Emerging Trends of Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) Salmonella Typhi in a Tertiary Care
Muhammad Zakir1, Maryam Khan1, Muhammad Ihtisham Umar2
1Institute of Molecular Biology and Biotechnology, The University of Lahore, Defense Road Campus, Lahore 54000, Pakistan.
Abstract:
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.
Insights
Multidrug-resistant (MDR) and extensively drug-resistant (XDR) Salmonella Typhi are prevalent in Lahore, Pakistan. This resistance poses a significant threat to typhoid fever treatment, necessitating urgent control measures.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Salmonella Typhi causes typhoid fever, a significant public health concern.
- Antibiotic resistance, including multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains, is a growing threat to effective typhoid treatment.
- Pakistan faces a particular challenge with rising MDR and XDR Salmonella Typhi.
Purpose of the Study:
- To determine the prevalence of MDR and XDR Salmonella Typhi in Lahore, Pakistan.
- To identify demographic factors and clinical settings associated with resistant Salmonella Typhi infections.
- To evaluate the effectiveness of different antibiotics against prevalent resistant strains.
Main Methods:
- Blood samples from 3000 patients were analyzed for bacterial identification.
- Antibiotic susceptibility testing was performed using the VITEK® 2 system.
- Statistical analysis included Mann-Whitney U and Kruskal-Wallis H tests.
Main Results:
- 600 positive cultures revealed a high prevalence of XDR (46.1%) and MDR (24.5%) Salmonella Typhi.
- The disease burden was higher in males (60.67%) and the 0-10 age group (70.4%).
- Piperacillin/Tazobactam and co-amoxiclav showed the highest effectiveness against resistant strains, while resistance was high for chloramphenicol and ampicillin.
Conclusions:
- This study confirms the significant presence of MDR and XDR Salmonella Typhi in Lahore.
- Age and gender did not significantly affect resistance patterns, but prevalence was high in both outpatient and inpatient settings.
- Urgent implementation of stringent control measures is crucial to combat the spread of resistant Salmonella Typhi strains.
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