Extensively Drug Resistant Typhoid Fever Seen at Tertiary Care Hospital in Lahore

Abstract

Background: Typhoid fever is endemic in Pakistan. Multi-drug resistance is commonly observed in Salmonella Typhi (S.Typhi) isolates, due to which first line of drugs, ampicillin, trimethoprimsulphamethoxazole and chloramphenicol become ineffective for treatment. Towards the end of 2016 these MDR strains also developed resistance to ceftriaxone and quinolones and were called extensively drug resistant (XDR). Since first reported outbreak of XDR S.Typhi, it continues to increase in number in Sindh.
Objectives: Present study was planned to see the sensitivity pattern of S.Typhi isolated in a tertiary care hospital, Lahore.
Study Design: Retrospective analysis
Setting and Duration: The study was done at Microbiology Department of Services Institute of Medical sciences from January 2018 to April 2019.

Materials & Methods: All 16288 blood culture samples received from indoor and outpatient department were analyzed for S. Typhi by standard microbiological techniques. Sensitivity of S. Typhi to ampicillin, trimethoprim-sulphamethoxazole, chloramphenicol, ciprofloxacillin, ceftriaxone, azithromycin and imipenem was assessed Kirby-Bauer method according to CLSI guidelines 2018.
Results: During Jan-Dec 2018, number of S. Typhi isolated were 29 out of these 13 were MDR and 14 XDR. In the first four months
of 2019, 69 S. Typhi were isolated; of these 6 were MDR and 58-XDR. Theses findings are significant p-value <0.00017. Another alarming finding was the presence of one azithromycin resistant XDR. Most of S. Typhi were isolated from children less than 15 years old.

Conclusions: With increasing XDR S. Typhi being isolated in Lahore, coordinated efforts are needed to control it. This will include
vaccination and awareness campaign for better hygiene, safe water and improved sanitary conditions. Antibiotic stewardship should be taken seriously at Government level and over the counter sale of antibiotics must be stopped.
Key Words: Typhoid, Salmonella typhi, Extensively drug resistant, XDR