scholarly journals Heading towards threat of resistant super bug…. current pattern of antimicrobial sensitivity to salmonella typhi in Karachi.

2020 ◽  
Vol 27 (05) ◽  
pp. 1070-1073
Author(s):  
Syed Tahseen Akhtar ◽  
Iftikhar Haider Naqvi ◽  
Owais Khan ◽  
Syed Tauqeer Ahmed Hasmi ◽  
Saiyeda Nayema Zehra Rizvi
Keyword(s):  
Typhoid Fever ◽  
Demographic Data ◽  
Treatment Options ◽  
Antibiotic Sensitivity ◽  
Salmonella Typhi ◽  
Multidrug Resistant ◽  
Drug Resistant ◽  
Continuous Variables ◽  
Antimicrobial Sensitivity ◽  
Study Setting

Objectives: The present study was aimed to find out the prevalence of MDR and XDR Typhoid and the remaining or alternate treatment options here in Karachi. Study Design: Descriptive retrospective analytical study. Setting: Department of Medicine, at Mamji Hospital Karachi. Period: From Jan 2019 till July 2019. Material & Methods: The medical records of all the patient admitted, were reviewed by the department of Medicine, at Mamjee Hospital Karachi specifically diagnosed to have Typhoid fever during the period between Jan 2019 till July 2019. A total of 72 patients were included in this study. Chart reviews were used to obtain and later collect the data. Typhoid was confirmed over Blood culture yielding Salmonella typhi. Demographic data and pattern of antibiotic sensitivity were collected. Statistical analysis was performed on SPSS version 17. Continuous variables were expressed as mean ± SD. Discrete variables were expressed as percentages and proportions. Results: From January 2019 till July 2019, 72 patients were diagnosed to have Typhoid fever (Salmonella Typhi culture positive) of which 43(60%) were male and majority of the patients were aged between 18 to 40 years 37(51%). Out of 14 antibiotics checked for sensitivity to Salmonella Typhi the Quinolones were the most resistant (85%) antibiotics followed by Ampicillin (83%) and Trimethoprim-sulfamethoxazole (82%). 48(66%) among 72 patients had extended drug resistant typhoid, 14(19%) were multidrug resistant typhoid while 11(15%) were pan sensitive. Conclusion: Majority of the patients had extended drug resistant typhoid, whereas quite a few had multidrug resistant typhoid. Most sensitive drugs were Imipenem, meropenem and Azithromycin whereas Quinolones along with other agents were found to have most resistance against Salmonella Typhi.

scholarly journals X-DR (Drug Resistant) typhoid fever in children.

2020 ◽  
Vol 27 (09) ◽  
pp. 1947-1951
Author(s):  
Muhammad Sohail ◽  
Jaweeria Masood ◽  
Jawaria Khalid ◽  
Zahid Mahmood Anjum ◽  
Iram Iqbal ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Significant Proportion ◽  
Antibiotic Sensitivity ◽  
Salmonella Typhi ◽  
Blood Cultures ◽  
Drug Resistant ◽  
Female Ratio ◽  
Sensitivity Pattern ◽  
Zones Of Inhibition ◽  
Culture Positive

Objectives: To study antibiotic sensitivity pattern of Salmonella typhi in children with enteric fever. Study Design: Prospective, Consecutive sampling. Setting: Children Hospital and Institute of Child Health, Faisalabad. Period: 6 Months June 2019 to November 2019. Material & Methods: All admitted children of age 1-16 years with strong clinical suspicion of typhoid fever and with no comorbidities were included in this study. Blood cultures and other relevant investigations were performed to rule out other causes of fever. After identification of organism as Salmonella typhi, antibiotics susceptibility testing was done by disk diffusion technique and zones of inhibition were interpreted according to clinical and Lab standard (CLSI) guidelines. Results: Out of 60 patients maximum children were < 5 year and >10 year of age. Maximum cases were admitted during July to September. Male to female ratio was 1.6:1. We were able to send blood cultures of 31 cases (51%) only. Out of them 14 cases (45%) were found culture positive. All culture positive (100%) were found sensitive to meropenem. 92.8% were found sensitive to azithromycin and 7.1% were found sensitive to amikacin. Overall 16 cases treated with meropenem, 10 cases (16%) with azithromycin and one with amikacin. However, 33 cases (55%) responded to ceftriaxone alone. Conclusion: Sensitivity pattern of Salmonella typhi revealed significant proportion of multidrug and extensive drug resistant strain. So, continue surveillance is needed in this regard to find actual burden of XDR typhoid fever. We recommend local district administration and health authorities to launch an awareness campaign regarding sanitation, good hygiene, use of safe of water and mass vaccination of children with conjugated vaccine against typhoid. Alongwith above measures antibiotic stewardship should be started.

scholarly journals Sensitivity Patterns of Bacterial Pathogens Isolated from Blood Cultures of Under-Five Children with Pneumonia and Clinical Sepsis

Life ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 450
Author(s):  
Sufia Islam ◽  
Ashiqur Rahman Akand ◽  
Tasnova Tasnim Nova ◽  
Christian Lehmann ◽  
Mohammod Jobayer Chisti
Keyword(s):  
Treatment Options ◽  
Clinical Signs ◽  
Antibiotic Sensitivity ◽  
Salmonella Typhi ◽  
Multidrug Resistant ◽  
Blood Cultures ◽  
Bacterial Strains ◽  
Coagulase Negative Staphylococci ◽  
Acinetobacter Species ◽  
Clinical Sepsis

Treatment options for pneumonia and sepsis by antibiotics are limited due to the development of multidrug-resistant bacterial strains. This unmatched case-control study determined the antibiotic sensitivity against bacterial isolates obtained from septic and nonseptic children with pneumonia. Children of either sex aged 0–59 months with a history of cough or shortness of breath and radiologically confirmed pneumonia were enrolled in this study. Cases with clinical signs of sepsis at admission (n = 151) were compared to cases without sepsis as controls (n = 107). A total of 205 children had a performance of blood culture, with 123 children suffering from clinical sepsis. Blood cultures showed bacterial growth in 19% of the septic samples, with 8% coagulase-negative staphylococci and 2.4% Acinetobacter species. Only 1.6% of the cases were infected by Streptococcus pneumonia, Haemophilus influenzae, Salmonella typhi and Klebsiella. In contrast, children without sepsis presented positive blood cultures with growth of Salmonella typhi in 2.4% of the cases and growth of Klebsiella in 1.2%. Bacteria were sensitive to imipenem in 100% of the cases (86% for meropenem, 83% for ceftazidime and 76% for ciprofloxacin). The mortality rate was significantly higher in children with pneumonia complicated by sepsis (odds ratio (OR) = 3.02, 95% confidence interval (CI), 1.11–8.64, p < 0.027). Knowledge about specific laboratory characteristics in children with pneumonia will facilitate an early diagnosis and treatment of sepsis and reduce mortality.

scholarly journals The molecular basis of extensively drug-resistant Salmonella Typhi isolates from pediatric septicemia patients

2021 ◽  
Author(s):  
Chanmi Kim ◽  
Iqra Latif ◽  
Durga P Neupane ◽  
Gi Young Lee ◽  
Ryan S Kwon ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Typhoid Fever ◽  
Molecular Basis ◽  
Treatment Options ◽  
Health Sector ◽  
Salmonella Typhi ◽  
Detection Methods ◽  
Medium Size ◽  
Drug Resistant ◽  
Extensively Drug Resistant

Sepsis is a syndromic response to infections and is becoming an emerging threat to the public health sector, particularly in developing countries. Salmonella Typhi (S. Typhi), the cause of typhoid fever, is one primary cause of pediatric sepsis in typhoid endemic areas. Extensively drug-resistant (XDR) S. Typhi is more common among pediatric patients, which is responsible for over 90% of the reported XDR typhoid cases, but the majority of antibiotic resistance studies available have been carried out using S. Typhi isolates from adult patients. Here, we characterized XDR S. Typhi isolates from a medium size cohort of pediatric typhoid patients to determine their antibiotic-resistance-related gene signatures associated with common treatment options to typhoid fever patients. This study informs the molecular basis of antibiotic-resistance among recent S. Typhi isolates from pediatric septicemia patients, therefore providing insights into the development of molecular detection methods and control strategies for XDR S. Typhi.

Resistance to nitrofurantoin is an indicator of extensive drug-resistant (XDR) Enterobacteriaceae

2021 ◽  
Vol 70 (4) ◽  
Author(s):  
Balaram Khamari ◽  
Prakash Kumar ◽  
Bulagonda Eswarappa Pradeep
Keyword(s):  
Antimicrobial Agents ◽  
Efflux Pump ◽  
Treatment Options ◽  
Strong Association ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
Content Type ◽  
Link Type

Introduction. Nitrofurantoin is one of the preferred antibiotics in the treatment of uropathogenic multidrug-resistant (MDR) infections. However, resistance to nitrofurantoin in extensively drug-resistant (XDR) bacteria has severely limited the treatment options. Gap statement. Information related to co-resistance or collateral sensitivity (CS) with reference to nitrofurantoin resistant bacteria is limited. Aim. To study the potential of nitrofurantoin resistance as an indicator of the XDR phenotype in Enterobacteriaceae . Methods. One hundred (45 nitrofurantoin-resistant, 21 intermediately resistant and 34 nitrofurantoin-susceptible) Enterobacteriaceae were analysed in this study. Antibiotic susceptibility testing (AST) against nitrofurantoin and 17 other antimicrobial agents across eight different classes was performed by using the Vitek 2.0 system. The isolates were screened for the prevalence of acquired antimicrobial resistance (AMR) and efflux pump genes by PCR. Results. In total, 51 % of nitrofurantoin-resistant and 28 % of intermediately nitrofurantoin resistant isolates exhibited XDR characteristics, while only 3 % of nitrofurantoin-sensitive isolates were XDR (P=0.0001). Significant co-resistance was observed between nitrofurantoin and other tested antibiotics (β-lactam, cephalosporin, carbapenem, aminoglycoside and tetracycline). Further, the prevalence of AMR and efflux pump genes was higher in the nitrofurantoin-resistant strains compared to the susceptible isolates. A strong association was observed between nitrofurantoin resistance and the presence of bla PER-1, bla NDM-1, bla OXA-48, ant(2) and oqxA-oqxB genes. Tigecycline (84 %) and colistin (95 %) were the only antibiotics to which the majority of the isolates were susceptible. Conclusion. Nitrofurantoin resistance could be an indicator of the XDR phenotype among Enterobacteriaceae , harbouring multiple AMR and efflux pump genes. Tigecycline and colistin are the only antibiotics that could be used in the treatment of such XDR infections. A deeper understanding of the co-resistance mechanisms in XDR pathogens and prescription of AST-based appropriate combination therapy may help mitigate this problem.

scholarly journals Drug-Resistant Salmonella typhi in Pakistan

2019 ◽  
Vol 59 (1) ◽  
pp. 31-33 ◽  
Author(s):  
Christine E. Petrin ◽  
Russell W. Steele ◽  
Elizabeth A. Margolis ◽  
Justin M. Rabon ◽  
Holly Martin ◽  
...  
Keyword(s):  
United States ◽  
Typhoid Fever ◽  
Enteric Fever ◽  
The United States ◽  
Salmonella Typhi ◽  
Antimicrobial Treatment ◽  
Third Generation ◽  
Drug Resistant ◽  
Oral Transmission ◽  
Third Generation Cephalosporins

Enteric fever (formerly typhoid fever) is a bacterial illness caused by fecal-oral transmission of Salmonella typhi or paratyphi. In early 2018, an outbreak of Salmonella typhi resistant to third-generation cephalosporins, ampicillin, ciprofloxacin, trimethroprim-sulfamethoxazole, and chloramphenicol was reported in Pakistan. This strain, termed “extensively resistant typhi,” has infected more than 5000 patients in endemic areas of South Asia, as well as travelers to and from these areas, including 5 cases in the United States. We present the case of one such child who developed extensively resistant enteric fever during a recent visit to Pakistan and required broader antimicrobial treatment than typically required. Clinicians should be aware that incoming cases of enteric fever may be nonsusceptible to commonly recommended antibiotics and that extensively resistant typhi requires treatment with carbapenems such as meropenem or azithromycin.

scholarly journals Shifting Gears: The Future of Polymyxin Antibiotics

Antibiotics ◽  
2019 ◽  
Vol 8 (2) ◽  
pp. 42 ◽  
Author(s):  
Lenhard ◽  
Bulman ◽  
Tsuji ◽  
Kaye
Keyword(s):  
Treatment Options ◽  
Multidrug Resistant ◽  
Drug Resistant ◽  
Carbapenem Resistant ◽  
The Future ◽  
Important Addition ◽  
Future Strategy ◽  
Future Utility ◽  
A Current

The manuscripts contained in this special edition of Antibiotics represent a current review of the polymyxins as well as highlights from the 3rd International Polymyxin Conference, which was held in Madrid, Spain, April 25 to 26, 2018. The role of the polymyxin antibiotics has evolved over time based on the availability of alternative agents. After high rates of nephrotoxicity caused the drug class to fall out of favor, polymyxins were once against utilized in the 21st century to combat drug-resistant pathogens. However, the introduction of safer agents with activity against drug-resistant organisms has brought the future utility of polymyxins into question. The present review investigates the future niche of polymyxins by evaluating currently available and future treatment options for difficult-to-treat pathogens. The introduction of ceftazidime-avibactam, meropenem-vaborbactam and plazomicin are likely to decrease polymyxin utilization for infections caused by Enterobacteriaceae. Similarly, the availability of ceftolozane-tazobactam will reduce the use of polymyxins to counter multidrug-resistant Pseudomonas aeruginosa. In contrast, polymyxins will likely continue be an important option for combatting carbapenem-resistant Acinetobacter baumannii until better options become commercially available. Measuring polymyxin concentrations in patients and individualizing therapy may be a future strategy to optimize clinical outcomes while minimizing nephrotoxicity. Inhaled polymyxins will continue to be an adjunctive option for pulmonary infections but further clinical trials are needed to clarify the efficacy of inhaled polymyxins. Lastly, safer polymyxin analogs will potentially be an important addition to the antimicrobial armamentarium.

scholarly journals Carbapenemase Genes and Multidrug Resistance of Acinetobacter Baumannii: A Cross Sectional Study of Patients with Pneumonia in Southern Vietnam

Antibiotics ◽  
2019 ◽  
Vol 8 (3) ◽  
pp. 148 ◽  
Author(s):  
Cuong Hoang Quoc ◽  
Thao Nguyen Thi Phuong ◽  
Hai Nguyen Duc ◽  
Trung Tran Le ◽  
Hang Tran Thi Thu ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Acinetobacter Baumannii ◽  
Demographic Data ◽  
Treatment Options ◽  
Bacterial Pathogen ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Carbapenem Resistant ◽  
Hospital Acquired

Background: Acinetobacter baumannii (Ab) is an opportunistic bacterial pathogen found in hospital-acquired infections including nosocomial pneumonia, especially multidrug-resistant Ab. This study aims to survey the drug resistance profiles of Ab isolated from patients in Thong Nhat Dong Nai General Hospital and assess the relationship between genotypes and antibiotic resistance; Methods: Ninety-seven Ab strains isolated from 340 lower respiratory tract specimens among pneumonia patients were used to screen the most common local carbapenemase genes. Antimicrobial susceptibility testing results and demographic data were collected and minimum inhibitory concentrations (MIC) of colistin were also determined; Results: Over 80% and 90% of Ab strains were determined as carbapenem-resistant and multidrug-resistant (MDR), respectively. Most of the strains carried carbapenemase genes, including blaOXA-51, blaOXA-23-like, blaOXA-58-like, and blaNDM-1, with proportions of 97 (100%), 76 (78.4%), 10 (10.3%), 6 (6.2%), respectively. Amongst these genes, blaOXA-23-like was the only gene which significantly influenced the resistance (p < 0.0001); and Conclusions: The severity of Ab antibiotic resistance is urgent and specifically related to carbapenemase encoding genes. Therefore, screening of MDR Ab and carbapenemase for better treatment options is necessary.

scholarly journals Curcumin Analogues as a Potential Drug against Antibiotic Resistant Protein, β-Lactamases and L, D-Transpeptidases Involved in Toxin Secretion in Salmonella typhi: A Computational Approach

2021 ◽  
Vol 2 (1) ◽  
pp. 77-100
Author(s):  
Tanzina Akter ◽  
Mahim Chakma ◽  
Afsana Yeasmin Tanzina ◽  
Meheadi Hasan Rumi ◽  
Mst. Sharmin Sultana Shimu ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Typhoid Fever ◽  
Homology Modeling ◽  
Salmonella Typhi ◽  
Multidrug Resistant ◽  
Drug Candidate ◽  
In Vivo Experiments ◽  
Curcumin Analogs

Typhoid fever caused by the bacteria Salmonella typhi gained resistance through multidrug-resistant S. typhi strains. One of the reasons behind β-lactam antibiotic resistance is -lactamase. L, D-Transpeptidases is responsible for typhoid fever as it is involved in toxin release that results in typhoid fever in humans. A molecular modeling study of these targeted proteins was carried out by various methods, such as homology modeling, active site prediction, prediction of disease-causing regions, and by analyzing the potential inhibitory activities of curcumin analogs by targeting these proteins to overcome the antibiotic resistance. The five potent drug candidate compounds were identified to be natural ligands that can inhibit those enzymes compared to controls in our research. The binding affinity of both the Go-Y032 and NSC-43319 were found against β-lactamase was −7.8 Kcal/mol in AutoDock, whereas, in SwissDock, the binding energy was −8.15 and −8.04 Kcal/mol, respectively. On the other hand, the Cyclovalone and NSC-43319 had an equal energy of −7.60 Kcal/mol in AutoDock, whereas −7.90 and −8.01 Kcal/mol in SwissDock against L, D-Transpeptidases. After the identification of proteins, the determination of primary and secondary structures, as well as the gene producing area and homology modeling, was accomplished. The screened drug candidates were further evaluated in ADMET, and pharmacological properties along with positive drug-likeness properties were observed for these ligand molecules. However, further in vitro and in vivo experiments are required to validate these in silico data to develop novel therapeutics against antibiotic resistance.

scholarly journals Identification of a Novel Therapeutic Target against XDR Salmonella Typhi H58 Using Genomics Driven Approach Followed Up by Natural Products Virtual Screening

2021 ◽  
Vol 9 (12) ◽  
pp. 2512
Author(s):  
Khurshid Jalal ◽  
Kanwal Khan ◽  
Muhammad Hassam ◽  
Muhammad Naseer Abbas ◽  
Reaz Uddin ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Drug Targets ◽  
Salmonella Typhi ◽  
Drug Resistant ◽  
Acid Biosynthesis ◽  
New Drug ◽  
Subtractive Genomics ◽  
Colanic Acid ◽  
Novel Drug ◽  
Potential Drug Targets

Typhoid fever is caused by a pathogenic, rod-shaped, flagellated, and Gram-negative bacterium known as Salmonella Typhi. It features a polysaccharide capsule that acts as a virulence factor and deceives the host immune system by protecting phagocytosis. Typhoid fever remains a major health concern in low and middle-income countries, with an estimated death rate of ~200,000 per annum. However, the situation is exacerbated by the emergence of the extensively drug-resistant (XDR) strain designated as H58 of S. Typhi. The emergence of the XDR strain is alarming, and it poses serious threats to public health due to the failure of the current therapeutic regimen. A relatively newer computational method called subtractive genomics analyses has been widely applied to discover novel and new drug targets against pathogens, particularly drug-resistant ones. The method involves the gradual reduction of the complete proteome of the pathogen, leading to few potential and novel drug targets. Thus, in the current study, a subtractive genomics approach was applied against the Salmonella XDR strain to identify potential drug targets. The current study predicted four prioritized proteins (i.e., Colanic acid biosynthesis acetyltransferase wcaB, Shikimate dehydrogenase aroE, multidrug efflux RND transporter permease subunit MdtC, and pantothenate synthetase panC) as potential drug targets. Though few of the prioritized proteins are treated in the literature as the established drug targets against other pathogenic bacteria, these drug targets are identified here for the first time against S. Typhi (i.e., S. Typhi XDR). The current study aimed at drawing attention to new drug targets against S. Typhi that remain largely unexplored. One of the prioritized drug targets, i.e., Colanic acid biosynthesis acetyltransferase, was predicted as a unique, new drug target against S. Typhi XDR. Therefore, the Colanic acid was further explored using structure-based techniques. Additionally, ~1000 natural compounds were docked with Colanic acid biosynthesis acetyltransferase, resulting in the prediction of seven compounds as potential lead candidates against the S. Typhi XDR strain. The ADMET properties and binding energies via the docking program of these seven compounds characterized them as novel drug candidates. They may potentially be used for the development of future drugs in the treatment of Typhoid fever.

scholarly journals 165. Emergence of Extensively Drug-Resistant Salmonella enterica Serotype Typhi Infections—United States, 2008–2020

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S99-S100
Author(s):  
Felicita Medalla ◽  
Louise Francois Watkins ◽  
Michael Hughes ◽  
Meseret Birhane ◽  
Layne Dorough ◽  
...  
Keyword(s):  
United States ◽  
Typhoid Fever ◽  
The United States ◽  
Empiric Therapy ◽  
Salmonella Typhi ◽  
International Travel ◽  
Drug Resistant ◽  
Extensively Drug Resistant ◽  
Large Outbreak ◽  
Control And Prevention

Abstract Background Typhoid fever, caused by Salmonella Typhi, is fatal in 12%–30% of patients not treated with appropriate antibiotics. In 2016, a large outbreak of extensively drug-resistant (XDR) Typhi infections began in Pakistan with cases reported globally, including the United States. In 2021, the Centers for Disease Control and Prevention (CDC) issued a health advisory on XDR infections among U.S. residents without international travel. We describe resistance of Typhi infections diagnosed in the United States to help guide treatment decisions. Methods Typhoid fever is a nationally notifiable disease. Health departments report cases to CDC through the National Typhoid and Paratyphoid Fever Surveillance system. Isolates are submitted to the National Antimicrobial Resistance Monitoring System for antimicrobial susceptibility testing (AST) using broth microdilution. AST results are categorized by Clinical and Laboratory Standards Institute criteria. We defined XDR as resistant to ceftriaxone, ampicillin, chloramphenicol, and co-trimoxazole, and nonsusceptible to ciprofloxacin. Results During 2008–2019, of 4,637 Typhi isolates, 52 (1%) were ceftriaxone resistant (axo-R); 71% were ciprofloxacin nonsusceptible, 1 azithromycin resistant (azm-R), and none meropenem resistant. XDR was first detected in 2018, in 2% of 474 isolates and increased to 7% of 535 in 2019. Of the 52 axo-R isolates, 46 were XDR, of which 45 were from travelers to Pakistan, and one from a non-traveler; 6 were not XDR, of which 4 were linked to travel to Iraq. In preliminary 2020 reports, 23 isolates were XDR; 14 were from travelers to Pakistan, 8 from non-travelers, and 1 from someone with unknown travel status. Among those with XDR infection, median age was 11 years (range 1–62), 54% were female, and 62% were from 6 states. Conclusion Ceftriaxone-resistant Typhi infections, mostly XDR, are increasing. Clinicians should ask patients with suspected Typhi infections about travel and adjust treatment based on susceptibility results. Carbapenem, azithromycin, or both may be considered for empiric therapy of typhoid fever among travelers to Pakistan or Iraq and in uncommon instances when persons report no international travel. Ceftriaxone is an empiric therapy option for travelers to countries other than Pakistan and Iraq. Disclosures All Authors: No reported disclosures

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