A study on the clinical spectrum, prescription pattern and diagnosis of enteric fever in a tertiary care hospital of North India

Abstract

Background: Enteric fever is a major public health concern in developing countries. Lack of diagnostics diagnosis and antimicrobial resistance challenges in treatment of enteric fever. Timely diagnosis and proper management of fever are essential to reduce the complications and emergence antibiotic resistance.Methods: A prospective observational study was conducted on 71 subjects between February 2018 and December 2019. Spectrum of the disease, antimicrobial resistance and prescription pattern were observed and performances of various diagnostic methods (like culture, serology and loop mediated isothermal amplification) were determined.Results: The most commonly observed clinical features included gastrointestinal complaints, anaemia, leukopenia, splenomegaly and hepatitis. Blood culture was positive for 49.3% (35/71) of the cases using conventional culture method. All samples positive by LAMP were also culture positive, out of which 80% (28/35) were S. typhi and 20% (7/35) were S. paratyphi A. Antimicrobial susceptibility to ciprofloxacin was 39.3% and 28.6% and ampicillin susceptibility was 32.1 and 28.6% in S. typhi and S. paratyphi A respectively. Only one multidrug resistant isolate was noted, while none was resistant to ceftriaxone or azithromycin. Cefixime and azithromycin combination therapy led to the earliest defervescence of fever.Conclusions: Oral combination therapy may be a good option to treat enteric fever and oral combination therapy may be a good option to treat enteric fever and performance of LAMP seem to be as good as culture with a shorter turnaround time. LAMP can be used to obviate the need of culture in resource limited settings.