Trends of Etiology and Drug Resistance in Enteric Fever in the Last Two Decades in Nepal: A Systematic Review and Meta-analysis

Abstract

Prospective time-trend analyses on shifting etiology and trends of drug resistance in enteric fever are scarce. Using published and unpublished datasets from Nepal, we performed a systematic review and meta-analysis to understand the trends in etiology and resistance to antimicrobials that have occurred since 1993. Thirty-two studies involving 21 067 Salmonella enterica serotype Typhi (ST) and S. enterica serotype Paratyphi A (SPA) isolates were included. There was an increasing trend in enteric fever caused by SPA during the last 2 decades (P < .01). We observed sharply increasing trends in resistance to nalidixic acid and ciprofloxacin for both ST and SPA. In contrast, multi-drug resistance (MDR), resistance to traditional first-line antibiotics such as chloramphenicol and co-trimoxazole have significantly decreased for both organisms. The resistance to ceftriaxone has remained low, suggesting it is likely to remain useful as a reserve antibiotic for treatment. Trends in decreasing resistance to traditional first-line antibiotics and decreasing MDR provide an opportunity to reconsider these first-line antimicrobials as therapeutic options.

Detection Of Mutated gyrA Gene From Nalidixic Acid Resistant Salmonella Typhi And Paratyphi A Isolated From Enteric Fever Patients In A Tertiary Care Hospital Of Bangladesh

“…In addition, 18.18% Salmonella typhi were resistant to ciprofloxacin which is similar to published data from India 3 and Nepal 16 . In contrast, 34.5% ciprofloxacin resistant strains were reported from New Delhi 17 .…”

Antimicrobial resistance trend of Salmonella typhi and paratyphi from 2011-2013: A descriptive study from tertiary care hospital of Nepal

“…This shows that MDR strains are decreasing. This fi nding is consistent with decreasing trend of MDR strains in Nepal 11 . Decrease in MDR may again be attributed to decrease in use of traditional fi rst line drugs.…”

“…A signifi cant decrease in resistance to chloramphenicol and cotrimoxazole has also been reported from Nepal 11,16,18 . Decrease in resistance may again make these antibiotics useful in near future.…”

“…Due to the multidrug resistance fl uoroquinolones such as ciprofl oxacin became the drug of choice for treating enteric fever 9,10 . Several publications have appeared in last decade documenting decreased susceptibility to fl uoroquinolones 11 . Understanding of the drug resistance trend helps in choosing the optimal empirical treatment.…”

Isolation and Characterization of Salmonella Enterica Serovar Typhimurium Circulating Among Healthy Chickens of Bangladesh

“…It is the matter of concern that, we observed high level of resistance (About 87%) toward ampicillin, which is alarming for Bangladesh because of first choice of drug for treatment of systemic salmonellosis in humans until 1980s (Karki et al, 2013). Zou et al (2012) reported that only 2.35% of the Salmonella isolated from North Carolina, USA were resistant to ampicillin and Fernandez et al (2003) reported 13.6% isolates from Sao Paulo State of Brazil to be resistant to the same antibiotic.…”