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Implementation of In Vitro Drug Resistance Assays: Maximizing the Potential for Uncovering Clinically Relevant Resistance Mechanisms
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Implementation of In Vitro Drug Resistance Assays: Maximizing the Potential for Uncovering Clinically Relevant Resistance Mechanisms

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Clinical Characteristics and Resistance Patterns of Extensively Drug-Resistant Salmonella Typhi in the Pediatric

Hamna Khalid1, Zoha Rehman1, Malik Muhammad Kabir1

  • 1Wah Medical College, Wah Cantt, Pakistan.

Sage Open Pediatrics
|January 19, 2026
PubMed

Insights

Extensively drug-resistant Salmonella Typhi (XDR typhoid) in Pakistani children presents significant challenges. Meropenem and azithromycin show promise, but strengthened stewardship, vaccination, and water safety are crucial.

Area of Science:

  • Pediatric infectious diseases
  • Antimicrobial resistance
  • Public health in developing nations

Background:

  • Extensively drug-resistant Salmonella Typhi (XDR typhoid) is a critical pediatric health issue in Pakistan.
  • Limited treatment options and high relapse rates exacerbate the challenge.
  • Contaminated water sources contribute to the spread of XDR typhoid.

Purpose of the Study:

  • To characterize the demographics, clinical presentation, and antimicrobial resistance patterns of pediatric XDR typhoid in Northern Punjab, Pakistan.
  • To evaluate treatment responses in children with XDR typhoid.
  • To identify factors associated with disease severity in pediatric XDR typhoid cases.

Main Methods:

  • A prospective cohort study was conducted from January 2024 to January 2025.
  • 65 children aged 1-12 years with culture-confirmed XDR S. Typhi were enrolled.
  • Clinical, laboratory, and treatment data were collected and analyzed using Chi-square tests.

Main Results:

  • The majority of patients (60%) were between 5 and 10 years old, with vomiting and headache being common symptoms.
  • All XDR S. Typhi isolates exhibited resistance to ceftriaxone and ciprofloxacin.
  • Meropenem (100% susceptibility) and azithromycin (96.9% susceptibility) were effective treatments.
  • Delayed fever clearance and longer hospitalization were associated with severe disease.

Conclusions:

  • Effective treatment options for XDR typhoid in children include meropenem and azithromycin.
  • Addressing XDR typhoid requires enhanced antimicrobial stewardship programs.
  • Improvements in vaccination strategies and water safety are essential to control XDR typhoid.
Abstract

Keywords:
CRPXDR typhoidantibiotic resistanceazithromycinmeropenempediatric typhoidsalmonella typhi

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