342 MULTI-DRUG RESISTANT (MDR) SALMONELLA TYPHI (ST) IN PAKISTANI CHILDREN

Abstract

Typhoid fever (TF) remains a major public health problem in Pakistan this problem is further compounded by development of MDR-ST. The MDR-ST is defined as resistance to the commonly used oral antibiotics(ATB): chloramphenicol (CLP), ampicillin (AMP) and trimethoprim-sulfamethoxazole (TMP-SMX). Susceptibility of ST was tested to CLP, AMP, TMP-SMX, ofloxacin(OFX), cefotaxime(CTX) and ceftriaxone(CTR). TF is defined as isolation of ST from blood or a positive Widal test in appropriate clinical situation. We prospectively investigated the presence of MDR-ST in 170 children admitted to CH-PIMS between 1/1/90-12/31/90. There were 111(65%) males and 59(35%) females; 27(16%) from rural and 143(84%) from urban areas. Average age was 6.2 yrs: 4(2%) 5 yrs old. All pts received antibiotics prior to admission to CH-PIMS and diagnosis of TF. ST was isolated in 109(64%) pts and Widal test was positive in 84(49%) pts. 23(14%) pts had both positive blood culture and Widal test. There were 79(72%) MDR-ST from as many pts; all isolates were sensitive to OFX, CTX and CTR. Of the 79 pts with MDR-ST 55(70%) were treated with OFX and 24(30%) with CTR. All pts responded to treatment and recovered from TF. 16 pts had complications of TF and there were no deaths. The clinical features of pts with MDR-ST were not useful in differentiating them from those pts who did not have MDR-ST.