Abstract
Enteric fever is a systemic infection caused by Salmonella Typhi (S.Typhi), Salmonella Paratyphi A (S.Paratyphi A), Salmonella Paratyphi B and Salmonella Paratyphi C. It is endemic in India and is a major public health problem in the country. Treatment with Ciprofloxacin which was considered the drug of choice for multi drug resistant Salmonellae, is now showing high rates of failure clinically. A total of 33 isolates (S.Typhi -19, S. Paratyphi A – 14) obtained from blood and bone marrow were tested for antimicrobial susceptibility by Kirby Bauer disc diffusion method. The minimum inhibitory concentrations of Ciprofloxacin & Ceftriaxone were determined by broth dilution method. Majority of the patients were young adults falling in the age group 16-35 years (57.7%).Only 2 isolates of S.Typhi were resistant to all three first line drugs (Ampicillin, Cotrimoxazole and Chloramphenicol) and classified as multi drug resistant S.Typhi (MDRST). One strain of S.Paratyphi A was resistant to Ampicillin. 90.9% of isolates were susceptible to Azithromycin. None of the isolates showed full susceptibility to Ciprofloxacin. 7 isolates showed intermediate susceptibility with an MIC of 0.5µg/mL. The MIC of Ceftriaxone showed an upward trend though still within the susceptible limits. 69.7% of the 33 isolates had an MIC of 0.06 µg/mL and 30.3% of isolates had an MIC of 0.12µg/mL. There is reemergence of susceptibility to the first line drugs. Presence of fluoroquinolone resistance and the rise in MIC of Ceftriaxone is a concern. Antibiotic stewardship has to be implemented urgently.
References
- Maskell D. Salmonella Infections: Clinical, Immunological and Molecular Aspects. Cambridge University Press; 2006.
- Capoor MR, Nair D, Hasan AS, Aggarwal P, Gupta B. Typhoid fever: narrowing therapeutic options in India. Http wwwtmmahidolacthseameo200637618-3738pdf 2006.
- Bhutta ZA. Current concepts in the diagnosis and treatment of typhoid fever. BMJ 2006;333:78–82.
- M SK. Comparison of Salmonella typhi and Paratyphi A Occurrence in a Tertiary Care Hospital. J ClinDiagn Res 2013. doi:10.7860/JCDR/2013/6551.3743.
- Walia M, Gaind R, Paul P, Mehta R, Aggarwal P, Kalaivani M. Age-related clinical and microbiological characteristics of enteric fever in India. Trans R Soc Trop Med Hyg 2006;100:942–8. doi:10.1016/j.trstmh.2006.02.015.
- Bhatia JK, Mathur AD, Arora MM. Reemergence of chloramphenicol sensitivity in enteric fever. Med J Armed Forces India 2007;63:212–214.
- Gupta V, Singla N, Bansal N, Kaistha N, Chander J. Trends in the Antibiotic Resistance Patterns of Enteric Fever Isolates–a Three Year Report from a Tertiary Care Centre. Malays J Med Sci MJMS 2013;20:71.
- Kumar S, Rizvi M, Berry N. Rising prevalence of enteric fever due to multidrug-resistant Salmonella: an epidemiological study. J Med Microbiol 2008;57:1247–50. doi:10.1099/jmm.0.2008/001719-0.
- Harish BN, Madhulika U, Parija SC. Isolated high-level ciprofloxacin resistance in Salmonella enterica subsp. enterica serotype Paratyphi A. J Med Microbiol 2004;53:819–819.
- Renuka K, Sood S, Das BK, Kapil A. High-level ciprofloxacin resistance in Salmonella enterica serotype Typhi in India. J Med Microbiol 2005;54:999–1000. doi:10.1099/jmm.0.45966-0.
- Al DSC et. Drug-Resistant Salmonella enterica Serotype Paratyphi A in India - Volume 6, Number 4—August 2000 - Emerging Infectious Disease journal - CDC n.d. doi:10.3201/eid0604.000420.
- Harish BN, Menezes GA, Sarangapani K, Parija SC. A case report and review of the literature: Ciprofloxacin resistant Salmonella entericaserovarTyphi in India. J Infect Dev Ctries 2008;2. doi:10.3855/jidc.229.
- Capoor MR, Nair D, Deb M, Aggarwal P. Enteric fever perspective in India: emergence of high-level ciprofloxacin resistance and rising MIC to cephalosporins. J Med Microbiol 2007;56:1131–2. doi:10.1099/jmm.0.47170-0.
- Saha SK, Darmstadt GL, Baqui AH, Crook DW, Islam MN, Islam M, et al. Molecular Basis of Resistance Displayed by Highly Ciprofloxacin-Resistant Salmonella entericaSerovarTyphi in Bangladesh. J ClinMicrobiol 2006;44:3811–3. doi:10.1128/JCM.01197-06.
- Islam M, Das K, Sharmin N, Hasan M, Azad AK. Antimicrobial susceptibility of Salmonella serovars isolated from blood. J Innov Dev Strategy 2008;2:22–27.
- Butler T, Sridhar CB, Daga MK, Pathak K, Pandit RB, Khakhria R, et al. Treatment of typhoid fever with azithromycin versus chloramphenicol in a randomized multicentre trial in India. J AntimicrobChemother 1999;44:243–50. doi:10.1093/jac/44.2.243.
- Saha SK, Talukder SY, Islam M, Saha S. A highly ceftriaxone-resistant Salmonella typhi in Bangladesh. Pediatr Infect Dis J 1999;18:387.
- Kulkarni K, Singh M, Kumar R. Is drug-resistant Salmonella typhi an emerging threat? BMJ Case Rep 2009;2009. doi:10.1136/bcr.04.2009.1783.
- Shrestha KL, Pant ND, Bhandari R, Khatri S, Shrestha B, Lekhak B. Re-emergence of the susceptibility of the Salmonella spp. isolated from blood samples to conventional first line antibiotics. Antimicrob Resist Infect Control 2016;5. doi:10.1186/s13756-016-0121-8.
- PorwAl A, BhAt S. Antibiotic Resistance among Enteric Fever Pathogens in a Tertiary Care Centre. Natl J Lab Med 2016;5:MO15–MO18.
Corresponding Author
Beena Philomina Jose
Department of Microbiology,
Government Medical College Kozhikode, Kerala, India- 673008
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Fax no. 04952355331, Phone no. 9497577333
DOI: https://dx.doi.org/10.18535/jmscr/v6i5.15
