Emerging Trends of Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) Salmonella Typhi in a Tertiary Care Hospital of Lahore, Pakistan.
Muhammad ZakirMaryam KhanMuhammad Ihtisham UmarGhulam MurtazaMuhammad AshrafSaba ShamimPublished in: Microorganisms (2021)
Salmonella Typhi is a Gram-negative pathogen that causes typhoid fever in humans. The use of antibiotics to treat typhoid has considerably mitigated its fatality risk, but rising multidrug-resistant (MDR) and extensively drug-resistant (XDR) resistance in Pakistan threatens effective treatment. This study determined the prevalence of MDR and XDR S . Typhi at a local hospital in Lahore. Blood samples ( n = 3000) were obtained and processed for bacterial identification. Antibiotic susceptibility test was performed using VITEK ® 2 Compound 30 System. Statistical data analysis was performed using a Mann-Whitney U and Kruskal-Wallis H test, respectively. The results revealed 600 positive cultures, of which the majority were found to be XDR S . Typhi (46.1%) and MDR S . Typhi (24.5%) strains. The disease burden of resistant Salmonella strains was greater in males (60.67%) than females (39.33%), with the most affected age group being 0-10 years old (70.4 %). In both the outpatient department (OPD) and general ward, the prevalence of XDR S . Typhi cases was found to be alarmingly high (48.24%), followed by MDR S . Typhi (25.04 %). The results of the statistical analysis demonstrated that the incidence of resistance in MDR and XDR S . Typhi strains was not affected by the age as well as the gender of patients ( p > 0.05). The occurrence of resistant strains against four tested antibiotics (azithromycin, ciprofloxacin, imipenem, and meropenem) was found to be similar in different wards and among hospitalized and OPD patients ( p > 0.05). Maximum resistance was observed against chloramphenicol and ampicillin in the OPD and pediatric ward. Piperacillin/Tazobactam was observed to be the most effective antibiotic, followed by co-amoxiclav ( p < 0.001). This study is effective in validating the existence of MDR and XDR S . Typhi in Lahore, where stringent methods should be applied for controlling its spread.
Keyphrases
- multidrug resistant
- drug resistant
- gram negative
- acinetobacter baumannii
- escherichia coli
- klebsiella pneumoniae
- end stage renal disease
- risk factors
- data analysis
- ejection fraction
- newly diagnosed
- chronic kidney disease
- tertiary care
- prognostic factors
- patient reported outcomes
- risk assessment
- pseudomonas aeruginosa
- single cell
- emergency department
- cystic fibrosis
- adverse drug
- patient reported
- replacement therapy
- smoking cessation
- combination therapy