Typhoidal Salmonella strains in Pakistan: an impending threat of extensively drug-resistant Salmonella Typhi

Hussain, Ashfaq; Satti, Luqman; Hanif, Faisal; Zehra, Nadia Midhat; Nadeem, Saman; Bangash, Tariq Mehmood; Peter, Aqeel

doi:10.1007/s10096-019-03658-0

Cited by 40 publications

(30 citation statements)

References 19 publications

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“…Typhi, only azithromycin is administered orally but the present danger is that mass administration of azithromycin for typhoid in addition to prophylactic use in COVID-19 management may accelerate the emergence and spread of azithromycin resistant XDR S. Typhi strains [ 34 ]. Resistance has already been reported in typhoidal Salmonella , conferred by single nucleotide changes in the acrB efflux system, from Bangladesh [ 35 ] and Pakistan [ 36 ], and the macrolide resistance genes mphA , mphB, and mefB have been reported as conferring resistance in non-typhoidal Salmonella [ 37 ]. It is likely only a matter of time before one of these mechanisms emerges in the XDR background, rendering carbapenems the only, more expensive, treatment option.…”

Section: Discussionmentioning

confidence: 99%

Emergence of Resistance to Fluoroquinolones and Third-Generation Cephalosporins in Salmonella Typhi in Lahore, Pakistan

et al. 2020

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Extensively drug-resistant (XDR) Salmonella Typhi has been reported in Sindh province of Pakistan since 2016. The potential for further spread is of serious concern as remaining treatment options are severely limited. We report the phenotypic and genotypic characterization of 27 XDR S. Typhi isolated from patients attending Jinnah Hospital, Lahore, Pakistan. Isolates were identified by biochemical profiling; antimicrobial susceptibility was determined by a modified Kirby–Bauer method. These findings were confirmed using Illumina whole genome nucleotide sequence data. All sequences were compared to the outbreak strain from Southern Pakistan and typed using the S. Typhi genotyping scheme. All isolates were confirmed by a sequence analysis to harbor an IncY plasmid and the CTX-M-15 ceftriaxone resistance determinant. All isolates were of the same genotypic background as the outbreak strain from Sindh province. We report the first emergence of XDR S. Typhi in Punjab province of Pakistan confirmed by whole genome sequencing.

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Section: Discussionmentioning

confidence: 99%

Emergence of Resistance to Fluoroquinolones and Third-Generation Cephalosporins in Salmonella Typhi in Lahore, Pakistan

et al. 2020

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“…All were sensitive to Azithromycin and Meropenam. 9 A similar study was conducted at Sheikh Zayed Hospital Lahore, which showed 43.4% XDR cases. 10 Another study at Shifa International Hospital from Jan 2015-Dec 2018 revealed 30 cases (4%) of XDR Salmonella out of 832 Salmonella typhi cases.…”

Section: Discussionmentioning

confidence: 75%

Extensively Drug-Resistant Salmonella typhi XDR Infection at Rawalpindi Medical University and Allied Hospitals

Izhar¹,

Ahmed²,

Rehan³

et al. 2020

JRMC

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Objective: To evaluate the prevalence of extensively drug-resistant Salmonella typhi (XDR) in RMU Allied Hospitals. Study Design: A descriptive cross-sectional study. Material and Methods: It is a cross-sectional, prospective study conducted at RMU Allied Hospitals from January 2019–December 2019. Blood culture samples were received in the pathology lab, they were collected by simple random sampling and processed by conventional incubation. Antibiotic susceptibility of the isolates was done on Muller Hinton agar using modified Kirby Bauer disk diffusion method and antibiotic zone diameters were measured according to CLSI guidelines. Results: Out of the total 8045 cultures, 911 (11%) showed growth, among which 179 (20%) were Salmonella typhi and 135 (15%) XDR Salmonella. Meropenem revealed the highest sensitivity, Chloramphenicol, and Augmentin revealed the highest resistance. Conclusion: Blood culture results revealed Salmonella typhi 20% with a significant number of XDR Salmonella 15%. Antibiotics susceptibility pattern exhibits Meropenem and Azithromycin as the only antibiotics for XDR Salmonella. Salmonella typhi infection has a significantly high prevalence among children as compared to adults. (p=0.0017) Injudicious use of antibiotics is one of the important aspects of the occurrence of antibiotic-resistant Salmonella.

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“…Another study in Pakistan reported that the frequency of MDR Salmonella typhi was 76% and Salmonella paratyphi was 34%. The frequency of XDR Salmonella typhi was 48% [19].…”

Section: Discussionmentioning

confidence: 96%

Trends of Antimicrobial Resistance in Typhoidal Strains of Salmonella in a Tertiary Care Hospital in Pakistan

Aslam¹,

Kharal

Aslam³

et al. 2021

Cureus

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Introduction: Enteric fever or typhoid fever is a major public health issue affecting greater than 27 million individuals globally and is responsible for greater than 200,000 deaths per year. Due to the extensive overuse of antimicrobials, the world is moving toward a pre-antibiotic era. The emergence and transmission of antibiotic-resistant Salmonella species are a global threat and a serious concern in developing countries such as Pakistan. This study aimed to determine the trends in antimicrobial resistance (AMR) of typhoidal strains of Salmonella in a tertiary care hospital in Pakistan. Materials and Methods: It was a descriptive, cross-sectional study conducted in the pathology department of Sharif City Hospital, Lahore, after approval by the ethical committee of the institution. A total of 50 blood culture specimens positive for Salmonella typhi and Salmonella paratyphi from January 2019 to March 2020 were included by the non-probability consecutive sampling technique. The samples were processed by conventional bacteriological methods for isolation and identification. The antimicrobial susceptibility testing was done by the Kirby-Bauer disc diffusion method as recommended by the Clinical and Laboratory Standard Institute (CLSI). The statistical package for social sciences (SPSS, IBM Corp., Armonk, NY) version 25 was used for data entry and analysis. Results: Among the first-line drugs (ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole), 70% of strains were resistant, and only 30% strains were sensitive to them. Among the cephalosporins, 52% strains were sensitive to ceftriaxone, and 48% strains were sensitive to ceftazidime, cefotaxime, and cefepime. Twenty-four percent of strains were sensitive to ciprofloxacin. Only 50% of strains were sensitive to ampicillin-sulbactam, and 92% of strains were sensitive to piperacillin-tazobactam. All the strains were 100% sensitive to imipenem and meropenem; 96% of strains were sensitive to co-amoxiclav, doxycycline, and azithromycin. The frequency of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Salmonella species was 16% and 54%. Conclusion: The increasing frequency of MDR and XDR Salmonella species in Pakistan is a major concern. A significant percentage of the typhoidal strains of Salmonella is resistant to the first-line (16%) and second-line (54%) antibiotics. Carbapenems and azithromycin are the last resort of therapy in such cases.

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Typhoidal Salmonella strains in Pakistan: an impending threat of extensively drug-resistant Salmonella Typhi

Cited by 40 publications

References 19 publications

Emergence of Resistance to Fluoroquinolones and Third-Generation Cephalosporins in Salmonella Typhi in Lahore, Pakistan

Emergence of Resistance to Fluoroquinolones and Third-Generation Cephalosporins in Salmonella Typhi in Lahore, Pakistan

Extensively Drug-Resistant Salmonella typhi XDR Infection at Rawalpindi Medical University and Allied Hospitals

Trends of Antimicrobial Resistance in Typhoidal Strains of Salmonella in a Tertiary Care Hospital in Pakistan

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