Continuous Threat of Growing Antimicrobial Resistance Among Salmonella Typhi Isolates: A Multicenter Study from Pakistan

Ashfaq Hussain; Muhammad Farooq; Muhammad Luqman  Satti; Faisal Hanif; Saba Sarwar; Fatima Sana

doi:10.51253/pafmj.v74i6.8977

Authors

Ashfaq Hussain Departments of Microbiology, Pakistan Navy Ship Shifa Hospital, Karachi Pakistan
Muhammad Farooq Departments of Microbiology, Combined Military Hospital, Sialkot/National University of Medical Sciences (NUMS) Pakistan
Muhammad Luqman Satti Departments of Microbiology, Pakistan Navy Ship Shifa Hospital, Karachi Pakistan
Faisal Hanif Departments of Microbiology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Saba Sarwar Departments of Microbiology, Pakistan Navy Ship Shifa Hospital, Karachi Pakistan
Fatima Sana Departments of Microbiology, Combined Military Hospital, Quetta/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i6.8977

Keywords:

Antimicrobial Resistance, Drug Resistance, Multidrug Resistant (MDR), Salmonella enterica Typhi (S. Typhi).

Abstract

Objective: To determine current susceptibility patterns of Salmonella enterica serovar Typhi (S. Typhi) in four cities of Pakistan and to deduce the frequency of multidrug resistant, extensively drug-resistant S. Typhi.

Study Design: Cross-sectional study.

Place and Duration of Study: Departments of Microbiology, Pakistan Navy Ship Shifa Hospital, Karachi, Pak Emirates Military Hospital, Rawalpindi, Combined Military Hospital, Sialkot, Combined Military Hospital, Abbottabad, Pakistan, from Apr 2019 to Sep 2020.

Methodology: Blood culture specimens of patients with suspected Enteric fever from four different institutes were received in respective laboratories. Culture and identification of isolates were done and specimens yielding growth of S. Typhi, were included in the study. Antibiotic susceptibility was tested according to Clinical and Laboratory Standards Institute guidelines 2019 and 2020.

Results: A total of 970 blood culture specimens yielded growth of S. Typhi. Maximum isolates were found from Pak Emirates Military Hospital, Rawalpindi, 395(40.7%) followed by Pakistan Navy Ship Shifa, Karachi 366(37.7%). The total number of multidrug resistant isolates were 679 (70%) and extensively drug resistant isolates were 457(47.1%) with maximum number of multidrug resistant and extensively drug resistant S. Typhi from Pakistan Navy Ship Shifa. Ciprofloxacin susceptible isolates were 50(5.2%) and maximum sensitive isolates were from Combined Military Hospital, Abbottabad. Resistance to azithromycin was found in four isolates (0.4%). There were no isolates resistant to meropenem.

Conclusion: Emergence of antibiotic resistance among S. Typhi strains is a threat which emphasizes the importance of surveillance of antimicrobial susceptibility patterns and amendment of current antibiotic prescribing practices.

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References

Yousafzai MT, Qamar FN, Shakoor S,. Ceftriaxone-resistant Salmonella Typhi outbreak in Hyderabad City of Sindh, Pakistan: high time for the introduction of typhoid conjugate vaccine. Clin Infect Dis 2019; 68: S16-21.

https://doi.org/10.1093/cid/ciy877

Hooda Y, Sajib MS, Rahman H, Luby SP. Molecular mechanism of azithromycin resistance among typhoidal Salmonella strains in Bangladesh identified through passive pediatric surveillance. PLoS Negl Trop Dis 2019; 13: e0007868.

https://doi.org/10.1371/journal.pntd.0007868

Patil N, Mule P. Sensitivity pattern of Salmonella Typhi and Paratyphi A isolates to chloramphenicol and other anti-typhoid drugs: An in vitro study. Infect Drug Resist 2019; 12: 3217.

https://doi.org/10.2147/IDR.S223119

Umair M, Siddiqui SA. Antibiotic susceptibility patterns of Salmonella Typhi and Salmonella Paratyphi in a tertiary care hospital in Islamabad. Cureus 2020; 12: e10228.

https://doi.org/10.7759/cureus.10228

Kim S, Lee KS, Pak GD, Excler JL, Sahastrabuddhe S, Marks F, et al. Spatial and temporal patterns of typhoid and paratyphoid fever outbreaks: a worldwide review, 1990–2018. Clin Infect Dis 2019; 69: S499-509.

https://doi.org/10.1093/cid/ciz611

Ameya G, Tsalla T, Getu F, Getu E. Antimicrobial susceptibility pattern, and associated factors of Salmonella and Shigella infections among under five children in Arba Minch, South Ethiopia. Ann Clin Microbiol Antimicrob 2018; 17: 1-7.

https://doi.org/10.1186/s12941-018-0288-0

Rasheed F, Saeed M, Alikhan NF, Baker D, Khurshid M, Ainsworth EV, et al. Emergence of resistance to fluoroquinolones and third-generation cephalosporins in Salmonella Typhi in Lahore, Pakistan. Microorganisms 2020; 8: 1336. https://doi.org/10.3390/microorganisms8091336

Wong W, Al Rawahi H, Patel S, Yau Y, Eshaghi A, Zittermann S, et al. The first Canadian pediatric case of extensively drug-resistant Salmonella Typhi originating from an outbreak in Pakistan and its implication for empiric antimicrobial choices. IDCases 2019; 15: e00492.

https://doi.org/10.1016/j.idcr.2019.e00492

Chatham-Stephens K, Medalla F, Hughes M, Appiah GD, Aubert RD, Caidi H, et al. Emergence of extensively drug-resistant Salmonella Typhi infections among travelers to or from Pakistan—United States, 2016–2018. Morb Mortal Wkly Rep 2019; 68: 11-13.

https://doi.org/10.15585/mmwr.mm6801a3

Saeed M, Rasool MH, Rasheed F, Saqalein M, Nisar MA, Imran AA, et al. Extended-spectrum beta-lactamases producing extensively drug-resistant Salmonella Typhi in Punjab, Pakistan. J Infect Dev Ctries 2020; 14: 169-176.

https://doi.org/10.3855/jidc.11706

Laghari GS, Hussain Z, Hussain SZ, Kumar H, Uddin SM, Haq A, et al. Antimicrobial susceptibility patterns of Salmonella species in Southern Pakistan. Cureus 2019; 11: e4379.

https://doi.org/10.7759/cureus.4379

Klemm EJ, Shakoor S, Page AJ, Qamar FN, Judge K, Saeed DK et al. Emergence of an extensively drug-resistant Salmonella enterica serovar Typhi clone harboring a promiscuous plasmid encoding resistance to fluoroquinolones and third-generation cephalosporins. mBio 2018; 9: 105-118.

https://doi.org/10.1128/mBio.00105-18

Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. 29th ed. Document M100. Wayne, PA: CLSI; 2019.

Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. 30th ed. Document M100. Wayne, PA: CLSI; 2020.

Hussain A, Satti L, Hanif F, Zehra NM, Nadeem S, Bangash TM et al. Typhoidal Salmonella strains in Pakistan: an impending threat of extensively drug-resistant Salmonella Typhi. Eur J Clin Microbiol Infect Dis 2019; 38: 2145-2149.

https://doi.org/10.1007/s10096-019-03657-0

Diaz-Guevara P, Montaño LA, Duarte C, Zabaleta G, Maes M, Martinez Angarita JC et al. Surveillance of Salmonella enterica serovar Typhi in Colombia, 2012–2015. PLoS Negl Trop Dis 2020; 14: e0008040.

https://doi.org/10.1371/journal.pntd.0008040

Bhetwal A, Maharjan A, Khanal PR, Parajuli NP. Enteric fever caused by Salmonella enterica serovars with reduced susceptibility of fluoroquinolones at a community based teaching hospital of Nepal. Int J Microbiol 2017; 2017: 1-8.

https://doi.org/10.1155/2017/9095128

Makkar A, Gupta S, Khan ID, Gupta RM, Rajmohan KS, Chopra H et al. Epidemiological profile and antimicrobial resistance pattern of enteric fever in a tertiary care hospital of North India–a seven year ambispective study. Acta Medica 2019; 61: 125-130. https://doi.org/10.14712/18059694.2019.151

Das JK, Hasan R, Zafar A, Ahmed I, Ikram A, Nizamuddin S et al. Trends, associations, and antimicrobial resistance of Salmonella Typhi and Paratyphi in Pakistan. Am J Trop Med Hyg 2018; 99: 48-54. https://doi.org/10.4269/ajtmh.18-0193

Qamar FN, Yousafzai MT, Sultana S, Baig A, Shakoor S, Hirani F et al. A retrospective study of laboratory-based enteric fever surveillance, Pakistan, 2012–2014. J Infect Dis 2018; 218: S201-205. https://doi.org/10.1093/infdis/jiy210

Zehra NM, Irfan F, Mirza IA, Imtiaz A, Nadeem S, Hameed F. Current trends of antimicrobial susceptibility of typhoidal Salmonellae isolated at tertiary care hospital. J Coll Physicians Surg Pak 2017; 27: 690-692.

Mutai WC, Muigai AW, Waiyaki P, Kariuki S. Multi-drug resistant Salmonella enterica serovar Typhi isolates with reduced susceptibility to ciprofloxacin in Kenya. BMC Microbiol 2018; 18: 1-5.

https://doi.org/10.1186/s12866-018-1340-5

Iqbal J, Dehraj IF, Carey ME, Dyson ZA, Garrett D, Seidman JC et al. A race against time: reduced azithromycin susceptibility in Salmonella enterica serovar Typhi in Pakistan. mSphere 2020; 5: e00215-220.

https://doi.org/10.1128/mSphere.00215-20

Levine MM, Simon R. The gathering storm: is untreatable typhoid fever on the way? mBio 2018; 9: e00482-18.

https://doi.org/10.1128/mBio.00482-18

Satti ML, Hanif F, Hussain A, Nadeem S, Younis F, Zehra NM. Rapid detection of ceftriaxone resistance in clinical isolates of extensively drug-resistant Salmonella enterica serovar Typhi. J Pak Med Assoc 2021; 71: 1639-43.

https://doi.org/10.47391/JPMA.152