Antimicrobial resistance in typhoidal salmonella in a tertiary care teaching centre in North India

Abstract

Introduction: Enteric fever continues to carry a high burden of morbidity and mortality in India. There have been reports of emergence of ceftriaxone resistant typhoidal Salmonella from Asia. Monitoring of antimicrobial resistance trends in typhoidal Salmonella is crucial to support in clinical decision making. Aim: To study the current susceptibility pattern of typhoidal salmonella isolates in our setup. Methods: This retrospective study was conducted on 144 non-repeat blood-culture isolates of S. Typhi, and S. Paratyphi A obtained from 3926 blood cultures received at 510-bedded tertiary-care hospital of North-India from 2017-2019. Identification and antibiograms were obtained by Vitek-2 compact and Kirby-Bauer's disc diffusion with sensitivity to azithromycin, and chloramphenicol. Result: S. Typhi and S. Paratyphi A in a ratio of 5.2:1 were seen between months of June and July predominantly distributed between 1-10 years age group. S. Typhi resistance to co-trimoxazole, chloramphenicol, ceftriaxone and azithromycin was 21.4%, 25.6%, 12.3% and 28% respectively. S. Paratyphi A resistance to co-trimoxazole, chloramphenicol, ceftriaxone and azithromycin was 4.3%, 17.3%, 34.7% and 21.7% respectively. Conclusion: Enteric-fever is a major public-health problem in India. Emergence of ceftriaxone-resistant Salmonella mandates appropriate investigation of all febrile illnesses with blood culture whenever possible. Provision of safe drinking water, good sanitation, hygiene and vaccination strategies are needed to sustain herd-immunity.