Isolation of Extensively Drug Resistant Salmonella Typhi in Blood Culture from Tertiary Care University Hospital

Abstract

Background: Typhoid fever is a serious systemic infection which affects all age group from children to elderly. It has multiple systemic effects as untreated infections may cause prolonged morbidity and hospitalization. The treatment modalities range multiple antibiotics like co- trimoxazole, ciprofloxacin, chloramphenicol and ampicillin. The treatment of choice in multidrug resistant Salmonella has been third generation cephalosporins like  Ceftriaxone.

Methodology: The total number of Blood culture received was 464, collected from January to December in year 2018 at Jinnah Sindh Medical University laboratory. The sample was received in BACTEC blood culture bottle. When a culture bottle signaled positive, the bottle was removed and an aliquot of the broth was Gram stain and processed for culture for organism identification and antimicrobial susceptibility testing.

Results: During 2018 from January till December 464 blood cultures came to JSMU Diagnostic laboratory and blood bank out of which 31 cases of enteric fever were diagnosed in automated blood culture Bactec. All the isolated Salmonella belonged to Salmonella typhi subgroup and there was no case of salmonella paratyphi A or B. out of 31, 25 Salmonella were resistant to Ceftriaxone sensitive only to azithromycin and Meropenem. All the 31 positive Salmonella cases were from patient of pediatric age group with range of 11 months to 14 years.

Conclusion: The rise of extensively drug resistant Salmonella is alarming and leaves limited treatment options with carbapenems which are costly as well as require administration by injectable route. Preventive measures like improved sanitation and vaccination may be adapted in order to curtail spread of such resistant strains of typhoid.
Key Words: XDR, Salmonella typhi, Extremely drug resistant enteric fever