Antimicrobial Sensitivity Patterns of Enteric Fever in Pakistan: A Comparison of Years 2009 and 2019

Abstract

Background

Pakistan is one of the endemic regions for typhoid fever and paratyphoid fever. This study aimed to identify the evolving antimicrobial sensitivity patterns of Salmonella species causing enteric fever and its implications on the clinical prescribing of antimicrobials.

Methods

This was a retrospective descriptive study conducted at a university hospital. Antimicrobial resistance was defined in terms of non-resistant, multidrug resistant (MDR) and extended drug resistant (XDR) as per WHO guidance. Data were collected from the years 2009 and 2019. Chi squared was applied to test for statistical significance (p < 0.05).

Results

A total of 200 patients (100 from 2009 and 100 from 2019) were included in the study. Non-resistant enteric fever cases reduced from 100% in 2009 to 44% in 2019, whereas the MDR and XDR enteric fever cases increased to 16% and 40%, respectively (p < 0.05). Cross tabulation carried out for individual drugs showed an independent rise in the sensitivities of individual first-line antimicrobials.

Conclusion

Antimicrobial resistant enteric fever has become a big challenge for Pakistan. The choice of antibiotic prescription has narrowed down to broader spectrum antimicrobials making it difficult to treat, leading to increased morbidity and mortality.

Keywords

antimicrobial resistance enteric fever extended drug-resistant enteric fever MDR multidrug-resistant enteric fever XDR

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References

Typhoid. World Health Organization. https://www.who.int/immunization/diseases/typhoid/en/ (accessed 04/10/20).

Radhakrishnan

, Als

, Mintz

. Introductory article on global burden and epidemiology of typhoid fever. Am J Trop Med Hyg 2018; 99: 4–9.

Patil

, Mule

. Sensitivity pattern of Salmonella typhi and Paratyphi A isolates to chloramphenicol and other anti-typhoid drugs: an in vitro study. Infect Drug Resist 2019; 12:3217.

About Antibiotic Resistance. Centers for Disease Control and Prevention. https://www.cdc.gov/drugresistance/about.html (accessed 04/10/20).

Britto

, Wong

, Dougan

. A systematic review of antimicrobial resistance in Salmonella enterica serovar Typhi, the etiological agent of typhoid. PLoS Negl Trop Dis 2018; 12: e0006779.

Patel

, Bharti

, Nath

. Drug resistance pattern in the recent isolates of Salmonella typhi with special reference to cephalosporins and azithromycin in the Gangetic plain. J Clin Diagn Res 2017; 11: DM01.

Parry

, Ribeiro

, Walia

. Multidrug resistant enteric fever in South Asia: unmet medical needs and opportunities. BMJ 2019; 364: k5322.

Qamar

, Yousafzai

, Sultana

. A retrospective study of laboratory-based enteric fever surveillance, Pakistan, 2012–2014. J Infect Dis 2018; 218: S201–5.

Balaji

, Kapil

, Shastri

. Longitudinal typhoid fever trends in India from 2000 to 2015. Am J Trop Med Hyg 2018; 99: 34–40.

10.

Klemm

, Shakoor

, Page

. Emergence of an extensively drug-resistant Salmonella enterica serovar Typhi clone harboring a promiscuous plasmid encoding resistance to fluoroquinolones and third generation cephalosporins. mBio 2018;9.

11.

Zaki

, Karande

. Multidrug-resistant typhoid fever: a review. J Infect Dev Ctries 2011; 5: 324–37.

12.

Bhatia

, Mathur

, Arora

. Re-emergence of chloramphenicol sensitivity in enteric fever. Med J Armed Forces India 2007; 63: 212–4.

13.

Wain

, Kidgell

. The emergence of multidrug resistance to antimicrobial agents for the treatment of typhoid fever. Trans R Soc Trop Med Hyg 2004; 98: 423–30.

14.

Kabra

, Madhulika, Talati

. Multidrug-resistant typhoid fever. Trop Doct 2000; 30: 195–7.

15.

Laghari

, Hussain

. Antimicrobial susceptibility patterns of Salmonella species in Southern Pakistan. Cureus 2019;11.

16.

Shrestha

, Pant

, Bhandari

. Re-emergence of the susceptibility of the Salmonella spp. isolated from blood samples to conventional first line antibiotics. Antimicrob Resist Infect Control 2016; 5:22.