Antibiotic Resistance Pattern of Salmonella Species in Children in a Tertiary Care Hospital
Objective: To determine the recent antibiotic resistance patterns of Salmonella species in children in a tertiary care hospital.
Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Pediatrics of Akbar Niazi Teaching Hospital, Bhara Kahu, from 18th March 2020 to 31st January 2021. A total of one hundred and seventy-eight (n=178) patients of either gender having age between 1 month to 12 years who had signs and symptoms of enteric fever and positive blood culture report of Salmonella species were enrolled in this study through non-probability, consecutive sampling. The demographic characteristics of patients along with the antibiotic sensitivity pattern of the Salmonella species were recorded on the predesigned proforma and analyzed through SPSS version 25.
Results: Out of the total of 178 patients, reports of blood cultures of 164(92.1%) patients showed Salmonella Typhi while those of 14(7.9%) patients showed Salmonella Paratyphi. Out of the total of 178 Salmonella cases, 11(6.2%) were extensively drug-resistant and 58(32.6%) were multidrug-resistant. All XDR cases were of Salmonella Typhi. Out of 14 Salmonella Paratyphi, 2(14%) were MDR but no XDR Salmonella Paratyphi was found. Nalidixic acid had the highest resistance (96.4%) followed by sulphamethoxazole (65.5%). Azithromycin had the least resistance (0%) followed by imipenem (1.8%), piperacillin-tazobatam (1.9%), and meropenem (2%). Resistance of ceftriaxone was 20.8% and that of ciprofloxacin was 28.2%.
Conclusion: No resistance of Salmonella species against azithromycin was found in our study. The presence of XDR typhoid fever cases and the rising resistance of Salmonella species to ceftriaxone and carbapenems are very alarming. To prevent this resistance, we should reserve carbapenems for complicated cases of resistant typhoid fever only. Minocycline and pipercillin-tazobactam are two other good cost-effective drugs in resistance to typhoid fever.
2. Shabbir Laghari G, Hussain Z, Zohaib Maroof Hussain S, Kumar H, Mohammad Mazhar Uddin S, Haq A. Antimicrobial Susceptibility Patterns of Salmonella Species in Southern Pakistan. Cureus. 2019;11(4):e4379.
3. World Health Organisation. Drug resistant Salmonella infections in Pakistan: update. Wkly Epidemiol Monit [Internet]. 2019;12(34). Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/Epi_Monitor_2019_12_34.pdf
4. Chatham-Stephens K, Medalla F, Hughes M, Appiah GD, Aubert RD, Caidi H, et al. Emergence of Extensively Drug-Resistant Salmonella Typhi Infections Among Travelers to or from Pakistan — United States, 2016–2018. MMWR Morb Mortal Wkly Rep. 2019 Jan 11;68(1):11–3.
5. Wong W, Rawahi H Al, Patel S, Yau Y, Eshaghi A, Zittermann S, et al. The first Canadian pediatric case of extensively drug-resistant Salmonella Typhi originating from an outbreak in Pakistan and its implication for empiric antimicrobial choices. IDCases. 2018 Jan 1;15:e00492.
6. World Health Organisation. WHO | Typhoid fever – Islamic Republic of Pakistan [Internet]. WHO. World Health Organization; 2018. Available from: http://www.who.int/csr/don/27-december-2018-typhoid-pakistan/en/
7. Saeed N, Usman M, Khan EA. An Overview of Extensively Drug-resistant Salmonella Typhi from a Tertiary Care Hospital in Pakistan. Cureus [Internet]. 2019 Sep 16;11(9):e5663. Available from: https://www.cureus.com/articles/22856-an-overview-of-extensively-drug-resistant-salmonella-typhi-from-a-tertiary-care-hospital-in-pakistan
8. Siddiqui H, Jahan F, Siddiqui MA. Pattern of Anti-microbial Drug Resistance in Childhood Typhoid Fever in a Selected Hospital in Karachi, Pakistan. Asian J Res Infect Dis [Internet]. 2019 Mar 12;2(1):1–9. Available from: http://www.sdiarticle3.com/review-history/47097
9. Ali A, Ali HA, Shah FH. Pattern of antimicrobial drug resistance of Salmonella Typhi and Paratyphi A in a Teaching Hospital in Islamabad. J PakMed Assoc [Internet]. 2017;67(3):375–9. Available from: https://jpma.org.pk/article-details/8113
10. Ali Shah SA, Nadeem M, Syed SA, Fatima Abidi ST, Khan N, Bano N. Antimicrobial Sensitivity Pattern of Salmonella Typhi: Emergence of Resistant Strains. Cureus [Internet]. 2020 Nov 30;12(11):e11778. Available from: https://www.cureus.com/articles/42316-antimicrobial-sensitivity-pattern-of-salmonella-typhi-emergence-of-resistant-strains
11. Wayne P. M100 Performance Standards for Antimicrobial Susceptibility Testing [Internet]. 27th ed. Patel JB, Weinstein MP, Patel R, editors. Clinical and Laboratory Standards Institute; 2017. 250 p. Available from: https://www.researchgate.net/profile/Nikolaos_Andritsos/post/Where_to_find_MICs_of_antimicrobial_agents/attachment/59d659e279197b80779af319/AS%3A544238144323584%401506767893696/download/2017_CLSI_M100_Performance+Standards+for+Antimicrobial+Susceptibility
12. Patil N, Mule P. Sensitivity Pattern Of Salmonella typhi And Paratyphi A Isolates To Chloramphenicol And Other Anti-Typhoid Drugs: An In Vitro Study. Infect Drug Resist [Internet]. 2019 Oct 14;Volume 12:3217–25. Available from: https://www.dovepress.com/sensitivity-pattern-of-salmonella-typhi-and-paratyphi-a-isolates-to-ch-peer-reviewed-article-IDR
13. Qamar FN, Yousafzai MT, Sultana S, Baig A, Shakoor S, Hirani F, et al. A Retrospective Study of Laboratory-Based Enteric Fever Surveillance, Pakistan, 2012-2014. J Infect Dis. 2018;218(Suppl 4):S201–5.
14. Sina A, Malik L. Emergence of Multi-Resistant Enteric Infection In A Paediatric Unit Of Karachi, Pakistan. J Pak Med Assoc [Internet]. 2018;68(12):1848–50. Available from: https://jpma.org.pk/PdfDownload/8982
15. Vala S, Shah U, Ahmad SA, Scolnik D, Glatstein M. Resistance Patterns of Typhoid Fever in Children: A Longitudinal Community-Based Study. Am J Ther. 2016;23(5):e1151–4.
16. Ali MK, Sultana S. Antimicrobial sensitivity patterns of salmonella typhi in children. Bangladesh J Med Sci [Internet]. 2016 Nov 3;15(3):416–8. Available from: https://www.banglajol.info/index.php/BJMS/article/view/30198
Copyright (c) 2021 Wajeeha Amber, Itrat Fatima, Qurat-ul-ain Khalid, Hira Hameed, Imran Mahmood Khan, Rubina Zulfqar
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
All research articles published in the Journal of Rawalpindi Medical College (JRMC) are fully open access: immediately freely available to read, download, and share. Copyrights of all articles published in JRMC are retained by the authors. First publication rights are granted to JRMC. The journal/publisher is not responsible for subsequent uses of the work.
All articles are published under the Creative Commons Attribution (CC BY-SA 4.0) license.