi infection when compared with urban dwellers. The microbial susceptibility testing revealed that all six of S.typhi isolates showed sensitive to Ceftriaxone and all 6 isolates showed resistant to nalidixic acid and Cefotaxime and 5(83.3%) susceptible to Chloramphenicol and Ciprofloxaciline. Multidrug resistance (resistance to three or more antibiotics) was observed among most of the isolates. Conclusion S. typhi bacteraemia is an uncommon but important cause of febrile illness in our study population. Ceftriaxone therapy is a suitable empirical antibiotic for those that are unwell and suspected of having this illness. Further surveillance is required to monitor possible hanging antibiotic resistant patterns in Ethiopia.

Prevalence and antimicrobial susceptibility level of typhoid fever in Ethiopia: A systematic review and meta-analysis

“…The sample size of the studies ranged from 95 in Southern Nations Nationalities of People’s Region (SNNPR) ( Ameya et al, 2017 ) to 4,872 in the capital city, Addis Ababa ( Weyessa, 2014 ). From the total of 15 articles, only 6 (40%) reported the prevalence of typhoid fever and the AMR level ( Habte et al, 2018 , Garedew et al, 2018 , Awol et al, 2021 , Zerfu et al, 2018 , Amsalu et al, 2021 , Ameya et al, 2017 , Weyessa, 2014 , Amsalu et al, 2021 , Teshome et al, 2019 , Feleke et al, 2015 , Tadesse and Tadesse, 2013 , Wlekidan et al, 2015 , Deksissa and Gebremedhin, 2019 , Andualem et al, 2014 , Birhanie et al, 2014 , Admassu et al, 2019 ). A total of 9,370 study participants were included.…”

“…Majority, (n = 7985/9,370; 85.22; ( Awol et al, 2021 , Zerfu et al, 2018 , Amsalu et al, 2021 , Weyessa, 2014 , Feleke et al, 2015 , Tadesse and Tadesse, 2013 , Wlekidan et al, 2015 , Deksissa and Gebremedhin, 2019 , Birhanie et al, 2014 , Admassu et al, 2019 ) participants were febrile patients and (1385/9,370, 14.78; ( Habte et al, 2018 , Garedew et al, 2018 , Ameya et al, 2017 , Andualem et al, 2014 ) were typhoid suspected cases. Most of the studies (n = 11/15; 73.3%) involved suspected typhoid patients who had some or all of the following symptoms (history of fever for ≥ 2 days, body temperature greater than 37.5 °C, abdominal pain, headache, constipation or diarrhea, fatigue, headache, joint, and back pain) ( Habte et al, 2018 , Awol et al, 2021 , Zerfu et al, 2018 , Amsalu et al, 2021 , Ameya et al, 2017 , Feleke et al, 2015 , Tadesse and Tadesse, 2013 , Wlekidan et al, 2015 , Deksissa and Gebremedhin, 2019 , Andualem et al, 2014 , Birhanie et al, 2014 ). Some of the studies (4/15) also considered taking antibiotic treatment for the last two weeks in average as inclusion) and exclusion criteria ( Ameya et al, 2017 , Wlekidan et al, 2015 , Deksissa and Gebremedhin, 2019 , Birhanie et al, 2014 ).…”

“…Eleven studies used culture technique for the diagnosis of typhoid fever: 6 used stool culture ( Garedew et al, 2018 , Amsalu et al, 2021 , Ameya et al, 2017 , Teshome et al, 2019 , Deksissa and Gebremedhin, 2019 , Admassu et al, 2019 ) and 5 used blood culture to identify salmonella S. Typhi ( Habte et al, 2018 , Garedew et al, 2018 , Awol et al, 2021 , Wlekidan et al, 2015 , Andualem et al, 2014 , Birhanie et al, 2014 ). Among the included studies, 10 of them used Widal test as a diagnostic method ( Garedew et al, 2018 , Zerfu et al, 2018 , Amsalu et al, 2021 , Ameya et al, 2017 , Weyessa, 2014 , Feleke et al, 2015 , Wlekidan et al, 2015 , Deksissa and Gebremedhin, 2019 , Andualem et al, 2014 , Birhanie et al, 2014 ).…”

“…Among a 288 collected blood samples, nearly half were positive in Widal test, and only 1 (0.7%) yielded Salmonella isolates during blood culture ( Garedew et al, 2018 ). In addition, a study conducted among febrile patients in Southern Ethiopia estimated the prevalence of typhoid fever through the detection of the pathogen using blood culture to be 1.6% ( Awol et al, 2021 ).…”

Environmental surveillance for Salmonella Typhi as a tool to estimate the incidence of typhoid fever in low-income populations

“…Typhoid is especially prevalent in urban, low socio-economic settings where overcrowding and unhygienic living conditions are common [4,5]. Incidence is typically lower in rural areas, although recent findings in rural or peri-urban sites describe a higher burden than previously appreciated [6,7]. Whilst increasing access to safe drinking water, improved sanitation and antibiotics have helped reduce the incidence of typhoid fever, its persistence in low-income countries and the emergence of antibiotic resistance, including extensively resistant (XDR) strains, are a major concern [8,9].…”