Trends of enteric fever and emergence of extensively drug-resistant typhoid in Pakistan: Population-based laboratory data from 2017-2019

Document Type

Article

Department

Pathology and Laboratory Medicine

Abstract

Background: Typhoid fever burdens low- and middle-income countries, especially children. Despite being curable, it now resists first-line antibiotics. This study aims to understand antimicrobial resistance patterns associated with multidrug-resistant (MDR) and extensively drug-resistant (XDR) typhoid fever cases in Pakistan.
Methods: We conducted a retrospective review of blood culture-confirmed typhoid cases from 5 large laboratory networks in Pakistan over a period of 3 years (2017-2019). Data were analyzed for 464 956 blood culture specimens, of which Typhi and Paratyphi were isolated in 23 924 (5%) of all blood cultures done.
Results: Sindh had the highest proportion of S. Typhi cases (72%) of all positive cases, followed by Punjab with 46.9%. The 5-14-years age group had the highest proportion of S. Typhi (MDR: 46.1%; XDR: 44.2%), followed by the 2-4-years age group (MDR: 27%; XDR: 26.2%). XDR isolates of S. Typhi were found in 57%. Most S. Typhi isolates were resistant to ampicillin (79.8%), chloramphenicol (80.8%), cefixime (64.6%), ciprofloxacin (66.4%), ceftriaxone (63.3%), and co-trimoxazole (80.2%). Most S. Paratyphi isolates were responsive to antibiotics, ampicillin (97.2%), chloramphenicol (98.6%), cefixime (99.5%), ceftriaxone (99.5%), and co-trimoxazole (98.7%). Resistance to ciprofloxacin was 85.9%. Both S. Typhi and S. Paratyphi were susceptible to azithromycin and imipenem, whereas 99.8% of S. Typhi and 100% of S. Paratyphi were sensitive to meropenem.
Conclusions: Increased prevalence of culture-confirmed XDR S. Typhi cases was observed in 2019 as compared with 2017, presumably due to the outbreak of XDR in Sindh.

Publication (Name of Journal)

Open Forum Infectious Diseases

DOI

10.1093/ofid/ofaf106

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