Abstract
To compare antimicrobial resistance in S. Typhi and S. Paratyphi A isolates from Pakistan. Blood samples were collected through > 175 laboratory collection points in major cities and towns across the country. The study included 3,671 S. Typhi and 1,475 S. Paratyphi A isolates (2001-2006). Multidrug resistance (MDR) was defined as resistance to first-line agents co-trimoxazole, chloramphenicol and ampicillin. In total, 79.3% S. Typhi and 59.9% S. Paratyphi A were isolated from patients under 15 years of age. During the study period, the MDR rate increased in S. Typhi (34.2 to 48.5% p<0.001). Quinolone resistance (MIC> 1 microg/ml) increased in both S. Typhi (1.6 to 64.1% p<0.001) and S. Paratyphi A (0 to 47% p<0.001). The increase in the proportion of strains showing high level quinolone resistance (MIC > 4 microg/ml) was greater in S. Paratyphi A when compared to S. Typhi. Resistance to first-line drugs was higher in those <15 years of age whereas quinolone resistance was higher in older patients. Differences between S. Typhi and S. Paratyphi A, in terms of evolution of resistance to first-line agents and to quinolones, are evident in this population. The rapid increase in quinolone resistance in S. Paratyphi A when compared to S. Typhi is concerning and requires further study.
Highlights
Enteric fever is an acute, life-threatening, febrile illness caused by Salmonella enterica serovars Typhi, Paratyphi A, B and C, and is estimated to be responsible for 21 million illnesses and 200,000 deaths worldwide annually
The aim of this study was to explore the current level of resistance to first-line agents and to quinolones amongst S. enterica serovars Typhi and Paratyphi A in Pakistan
We further aimed to study the change in antimicrobial resistance among these organisms over a six-year period, 2001-2006
Summary
Enteric fever is an acute, life-threatening, febrile illness caused by Salmonella enterica serovars Typhi, Paratyphi A, B and C, and is estimated to be responsible for 21 million illnesses and 200,000 deaths worldwide annually. It is further associated with significant economic consequences in developing countries [1]. The aim of this study was to explore the current level of resistance to first-line agents and to quinolones amongst S. enterica serovars Typhi and Paratyphi A in Pakistan. We further aimed to study the change in antimicrobial resistance among these organisms over a six-year period, 2001-2006
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