The Menace Of Drug Resistant Salmonella Typhi In Children: Experience From A Tertiary Care Hospital in Pakistan

Abstract

Abstract:

Objective:

Typhoid fever caused by Salmonella Typhi is still a major health concern in developing world. Recent surge of drug resistant strains have raised alarms of public health officials. The objective of this study is to evaluate the current trends in the resistance pattern of Salmonella Typhi in a tertiary care hospital in Lahore.

Place and Duration Of Study:

This cross sectional study was conducted in the Department of Pediatrics, Combined Military Hospital Lahore Pakistan from August 2017 to August 2019.

Methods:

We investigated 424 children between 1 to 4 year of age presenting with high grade fever and Salmonella Typhi isolate from blood cultures. The antimicrobial sensitivity was determined using Kirby-Bauer disc diffusion method as per Clinical and Laboratory Standards Institute Guidelines. Demographic data and antibiogram profile was recorded along with clinical presentation and response to treatment.

Results:

Out of the 424 children 55.2% (n=234) isolates of Salmonella Typhi were found to be extensively Drug resistant (XDR) while 34.7% (n=147) were resistant only to first line antibiotics(MDR). All XDR cases were sensitive to  azithromycin and meropenem. Out of 234 XDR cases 146 children (62.3%) responded well to oral azithromycin only and in 88 children (37.6%) meropenem was added in addition to azithromycin.

Conclusion:

The alarmingly high prevalence of XDR typhoid and its increased propensity to cause systemic complications is a key concern for morbidity, mortality in children as well as financial burden on health services. We recommend restricting use of azithromycin and meropenem in culture proven cases of XDR typhoid.

Keywords: XDR, typhoid fever, MDR, Pakistan.