Trends in antimicrobial susceptibility of blood culture-positive typhoid fever over half a decade in adults attending a tertiary care teaching hospital in South India

Authors

  • Mohammed Rafiuddin Rashed Department of Pharmacology, MES Medical College, Perinthalmanna, Kerala, India
  • Ashish Yadav Department of Pharmacology, MES Medical College, Perinthalmanna, Kerala, India
  • Ramakrishna Pai Jakribettu Department of Pharmacology, MES Medical College, Perinthalmanna, Kerala, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20194796

Keywords:

Salmonella, Typhoid, India, Resistance, Sensitivity, Amoxicillin

Abstract

Background: Typhoid fever is a public health concern in developing countries. Developed countries have also been influenced due to tourism. The drugs used for treating typhoid fever can and have been rendered unusable due to resistance. Monitoring and updating the Salmonella antibiogram is needed to prevent therapeutic failures. This study confirms to the same goal.

Methods: This study was conducted retrospectively in a tertiary care hospital in North Kerala with data collected from 2013 to 2017. Years were categorized into four quarters to analyze seasonality. Positive blood culture samples of adults, identified to be Salmonella typhi or paratyphi were subjected to antimicrobial sensitivity.

Results: 37 Salmonella isolates were included. July-September quarter was found to have maximum incidence of typhoid fever followed by April-June quarter. All isolates were 100% sensitive to ceftriaxone, chloramphenicol, and amoxicillin-clavulanic acid. Sensitivity lacked for nalidixic acid (48.65%), ciprofloxacin (48.65%) and levofloxacin (70.27%). Sensitivity to ampicillin and cotrimoxazole was 86.49% and 91.89%. Azithromycin efficacy was good overall (94.59%) with resistant isolates emerging in final year of this study.

Conclusions: Monsoon is most conducive for typhoid fever occurrence followed by summer. This study confirms utility of ceftriaxone and futility of quinolones and fluoroquinolones in typhoid fever treatment. Azithromycin has started showing emergence of resistance. Ampicillin and cotrimoxazole cannot be relied upon due to variability in sensitivity patterns. Chloramphenicol showed full efficacy throughout the study period which is encouraging. Amoxicillin-clavulinic acid, surprisingly was 100% effective throughout study period. However, no contemporary data is available for comparison.

References

Mogasale V, Maskery B, Ochiai RL, Lee JS, Mogasale VV, Ramani E, et al. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment. Lancet Global Health. 2014;2(10):e570-80.

Ochiai RL, Acosta CJ, Danovaro-Holliday MC, Baiqing D, Bhattacharya SK, Agtini MD, et al. A study of typhoid fever in five Asian countries: disease burden and implications for controls. Bull World Health Organ. 2008;86:260-8.

John J, Van Aart CJC, Grassly NC. The Burden of Typhoid and Paratyphoid in India: Systematic Review and Meta-analysis. Baker S, editor. PLoS Negl Trop Dis. 2016;10(4):e0004616.

Dahiya S, Sharma P, Kumari B, Pandey S, Malik R, Manral N, et al. Characterisation of antimicrobial resistance in Salmonellae during 2014–2015 from four centres across India: an ICMR antimicrobial resistance surveillance network report. Indian J Med Microbiol. 2017;35(1):61.

Collee JG, Miles RS, Watt B. Tests for the identification of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A, eds. Mackie and McCartney Practical Medical Microbiology. 14th ed. London: Churchill Livingstone; 1996: 131-149.

Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement. CLSI Document M100-22. Wayne, PA: Clinical and Laboratory Standards Institute; 2012.

Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Third Informational Supplement. CLSI Document M100-23. Wayne, PA: Clinical and Laboratory Standards Institute; 2013.

Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fifth Informational Supplement. CLSI Document M100-25. Wayne, PA: Clinical and Laboratory Standards Institute; 2015.

Sharma P, Dahiya S, Manral N, Kumari B, Kumar S, Pandey S, et al. Changing trends of culture-positive typhoid fever and antimicrobial susceptibility in a tertiary care North Indian Hospital over the last decade. Indian J Med Microbiol. 2018;36(1):70.

Singh L, Cariappa MP. Blood culture isolates and antibiogram of Salmonella: experience of a tertiary care hospital. Med J Armed Forces India. 2016;72(3):281-4.

Bhattacharya SS, Das U, Choudhury BK. Occurrence and antibiogram of Salmonella typhi and S. paratyphi A isolated from Rourkela, Orissa. Indian J Med Res. 2011;133(4):431-3.

Choudhary A, Gopalakrishnan R, Senthur NP, Ramasubramanian V, Ghafur KA, Thirunarayan MA. Antimicrobial susceptibility of Salmonella enterica serovars in a tertiary care hospital in southern India. The Indian J Med Res. 2013;137(4):800.

Sharma P, Dahiya S, Kumari B, Balaji V, Sood S, Das BK, et al. Pefloxacin as a surrogate marker for quinolone susceptibility in Salmonella enterica serovars typhi paratyphi A in India. Indian J Med Res. 2017;145(5):687.

Gokul BN, Menezes GA, Harish BN. ACC-1 β-Lactamase–producing Salmonella enterica serovar Typhi, India. Emerg Infect Dis. 2010;16(7):1170-1.

Nolan CM, White PC. Treatment of typhoid carriers with amoxicillin. Correlates of successful therapy. JAMA. 1978;239(22):2352-4.

Dolna I, Gosciniak G, Ruczkowska J. Sensitivity of Salmonella strains to augmentin and new generation cephalosporins and aminoglycosides. Przegl Epidemiol. 1989;43(2):218-22.

Sania KM, Shyamasakhi PD, Pramodini KD, Sulochana KD. Evaluation of minimum inhibitory concentration of chloramphenicol for Salmonella spp. Isolated from enteric fever cases in a tertiary hospital in Imphal. Int J Pharm Sci Res. 2016;7(9):3815-19.

Mohanty S, Renuka K, Sood S, Das BK, Kapil A. Antibiogram pattern and seasonality of Salmonella serotypes in a North Indian tertiary care hospital. Epidemiol Infect. 2006;134(5):961-6.

Ramesh U, Das S, Balasubramanian A. Re-emergence of chloramphenicol-susceptible Salmonella typhi and Paratyphi A strains in India. Indian J Med Microbiol. 2016;34(2):262.

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Published

2019-10-22

How to Cite

Rashed, M. R., Yadav, A., & Jakribettu, R. P. (2019). Trends in antimicrobial susceptibility of blood culture-positive typhoid fever over half a decade in adults attending a tertiary care teaching hospital in South India. International Journal of Basic & Clinical Pharmacology, 8(11), 2523–2527. https://doi.org/10.18203/2319-2003.ijbcp20194796

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Original Research Articles