REVIEWING ANTIBIOGRAM OF SALMONELLA TYPHI AS BLOOD CULTURE ISOLATE IN A TERTIARY CARE HOSPITAL, KOLKATA- REVERTING SUSCEPTIBILITY PROFILE

Abstract

BACKGROUND: Enteric fever is still a major contributor to the disease burden in India. According to National Health Profile 2018, a total of 493 deaths occurred in 2017 in India due to typhoid fever. Early diagnosis and treatment with proper drugs are the only option to reduce mortality. After development of resistance to fluoroquinolones (once the most frequently used drugs for treatment of multidrug resistant enteric fever), we are currently left with third generation cephalosporins and azithromycin. But irrational use of these drugs may lead to development of resistance in near future. So, it is time to review re-introduction of the age old first line drugs like ampicillin, chloramphenicol and co-trimoxazole, in the treatment of typhoid fever. The aim of our study was to review the susceptibility pattern of Salmonella Typhi based on their MIC and rational use of antibiotics to prevent further development of MDR strains. METHODS: In this retrospective study, 4142 blood samples were collected and studied for one-year period. Isolated organisms and their drug susceptibility patterns were analysed based on their MIC. RESULTS: Among the 1187 (28.65%) culture positive isolates, 1.85% of Salmonella spp. were isolated including 22 Salmonella Typhi and single isolate of Salmonella Paratyphi A. Most of the isolates were from male patients (68.18%) with less than 20 years of age (77.27%). Salmonella Typhi showed 100% sensitivity to ampicillin, chloramphenicol and co-trimoxazole. It also showed 100% resistance to nalidixic acid and 54.55% resistance to ciprofloxacin. However, 100% sensitivity to third generation cephalosporins, carbapenems, colistin and azithromycin was also observed. A single isolate of Salmonella Paratyphi A showed same resistogram as of Salmonella Typhi. CONCLUSIONS: Delay in instituting effective antimicrobial treatment results in poor outcome in patients suffering from typhoid fever. As there are variations in the antibiotic susceptibility patterns of Salmonella isolates, periodic monitoring of resistance pattern will remain essential for effective empirical therapy which should correspond with patterns of antimicrobial susceptibility of local Salmonella strains; otherwise irrational use of antibiotics may again cause appearance of MDR strains in the near future.