Extensively Drug-Resistant Salmonella enterica serovar Typhi in Pediatric population during CoVID-19 Pandemic

Abstract

Purpose: The Extensively Drug-resistant (XDR) Salmonella isolates exhibiting resistance to the first line and the second-line antibiotic options are presently a grave public health concern in Pakistan. Here, we report the first large-scale emergence and spread of an XDR S. Typhi in Peshawar, Pakistan during Coronavirus disease (CoVID-19) pandemic. Initially XDR typhoid cases were reported during post rainy season but now the disease has become endemic during winter months. Methods & Materials: From December 2020 till January 2021, we reported the high level of emerging resistance to different groups of antibiotics among Salmonella isolates from paediatric age group with enteric fever. A total of 548 blood cultures from symptomatic patients were submitted to Microbiology section of Pathology Laboratory, Rehman Medical Institute, Peshawar. All samples were incubated in BACTEC 9240 and processed according to standard guidelines (sub-cultured on Blood and MacConkey's agar and non-lactose fermenting colonies were biochemically tested for Salmonella typhi and confirmed by Salmonella specific anti-sera. Demographic data including age, gender, address and clinical features were also recorded. Results: Salmonella Typhi was isolated in 71 and 548 blood samples during December 2020 and January 2021, out of which 66 (92.9%) and 5% (7%) were MDR, respectively. All isolates revealed high level of resistance to co-trimaxazole (93%) and complete resistance to chloramphenicol (100%), ampicillin (100%), ciprofloxacin (100%), ceftriaxone (100%), cefixime (100%). All XDR typhoid isolates were sensitive to azithromycin and carbapenems. The children under 15 years’ age (88%) has a significantly high prevalence among children as compared to adults (p=0.0016), males (76%) were affected more than females (24%). Conclusion: The emergence of XDR S. typhi with high level of resistance is quite alarming. With inadequate treatments options, the present situation calls for immediate effective preventive measures including food and water safety, improved sanitation, public awareness sessions and typhoid vaccination campaigns.