Antimicrobial Susceptibility Patterns of Salmonella typhi and paratyphi in tertiary care hospital of Sialkot

Abstract

Objective

Typhoid fever is one of the major infectious diseases among the children and adolescent population of Pakistan. The strains with  multidrug-resistant (MDR) and extended drug-resistant (XDR) typhoid are emerging in different areas of Pakistan. Antimicrobial therapy is really becoming challenging and research is needed to have proper surveillance of culture and sensitivity pattern of salmonella in this part of the world. This study was conducted to evaluate the antibiotic susceptibility pattern of Salmonella  typhi and paratyphi in a tertiary care hospital, Sialkot.

Materials and methods

This was retrospective study conducted at the Department of Pediatrics, Allama Iqbal memorial teaching hospital, Sialkot. All the blood cultures positive for salmonella typhi and salmonella paratyphi  from June 2020 to November 2022 were included in the study.

Results

Blood cultures of 500 patients with suspected enteric fever were taken and those who were positive for salmonella were included in the study. There were 62 (12.4%) results which were positive for of S. typhi and S. paratyphi. The sensitivity pattern to different antibiotics was determined and antibiogram was formulated. The Sensitivity to carbapenems was 96.7%, azithromycin was 95.2%, Cotrimoxazole was 77.4%, penicillins & third generation cephalosporins was 75.8% and to ciprofloxacin was only 16.1%. The proportion of MDR and XDR cases were 15 (24%) each.

Conclusion

We found that Cotrimoxazole has best culture and sensitivity pattern among the first line drugs recommended for the enteric fever. A significant proportion of cases are sensitive to penicillins and third generation cephalosporins, both of these group of antibiotics have similar suscepitibility pattern. Azithromycin and carbapenems has highest suscepitibility but ciprofloxacin is least suscepitible. So there is place for first and second line antibiotics in uncomplicated enteric fever and azithromycin can be used in case of failure to respond to these drugs. Carbapenems should be used in complicated enteric fever only and should be preserved to avoid resistance to it. The emergence of carbapenems and azithromycin resistance is alarming.