Abstract
CONTEXT: Enteric fever prevails to be a considerable health issue worldwide. Ciprofloxacin became the mainstay of its therapy after multidrug resistant salmonellae emerged. Treatment failure was soon recorded with ciprofloxacin, the index being in-vitro resistance to nalidixic acid. Chloramphenicol sensitive strains have resurfaced. Resistance to alternatives- macrolides is cropping up though not documented widely. These variations in addition to the fact that India is witnessing escalating resistance to antibiotics, stress the significance of continual surveillance of salmonellae resistance. INTENT: The study undertaken intends to document the current deviations in the antibiogram of the Salmonella isolates from blood culture, with a perspective of evaluating ciprofloxacin susceptibility and macrolide resistance, further considering, if there is a need to modify the antibiotic strategies for this condition. METHODOLOGY: The isolates from blood cultures from January 2012 to September 2013 obtained using commercial BACTEC 9120 system, sub-cultured and processed for determining salmonellae serotypes were further subjected to drug susceptibility testing for patterning their resistance. MICs to ciprofloxacin of nalidixic acid resistant (NAR) isolates were recognized. RESULTS: Salmonella was isolated from 114 out of 8210 blood culture specimens received. There were 74 Salmonella Typhi isolates, 39 Salmonella Paratyphi A and 1 Salmonella Paratyphi B. Highest resistance of salmonellae (85.96%) was exhibited to nalidixic acid and highest susceptibility (100%) to ceftriaxone. Decreased ciprofloxacin susceptibility-DCS (MIC of 0.125-1μg/ml) was noticed in around 90% of NAR salmonellae. Isolates demonstrated sizable resistance (42.10%) to azithromycin. Only three strains were multidrug resistant. INTERPRETATION AND CONCLUSION: Routine screening of nalidixic acid sensitivity should be encouraged as a means to predict decreased fluoroquinolone susceptibility, thereby preventing therapeutic failure. In order to avert the profound impact of antimicrobial resistance and to define the best possible therapy, periodic monitoring of Salmonella antibiogram is of prime value. The upsurge of occurrence of ciprofloxacin resistance, impending resistance to macrolide- azithromycin, re-emergence of chloramphenicol sensitive strains is of particular concern and necessitates a change towards 'evidence-based' treatment and rationalization of existing empirical therapy of enteric fever shifting the vital focus towards antibiotic recycling.
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