FREQUENCY ASSESSMENT OF EMERGENCE OF EXTENSIVELY DRUG RESISTANT SALMONELLA TYPHI STRAINS IN QUETTA, BALOCHISTAN

Abstract

Objective: To determine frequency of multidrug resistant and extensive drug resistant strains of Salmonella typhi and Salmonella paratyphi in Quetta, Balochistan of Pakistan Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Combined Military Hospital Quetta, Pakistan, from Mar 2019 to Mar 2020. Methodology: A total of two thousand seven hundred and sixty (n=2760) suspected cases of typhoid fever, irrespective of age and gender reporting at the hospital during one year were enrolled. Isolates were cultured and identified using standard microbiological procedures. Antimicrobial sensitivity against the typhoidal Salmonellae was determined using Kirby-Bauer disc diffusion method. All the extensively drug-resistant isolates were confirmed by Vitek 2 system. Results: A total of 173 (6.3%) cultures showed positive results. Mean age of culture positive cases was 18.9 ± 11.1 years. Out of 173 positive blood cultures, 136 (78.6%) were of males and 37 (21.1%) were from females. Antibiotic susceptibility results showed that 166 (96%) of isolates were Salmonella typhi. Multi-drug resistant strains were observed in 104 (60.1%) and extensive drug resistant strains were observed in 81 (46.8%) isolates. Conclusion: Frequencies of MDR (60.1%) and XDR (46.8%) strains of S. typhi isolates from confirmed cases of enteric fever were remarkable in Quetta, Balochistan. We recommend empiric therapy with azithromycin in patients with uncomplicated disease and therapy with carbapenam for complicated cases of enteric fever acquired in Karachi or Balochistan.