scholarly journals Minimum inhibitory concentration of Ceftazidime-Avibactam against Clinical isolates of XDR Salmonella enterica Serovar Typhi

2021 ◽  
Author(s):  
Kokab Jabeen ◽  
Sidrah Saleem ◽  
Summiya Nizam-ud-din ◽  
Faiqa Arshad ◽  
Zill-e-huma ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Salmonella Enterica ◽  
Clinical Laboratory ◽  
Test Method ◽  
Clinical Isolates ◽  
Automated System ◽  
Diffusion Method ◽  
Drug Resistant ◽  
Disc Diffusion ◽  
Extensively Drug Resistant

Abstract Background: Typhoid fever is a major healthcare problem in low and middle-income countries. The emergence of extensively drug-resistant (XDR) typhoid has further narrowed down the way to already limited therapeutic options. WHO has listed S.Typhi amongst the priority pathogens against which new treatment options should be discovered.Objective: To determine In-vitro activity of Ceftazidime-avibactam against clinical isolates of XDR S.Typhi.Study design: This is a cross-sectional studyPlace and duration of the study: The Department of Microbiology, University of health sciences, Lahore from January to June 2021.Methodology: Antimicrobial susceptibility was performed initially by Kirby Bauer disc diffusion method for 150 of XDR Salmonella enterica Serovar Typhi and MICs of all the recommended antibiotics was determined by VITEK 2 (bioMérieux) fully automated system using Clinical Laboratory Standard Institute (CLSI) 2021 guidelines. MICs by the E-test method were determined for Ceftazidime-avibactam and Azithromycin only. All tests were done in duplicate.Results: All 150 (100%) isolates were sensitive to Ceftazidime-avibactam by disc diffusion and E-test methods. Out of 150 isolates 8(5.3%) were having high MICs against Azithromycin.Conclusions: Ceftazidime-avibactam can be used wisely to treat ESBL producing XDR typhoid fever cases especially in countries like Pakistan where Typhoid fever is endemic and majority of isolates are extensively drug resistant.

scholarly journals An Update on Isolation of Extensively Drug Resistant (XDR) Salmonella enterica from Blood Cultures in a Tertiary Care Centre

2019 ◽  
Vol 33 (4) ◽  
pp. 1-5
Author(s):  
Sadia Hameed
Keyword(s):  
Antimicrobial Resistance ◽  
Blood Culture ◽  
Typhoid Fever ◽  
Salmonella Enterica ◽  
Antimicrobial Agents ◽  
Salmonella Typhi ◽  
Blood Cultures ◽  
Drug Resistant ◽  
Second Line ◽  
Extensively Drug Resistant

Introduction: Typhoid fever is a public health issue, burdening many regions of the world with poor socioeconomic background. Management of this disease faces the major hurdle of antimicrobial resistance. The present study reveals current pattern of antimicrobial susceptibility among Salmonella enterica (Salmonella typhi & Salmonella paratyphi A) blood culture isolates from typhoid fever cases. Regular data collection about Salmonella infections and their response to antimicrobial agents, coupled with a long term commitment to providing adequate health information systems, is the key to effective planning and policy formation against typhoid fever. Aims & Objectives: To evaluate the prevalence of ceftriaxone resistant Salmonella enterica isolates from blood cultures in Shaikh Zayed Medical Complex for updating nosocomial antimicrobial resistance data. Place and duration of study: This research study was conducted at Shaikh Zayed Medical Complex, Lahore from March 2018 to May 2019. Material & Methods: Blood cultures positive for Salmonella enterica were analyzed, taking into consideration the gender & age of patients with typhoid fever. Antimicrobial susceptibility testing was carried out through disc diffusion method. The recommended antimicrobial agents for S. typhi (Salmonella typhi) & S. paratyphi A (Salmonella Parathyphi A) (as per CLSI, USA 2018/2019 guidelines; described later), were tested and analyzed during this study with the main focus on 3rd generation cephalosporin resistance pattern. Among second line treatment options, meropenem and azithromycin were selected for study. Results: Out of 899 isolates of Salmonella enterica (from 13964 samples for blood culture), 849 (94.4%) were S. typhi and 50 (5.6%) were S. paratyphi A. Of these, 57.1% isolates were from males, 42.9% from females, 81.7% from children (age less than 12 years) and 18.3% were from adults (age more than 12 years). A continuously rising resistance percentage was observed for 3rd generation cephalosporins over the span of fifteen months. It was 43.4% for ceftriaxone (CRO). No case of meropenem and azithromycin resistance was observed during study period. Conclusion: Demographic information was provided by this study regarding high level of resistance among Salmonella enterica isolates particularly S. typhi .The first line antibiotic drugs were a complete failure in ongoing outbreak of typhoid fever. The novel results of this study are the high resistance percentages for 3rd generation cehalosporins, whether oral or parenteral. This result is worrisome as it will leave us with no option but to resort to second line drugs. However, an increasing trend of blood culturing was observed in this research. Extensively drug resistant (XDR) Salmonella infection has definitely highlighted the importance of blood culture and its use as a more preferred diagnostic tool. Key words: Typhoid fever, Extensively drug resistant (XDR) Salmonella enterica, (S. typhi & S. paratyphi A), Antimicrobial Resistance, CRO (Ceftriaxone) resistance.

scholarly journals Emergence of an Extensively Drug-Resistant Salmonella enterica Serovar Typhi Clone Harboring a Promiscuous Plasmid Encoding Resistance to Fluoroquinolones and Third-Generation Cephalosporins

mBio ◽  
2018 ◽  
Vol 9 (1) ◽  
Author(s):  
Elizabeth J. Klemm ◽  
Sadia Shakoor ◽  
Andrew J. Page ◽  
Farah Naz Qamar ◽  
Kim Judge ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Typhoid Fever ◽  
Salmonella Enterica ◽  
Large Scale ◽  
Enteric Bacteria ◽  
Whole Genome ◽  
Third Generation ◽  
Drug Resistant ◽  
Extensively Drug Resistant ◽  
Third Generation Cephalosporins

ABSTRACT Antibiotic resistance is a major problem in Salmonella enterica serovar Typhi, the causative agent of typhoid. Multidrug-resistant (MDR) isolates are prevalent in parts of Asia and Africa and are often associated with the dominant H58 haplotype. Reduced susceptibility to fluoroquinolones is also widespread, and sporadic cases of resistance to third-generation cephalosporins or azithromycin have also been reported. Here, we report the first large-scale emergence and spread of a novel S. Typhi clone harboring resistance to three first-line drugs (chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) as well as fluoroquinolones and third-generation cephalosporins in Sindh, Pakistan, which we classify as extensively drug resistant (XDR). Over 300 XDR typhoid cases have emerged in Sindh, Pakistan, since November 2016. Additionally, a single case of travel-associated XDR typhoid has recently been identified in the United Kingdom. Whole-genome sequencing of over 80 of the XDR isolates revealed remarkable genetic clonality and sequence conservation, identified a large number of resistance determinants, and showed that these isolates were of haplotype H58. The XDR S. Typhi clone encodes a chromosomally located resistance region and harbors a plasmid encoding additional resistance elements, including the bla CTX-M-15 extended-spectrum β-lactamase, and carrying the qnrS fluoroquinolone resistance gene. This antibiotic resistance-associated IncY plasmid exhibited high sequence identity to plasmids found in other enteric bacteria isolated from widely distributed geographic locations. This study highlights three concerning problems: the receding antibiotic arsenal for typhoid treatment, the ability of S. Typhi to transform from MDR to XDR in a single step by acquisition of a plasmid, and the ability of XDR clones to spread globally. IMPORTANCE Typhoid fever is a severe disease caused by the Gram-negative bacterium Salmonella enterica serovar Typhi. Antibiotic-resistant S. Typhi strains have become increasingly common. Here, we report the first large-scale emergence and spread of a novel extensively drug-resistant (XDR) S. Typhi clone in Sindh, Pakistan. The XDR S. Typhi is resistant to the majority of drugs available for the treatment of typhoid fever. This study highlights the evolving threat of antibiotic resistance in S. Typhi and the value of antibiotic susceptibility testing and whole-genome sequencing in understanding emerging infectious diseases. We genetically characterized the XDR S. Typhi to investigate the phylogenetic relationship between these isolates and a global collection of S. Typhi isolates and to identify multiple genes linked to antibiotic resistance. This S. Typhi clone harbored a promiscuous antibiotic resistance plasmid previously identified in other enteric bacteria. The increasing antibiotic resistance in S. Typhi observed here adds urgency to the need for typhoid prevention measures.

Rapid detection of ceftriaxone resistance in clinical isolates of extensively drug resistant Salmonella enterica serovar Typhi

2021 ◽  
pp. 1-12
Author(s):  
Muhammad Luqman Satti ◽  
Faisal Hanif ◽  
Ashfaq Hussain ◽  
Saman Nadeem ◽  
Faryal Younis ◽  
...  
Keyword(s):  
Salmonella Typhi ◽  
Cross Sectional Study ◽  
Clinical Isolates ◽  
Diffusion Method ◽  
Disc Diffusion ◽  
Color Test ◽  
Cross Sectional ◽  
Salmonella Enterica Serovar Typhi ◽  
Extensively Drug Resistant ◽  
Vitek 2

Abstract Objective: To see the efficacy of rapid color test for the sensitivity of ceftriaxone against clinical isolates of Salmonella Typhi. Methods: This descriptive cross sectional study was carried out at the department of Microbiology, Pakistan Navy Ship (PNS) Shifa Hospital, Karachi from Nov 2018 through April 2019.We tested 97 clinical isolates of Salmonella Typhi by this rapid color test. All the isolates were also test by conventional disc diffusion method and MICs by Vitek-2 system. Results: Out of these isolates, 83 were ceftriaxone resistant while 14 isolates were ceftriaxone sensitive. Sensitivity and specificity of rapid color test were 100% when compared with results of disc diffusion, E-test and Vitek 2 system. All the results were readable within 2 hours on color test. Conclusion: This color test is rapid, accurate and inexpensive and can be used as a screening test for ceftriaxone resistance in typhoid endemic areas. Keywords: Ceftriaxone; drug resistance; meropenem Continuous...

scholarly journals First Case of Typhoid Fever due to Extensively Drug-resistant Salmonella enterica serovar Typhi in Italy

Pathogens ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. 151 ◽  
Author(s):  
Michela Procaccianti ◽  
Alice Motta ◽  
Stefano Giordani ◽  
Sara Riscassi ◽  
Battista Guidi ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Salmonella Enterica ◽  
Empiric Therapy ◽  
Fluoroquinolone Resistance ◽  
Drug Resistant ◽  
Salmonella Enterica Serovar Typhi ◽  
Extensively Drug Resistant ◽  
First Case ◽  
Life Threatening ◽  
Additional Resistance

Typhoid fever is a potentially severe and occasionally life-threatening bacteraemic illness caused by Salmonella enterica serovar Typhi (S. Typhi). In Pakistan, an outbreak of extensively drug-resistant (XDR) S. Typhi cases began in November 2016. We report on a five-year-old boy who contracted enteric fever while travelling in Pakistan and was diagnosed after returning to Italy in September 2019. Blood culture isolated Salmonella enterica serovar Typhi that was XDR to all first-line antibiotics, including ceftriaxone and fluoroquinolones. Empiric therapy was switched to meropenem, and the patient recovered completely. Whole-genome sequencing showed that this isolate was of haplotype H58. The XDR S. Typhi clone encoded a chromosomally located resistance region and harbored a plasmid encoding additional resistance elements, including the blaCTX-M-15 extended-spectrum β-lactamase and the qnrS fluoroquinolone resistance gene. This is the first case of typhoid fever due to XDR S. Typhi detected in Italy and one of the first paediatric cases reported outside Pakistan, highlighting the need to be vigilant for future cases. While new vaccines against typhoid are in development, clinicians should consider adapting their empiric approach for patients returning from regions at risk of XDR S. Typhi outbreak with typhoid symptoms.

Decreased carO gene expression and OXA-type carbapenemases among extensively drug-resistant Acinetobacter baumannii strains isolated from burn patients in Tehran, Iran

2020 ◽  
Author(s):  
Elham Abbasi ◽  
Hossein Goudarzi ◽  
Ali Hashemi ◽  
Alireza Salimi Chirani ◽  
Abdollah Ardebili ◽  
...  
Keyword(s):  
Gene Expression ◽  
Acinetobacter Baumannii ◽  
High Rate ◽  
Burn Patients ◽  
Drug Resistant ◽  
Disc Diffusion ◽  
Carbapenem Resistant ◽  
Extensively Drug Resistant ◽  
Sds Page ◽  
Extensively Drug Resistance

AbstractA major challenge in the treatment of infections has been the rise of extensively drug resistance (XDR) and multidrug resistance (MDR) in Acinetobacter baumannii. The goals of this study were to determine the pattern of antimicrobial susceptibility, blaOXA and carO genes among burn-isolated A. baumannii strains. In this study, 100 A. baumannii strains were isolated from burn patients and their susceptibilities to different antibiotics were determined using disc diffusion testing and broth microdilution. Presence of carO gene and OXA-type carbapenemase genes was tested by PCR and sequencing. SDS-PAGE was done to survey CarO porin and the expression level of carO gene was evaluated by Real-Time PCR. A high rate of resistance to meropenem (98%), imipenem (98%) and doripenem (98%) was detected. All tested A. baumannii strains were susceptible to colistin. The results indicated that 84.9% were XDR and 97.9% of strains were MDR. In addition, all strains bore blaOXA-51 like and blaOXA-23 like and carO genes. Nonetheless, blaOXA-58 like and blaOXA-24 like genes were harbored by 0 percent and 76 percent of strains, respectively. The relative expression levels of the carO gene ranged from 0.06 to 35.01 fold lower than that of carbapenem-susceptible A. baumannii ATCC19606 and SDS – PAGE analysis of the outer membrane protein showed that all 100 isolates produced CarO. The results of current study revealed prevalence of blaOXA genes and changes in carO gene expression in carbapenem resistant A.baumannii.

scholarly journals Complete Genome Sequences of Four Extensively Drug-Resistant Acinetobacter baumannii Isolates from Thailand

2020 ◽  
Vol 9 (40) ◽  
Author(s):  
Peechanika Chopjitt ◽  
Thidathip Wongsurawat ◽  
Piroon Jenjaroenpun ◽  
Parichart Boueroy ◽  
Rujirat Hatrongjit ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Complete Genome ◽  
Sequence Type ◽  
Clinical Isolates ◽  
Drug Resistant ◽  
Genome Sequences ◽  
Content Type ◽  
Type Isolate ◽  
Resistant Genes ◽  
Extensively Drug Resistant

ABSTRACT Here, we report the complete genome sequences of four clinical isolates of extensively drug-resistant Acinetobacter baumannii (XDRAB), isolated in Thailand. These results revealed multiple antimicrobial-resistant genes, each involving two sequence type 16 (ST16) isolates, ST2, and a novel sequence type isolate, ST1479.

scholarly journals Extensively Drug Resistant Salmonella Enterica Serovar Typhi Misdiagnosis In Pakistan: A Matter Of Serious Concern

2021 ◽  
Vol 03 (09) ◽  
pp. 25-27
Author(s):  
Umar Saeed ◽  
◽  
Sara Rizwan Uppal ◽  
Zahra Zahid Piracha ◽  
Rizwan Uppal ◽  
...  
Keyword(s):  
Salmonella Enterica ◽  
Urban Areas ◽  
Implementation Strategies ◽  
Drug Resistant ◽  
Igg Antibodies ◽  
Salmonella Enterica Serovar Typhi ◽  
Rural And Urban Areas ◽  
Extensively Drug Resistant ◽  
Health Authorities ◽  
Rural And Urban

There have been several outbreaks of antimicrobial resistant (AMR) strains of Salmonella enterica serovar Typhi that cause extensively drug resistant (XDR) typhoid fever in Pakistan. It has been observed that many clinicians use serological diagnostic tests such as Widal agglutination, and TyphiDOT that detects IgM and IgG antibodies against the outer membrane protein of S. Typhi. However, it has been confirmed by many scientists that these test may lead to misdiagnosis against XDR S. Typhi. Due to lack of implementation strategies health authorities are unable to hamper Widal or TyphiDOT tests which are still practiced in many rural and urban areas.

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