Pattern of Drug Resistance of Salmonella Typhi, Clinical Profile and Complications Developed Among Children Admitted in A Tertiary Care Set Up
Background: Typhoid fever is an alarming threat all over the world in general and in particular in our geographical area like Pakistan. This situation is worsened by extensively drug resistant strain of Salmonella species particularly in province of Sindh. Objective: The aim of study to highlight the drug resistance pattern in isolates of Salmonella typhi and Salmonella Para typhi in order to overcome the complications developed in children. Study Design: Observational cross sectional study. Settings: Microbiology laboratory of PNS Shifa with collaboration of Medicine Department, Karachi Pakistan. Duration: August 2021 till August 2022. Methods: This study was conducted by taking isolates of XDR Salmonella Typhi from samples of blood using a BD BACTEC™ automated blood culture system. Clinical and diagnostic summary of the patients including gender, age, duration of illness, laboratory parameters and antibiotic susceptibility pattern of the pathogen were monitored by logistic regression to recognize the factors associated with complications. Results: Total of 1200 patients were admitted to PNS Shifa hospital as clinically diagnosed cases of typhoid fever. Out of these, 106 were found as XDR (extensively drug resistant). Median (IQR) age of the patients was 4.5 years; 52% were male. Laboratory findings revealed C-reactive protein was 8.1 with confidence interval 6.51-7.5. Out of 106 two patients (1.9%) were expired as a result of intestinal perforation. 45 patients (42.5%) patients were cured properly. Amongst culture-screened cases (n=106), isolates resistant to ampicillin, chloramphenicol and trimethoprim, 3rd generation cephalosporins, fluoroquinolons, and sulphamethoxazole was 106 /106 (100%) respectively, were extensively drug-resistant. Conclusion: Our study explains that enteric fever in under-five year children poses a chief public health crisis in Pakistan. We need to take measures and make policies to control this endemic; we are standing on the edge of pan-drug resistance in isolates of Salmonella typhi. We conclude from our findings that the implementation of screening tests is effective for detection of resistant strain.