Antimicrobial Sensitivity Trend in Blood Culture Positive Enteric Fever at Kathmandu Model Hospital

Background: For diagnosis of enteric fever, the culture of the organism from different body fluids is the gold standard. After diagnosis, it is important to treat with the right antibiotic before any complications can occur. The retrospective study is designed to explore the antibiotic sensitivity trend in blood culture positive typhoid fever cases and the extent of drug resistance before treatment is administered.Methods: A retrospective study was carried out for culture isolated enteric fever patients admitted in Kathmandu Model Hospital. The discharged records from January 2012 to December 2016 were analyzed. The patients above 15 years and with culture isolated enteric fever were included in the study.Results: One hundred fifty-nine strains of Salmonella typhi and paratyphi were isolated from Jan 2012 to Dec 2016 at Kathmandu Model Hospital. Out of 159 isolated, 125 (78.6%) were Salmonella typhi and 34 (21.4%) were paratyphi. Among them co-trimoxazole, chloramphenicol, ceftriaxone, cefotaxime, cefixime, and ofloxacin demonstrated 100% sensitivity. Similarly, amoxicillin sensitivity was 98.1% (n=156) while ciprofloxacin was sensitive in 6.3% (n=10), intermediately sensitive in 49.1% (n=78) and resistance in 44.7% (n=71).The newer quinolone levofloxacin showed 78.5% (n=11) sensitivity. Azithromycin was sensitive in 99.2% (n=132) of total isolated Salmonella species both typhi and paratyphi.Conclusions: A high degree of sensitivity was noted to chloramphenicol and co-trimoxazole, showing sensitivity has returned to conventional antibiotics. The drug-like ofloxacin is still the best responding drug in our contest whereas ciprofloxacin resistance is still high, but five years patterns show a trend of rollback of sensitivity.

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Antimicrobial Sensitivity Trend in Blood Culture Positive Enteric Fever

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v16i2.1377 ◽

2018 ◽

Vol 16 (2) ◽

pp. 228-232

Author(s):

Rajesh Dhoj Joshi ◽

Sachin Khadka ◽

Deepak Man Joshi ◽

Basudha Shrestha ◽

Ganesh Dangal ◽

...

Keyword(s):

Retrospective Study ◽

Blood Culture ◽

Enteric Fever ◽

Antibiotic Sensitivity ◽

Salmonella Typhi ◽

Antimicrobial Sensitivity ◽

Conventional Antibiotics ◽

The Right ◽

High Degree ◽

Culture Positive

Background: For diagnosis of enteric fever, the culture of the organism from different body fluids is the gold standard. After diagnosis, it is important to treat with the right antibiotic before any complications can occur. The retrospective study is designed to explore the antibiotic sensitivity trend in blood culture positive typhoid fever cases and the extent of drug resistance before treatment is administered.Methods: A retrospective study was carried out for culture isolated enteric fever patients admitted in Kathmandu Model Hospital. The discharged records from January 2012 to December 2016 were analyzed. The patients above 15 years and with culture isolated enteric fever were included in the study.Results: One hundred fifty-nine strains of Salmonella typhi and paratyphi were isolated from Jan 2012 to Dec 2016 at Kathmandu Model Hospital. Out of 159 isolated, 125 (78.6%) were Salmonella typhi and 34 (21.4%) were paratyphi. Among them co-trimoxazole, chloramphenicol, ceftriaxone, cefotaxime, cefixime, and ofloxacin demonstrated 100% sensitivity. Similarly, amoxicillin sensitivity was 98.1% (n=156) while ciprofloxacin was sensitive in 6.3% (n=10), intermediately sensitive in 49.1% (n=78) and resistance in 44.7% (n=71).The newer quinolone levofloxacin showed 78.5% (n=11) sensitivity. Azithromycin was sensitive in 99.2% (n=132) of total isolated Salmonella species both typhi and paratyphi. Conclusions: A high degree of sensitivity was noted to chloramphenicol and co-trimoxazole, showing sensitivity has returned to conventional antibiotics. The drug-like ofloxacin is still the best responding drug in our contest whereas ciprofloxacin resistance is still high, but five years patterns show a trend of rollback of sensitivity. Keywords: Cephalosporin; enteric fever; sensitivity.

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Antibiotic Sensitivity and Resistance Patterns of Salmonella Typhi in Rajshahi Medical College Hospital

TAJ Journal of Teachers Association ◽

10.3329/taj.v33i2.51307 ◽

2020 ◽

Vol 33 (2) ◽

pp. 10-14

Author(s):

Md Azizul Haque ◽

Laila Shamima Sharmin ◽

KM Faisal Alam ◽

Md Mohimanul Hoque ◽

M Morsed Zaman Miah ◽

...

Keyword(s):

Blood Culture ◽

Enteric Fever ◽

Antibiotic Sensitivity ◽

Salmonella Typhi ◽

Medical College Hospital ◽

Personal Hygiene ◽

Care Hospital ◽

College Hospital ◽

Medical College ◽

Sensitivity Pattern

Typhoid and paratyphoid fevers, collectively known as enteric fever, is caused by Salmonella enterica subspecies serovars Typhi and Paratyphi A, B and C. Despite this declining global trend, enteric fever is still considered to be a major public health hazard in Bangladesh and other developing countries due to poor sanitation, inadequate food safety measures and poor personal hygiene. In Bangladesh, the incidence of typhoid fever was reported to be 200 episodes per 100,000 person-years during 2003–2004. Multidrug-resistant (resistance to the first-line antimicrobials ampicillin, cotrimoxazole, and chloramphenicol) strains of S. Typhi and S. Paratyphi are on the rise globally and even cases of extensively drug-resistant (XDR) typhoid cases resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, third generation cephalosporins and fluoroquinolones are being reported from many corners of the world. This descriptive, observational study was carried out in Rajshahi Medical College Hospital Hospital, Rajshahi, Bangladesh from July 2017 to June 2019. Antibiotic sensitivity pattern of total 76 cases of enteric fever due to Salmonella Typhi were studied. Blood culture was carried out by BACT ALERT-3D, Automated blood culture analyzer from BioMeriuex SA, France Patented FAN Plus method. Based on the minimum inhibitory concentration (MIC), the organism was categorized as sensitive, intermediate, and resistant against the respective antibiotics as per Clinical and Laboratory Standards Institute (CLSI) criteria. We are reporting antibiotic sensitivity and resistant patterns of S. Typhi documented in Rajshahi Medical College Hospital, a large tertiary care hospital in Northern Bangladesh. TAJ 2020; 33(2): 10-14

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Antimicrobial sensitivity patterns of salmonella typhi in children

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v15i3.30198 ◽

2016 ◽

Vol 15 (3) ◽

pp. 416-418

Author(s):

Md Khoyber Ali ◽

Shahin Sultana

Keyword(s):

Blood Culture ◽

Nalidixic Acid ◽

Medical Science ◽

Antibiotic Sensitivity ◽

Public Health Problem ◽

Salmonella Typhi ◽

Diffusion Method ◽

Sensitivity Testing ◽

Antimicrobial Sensitivity ◽

Sensitivity Pattern

Background: Enteric fever is an important public health problem in developing countries including Bangladesh. A changing antibiotic sensitivity pattern of Salmonella typhi and emergence of resistance has increased to a great concern. Objective: Aim of the study was to investigate the antibiotic sensitivity pattern of Salmonella typhi. Methods: A total of 181 Salmonella typhi samples from 5 to 15 years age group were collected from blood culture during the period of October to December 2014 from IBN SINA Hospital, Dhaka, Bangladesh. Specimens from the blood culture were identified by standard procedures as needed. Antimicrobial susceptibility testing was performed by disk diffusion method according to The Clinical Laboratory Standard Institute guidelines. Results: Among the tested antibiotics, S. typhi was susceptible to ceftriaxone 100%, followed by cefixime and gentamicin 99.4%, ciprofloxacin 98.6%, cotrimoxazole 88.9%, azithromycin 88.4 % and least susceptible antibiotic was Ampicillin 62.5% and nalidixic acid 5%. Conclusion: The antimicrobial sensitivity testing showed that the Salmonella typhi were highly sensitive (>88%) to most of the drugs used in this study, whereas nalidixic acid showed only 5% sensitivity. So this study indicates that ceftriaxone, cefixime, gentamicin and ciprofloxacin can be used as a first line therapy and nalidixic acid should be avoided for treatment.Bangladesh Journal of Medical Science Vol.15(3) 2016 p.416-418

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Study on the efficacy of ceftriaxone versus azithromycin for the treatment of uncomplicated enteric fever among the patients admitted in a tertiary level hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20214883 ◽

2021 ◽

Vol 11 (1) ◽

pp. 1

Author(s):

Sougata Mitra ◽

Masuma Khanam ◽

M. Iqbal Hossain ◽

Rukhsana Quadir

Keyword(s):

Blood Culture ◽

Physical Examination ◽

Typhoid Fever ◽

Clinical Cure ◽

Enteric Fever ◽

Salmonella Typhi ◽

Clearance Time ◽

Medical College ◽

Fever Clearance Time ◽

Culture Positive

Background: Typhoid fever is a severe debilitating and potentially life threating illness. In Bangladesh, typhoid fever is a round the year problem which sometimes take epidemic proportions. The reasons behind such occurrences are unsafe water supply, defective sewage system and unhygienic food handling practice. This study aimed to compare the efficacy of ceftriaxone and azithromycin in the treatment of uncomplicated enteric fever.Methods: An observational study was conducted at the department of pharmacology in Dhaka medical college, Dhaka, Bangladesh. Data were collected from blood culture positive patients for Salmonella typhi and Salmonella paratyphi, who admitted in the Dhaka medical college and hospital, Dhaka during the period of July 2015 to June 2016. Data was collected by using a structured questioner, face to face interview, physical examination and investigation reports. Patients were hospitalized during the entire treatment period and at admission evaluation was made by history and physical examination in a structured format. Subjects ware asked regarding changes in symptoms and possible adverse effects of the study drugs. All patients were asked to return two weeks after completion of treatment for follow up. Blood culture of Salmonella typhi or Salmonella paratyphi were done in all cases. Total 91 patients were culture positive for either S. typhi or S. paratyphi which were finally studied.Results: During the study period out of 91 patients, 51 were receiving ceftriaxone and 40 were receiving azithromycin. Clinical cure was achieved in 46 patients (90%) of ceftriaxone group and in 31 patients (78%) in the azithromycin group. There were no significant differences of clinical cure between both treatment groups (p>0.05). Mean fever clearance time in ceftriaxone group was 3±1.4 days and was 4±1.6 days for azithromycin group. Difference in fever clearance time was statistically significant (p<0.05). No clinical relapses were detected in any study subject. No major side effects of both drugs occurred in any subject.Conclusions: These results indicated that both ceftriaxone and azithromycin were effective against enteric fever caused by sensitive organisms and multi drug resistant S. typhi and S. paratyphi. It is concluded that ceftriaxone is more effective and can be a convenient alternative for the treatment of enteric fever, especially in developing countries like us where medical resources are scarce.

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Antimicrobial Sensitivity Pattern of Salmonella spp. Clinical Isolates in Blood Culture: A Tertiary Center Study

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v11i2.48965 ◽

2020 ◽

Vol 11 (2) ◽

pp. 134-137

Author(s):

ABM Shakil Gani ◽

Ayman Wadud ◽

Mizanur Rahman ◽

Sushmita Roy ◽

Selin Aktari

Keyword(s):

Blood Culture ◽

Enteric Fever ◽

Salmonella Typhi ◽

Diffusion Method ◽

Resistance Pattern ◽

Local Resistance ◽

Salmonella Spp ◽

Antimicrobial Sensitivity ◽

Sensitivity Pattern ◽

Tertiary Center

Objective: Bangladesh is an endemic area for enteric fever. Adequate and timely antimicrobial treatment invariably cures this disease. But resistant strains of Salmonella spp. have made it difficult to treat nowadays. This study will help clinicians in understanding the local resistance pattern of enteric fever and identifying recent changes in the trends of the sensitivity pattern of commonly used antibiotics in Bangladesh. Materials and Methods: This cross-sectional study was conducted during the period from January 2016 to June 2019 in Sheikh Hasina Medical College, Tangail, to determine the antimicrobial sensitivity patterns of Salmonella typhi and paratyphi isolated by blood culture from clinically suspected typhoid fever patients. The blood sample was processed on BACTEC 9050 and isolates obtained from subculture were serotyped. Then antibiotic susceptibility testing was carried out using the disk diffusion method. Results and Discussion: A total of 137 cases were recorded in four years. All cephalosporins were found sensitive in more than 90% of cases. We did not find any resistance to Ceftriaxone in our patients’ group. Moxifloxacin and Levofloxacin showed higher sensitivity than Ciprofloxacin (100% and 96% Vs 90%). Nalidixic acid demonstrated lower sensitivity than previously reported (less than 5%), while Gentamicin showed the highest sensitivity around 100%. Conclusion: Multidrug-resistant (MDR) Salmonella typhi and paratyphi are emerging rapidly. To overcome this global issue, rational use of antibiotics has to be ensured. Physicians should also be aware of the local resistance pattern so that they can treat their patients effectively. J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 134-137

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Estimating the burden of enteric fever in Chhattisgarh: A single-center study on culture-positive cases from a newly built tertiary care hospital

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_154_18 ◽

2019 ◽

Vol 11 (03) ◽

pp. 234-239 ◽

Cited By ~ 1

Author(s):

Debabrata Dash ◽

Padma Das ◽

Anudita Bhargava ◽

Ujjwala Nitin Gaikwad ◽

Sanjay Singh Negi ◽

...

Keyword(s):

Blood Culture ◽

Enteric Fever ◽

Tertiary Care ◽

Laboratory Data ◽

Central India ◽

Empiric Therapy ◽

Blood Stream ◽

Salmonella Typhi ◽

Care Hospital ◽

Culture Positive

Abstract BACKGROUND: Enteric fever is the most common cause of community acquired blood stream infections in under developed and developing countries. The enteric fever is exclusive to humans and transmitted through the faeco-oral route. Though India is an endemic zone for enteric fever, the data is very scarce from Central India. The present study was undertaken to determine the prevalence of enteric fever in this region and to know the antimicrobial susceptibility pattern of the isolated typhoidal Salmonellae. MATERIAL AND METHOD: We conducted a retrospective analysis of blood culture positive cases of enteric fever over a period of two years (December 2015 to December 2017). All blood cultures submitted for suspected enteric fever and associated symptoms were included in the study. Relevant demographic, clinical and laboratory data were analyzed. RESULT: A total of 51 cases (3.56%) were of typhoidal Salmonella from a total of 1430 blood culture submission. Salmonella Typhi were 70.5% while Salmonella Paratyphi A were 29.5% of the total isolated Salmonellae. The most vulnerable age group was 10-19years (41.2%). The mean minimum inhibitory concentration of ciprofloxacin for Salmonella Typhi and Salmonella Paratyphi A are 1.20 and 1.97 μg/ml respectively. All the isolates were susceptible to ceftriaxone. Highest isolation was in the July – September quarter (35.3%). CONCLUSION: There is a high prevalence of the disease which needs urgent focus on safe water, sanitation services and also to establish guidelines for empiric therapy for enteric fever.

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ANTIMICROBIAL SUSCEPTIBILITY IN CULTURE POSITIVE ENTERIC FEVER

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i7.357 ◽

2019 ◽

Vol 3 (7) ◽

Author(s):

Dr. Manish Kulshrestha ◽

Dr. Anjali Kulshrestha

Keyword(s):

Bone Marrow ◽

Blood Culture ◽

Nalidixic Acid ◽

Antimicrobial Susceptibility ◽

Salmonella Enterica ◽

Enteric Fever ◽

Multidrug Resistant ◽

Bone Marrow Culture ◽

Diffusion Method ◽

Culture Positive

INTRODUCTION: Enteric fever includes typhoid and paratyphoid fever. Peak incidence is seen in children 5–15 years of age; but in regions where the disease is highly endemic, as in India, children younger than 5 years of age may have the highest infection rates. There are about 22 million new typhoid cases occur each year. Young children in poor, resource limited areas, who make up the majority of the new cases and there is a mortality figures of 215,000 deaths annually. A sharp decline in the rates of complications and mortality due to typhoid fever is observed as a result of introduction of effective antibiotic therapy since 1950s. MDR-ST became endemic in many areas of Asia, including India soon after multidrug-resistant strains of Salmonella enterica serotype typhi (MDR-ST) that were resistant to all the three first-line drugs then in use, namely chloramphenicol, amoxycillin and co-trimoxazole emerged in early 1990s. MATERIAL AND METHODS: Only blood culture or bone marrow culture positive cases were included. The patients with culture isolated enteric fever were included in the study. Antimicrobial susceptibility testing was carried out by disk diffusion method using antibiotic discs. The analysis of the antimicrobial susceptibility was carried out as per CLSI interpretative guidelines. RESULTS: A total of 82 culture positive cases were included in the present study. 80 culture isolates were from blood culture and 2 from the bone marrow culture. Salmonella entericasubspecies enterica serovartyphi (S typhi) was isolated from 67 (81.70%) patients while Salmonella enterica subspecies entericaserovarparatyphi (S paratyphi A) was isolated from 13 (15.85%) cases and 2 (2.44%) were Salmonella enterica subspecies entericaserovarschottmuelleri (S paratyphi B). Of the 82 cases 65(79.3%) isolates were resistant to ciprofloxacin, 17 (20.7%) were resistant to nalidixic acid, one (1.2%) case each was resistant to Cefotaxime and ceftriaxone, 2 (2.4%) were resistant to chloramphenicol, 10 (12.2%) were resistant and to cotrimoxazole 3 (3.7%) were resistant. CONCLUSION: In a culture positive cases 65(79.3%) isolates were resistant to ciprofloxacin and 17 (20.7%) were resistant to nalidixic acid. Multidrug resistant isolates were 65(79.3%).

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Is Antimicrobial Resistance Pattern of Enteric Fever Changing in Kathmandu Valley?

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v32i3.6625 ◽

2013 ◽

Vol 32 (3) ◽

pp. 221-228

Author(s):

Ganesh Kumar Rai ◽

Subhana Karki ◽

Bina Prajapati

Keyword(s):

Antimicrobial Resistance ◽

Nalidixic Acid ◽

Enteric Fever ◽

Public Health Problem ◽

Salmonella Typhi ◽

Resistance Pattern ◽

Kathmandu Valley ◽

Sensitivity Testing ◽

Antimicrobial Sensitivity ◽

Sensitivity Pattern

Introduction: Enteric fever is a public health problem in developing countries including Nepal. Antimicrobial sensitivity pattern of Salmonella sp causing enteric fever is changing over time and also differs according to geographical location. Periodic surveillance of antimicrobial resistance of Salmonella sp is mandatory for management of enteric fever rationally. The objective of this study was to analyze the resistance pattern of Salmonella sp to commonly used antimicrobials. Materials and Methods: This was a retrospective study undertaken reviewing the records of blood isolates of Salmonella sp over one year period at Kanti Children’s Hospital, Nepal. Antimicrobial sensitivity testing was done following Kirby Bauer’s disk diffusion technique using Muller Hinton agar. Results: Salmonella typhi was found to be 100% resistance to ampicillin and resistance to nalidixic acid and ciprofloxacin was also high. The resistance to chloramphenicol and ofloxacin was low. No resistance was found to amoxicillin, ceftriaxone, cefotaxime and amikacin. However, among the sensitive isolates of Salmonella typhi intermediate sensitivity to ceftriaxone and ceftazidime was reported to be high. Among the isolates of S paratyphi A, the resistance to nalidixic acid was 100% followed by 75% to ciprofloxacin. No resistance was found to chloramphenicol, ceftriaxone, cefixime, amikacin and low resistance to amoxicillin and ofloxacin. Among the sensitive isolates of S paratyphi A, majority of them were only moderately sensitive to cefotaxime and ceftazidime and about 1/3 of the organisms had only intermediate sensitivity to ceftriaxone. Conclusiion: Commonly used parenteral third generation cephalosporins, first line drugs like chloramphenicol and amoxicillin and ofloxacin among fluoroquinolones were found to be effective in vitro in treating enteric fever. However, Salmonella typhi was found to be highly resistant to the most frequently used drugs like ciprofloxacin and cefixime and Salmonella paratyphi A to ciprofloxacin. A comparative chart of antimicrobial sensitivity of enteric fever in children over 10 year period from different hospitals of Kathmandu valley is also presented in the study. DOI: http://dx.doi.org/10.3126/jnps.v32i3.6625 J. Nepal Paediatr. SocVol.32(3) 2012 221-228

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Susceptibility Pattern of Pathogens Causing Blood Stream Infections in a Tertiary Care Hospital: A Two-year Retrospective Study from Southern Nigeria

Microbiology Research Journal International ◽

10.9734/mrji/2021/v31i330306 ◽

2021 ◽

pp. 53-60

Author(s):

Bassey Ewa Ekeng ◽

Ubleni Ettah Emanghe ◽

Bernard Ekpan Monjol ◽

Anthony Achizie Iwuafor ◽

Ernest Afu Ochang ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Blood Culture ◽

Blood Stream ◽

Multidrug Resistant ◽

Diffusion Method ◽

Disc Diffusion ◽

Blood Stream Infections ◽

Gram Negative ◽

Antimicrobial Sensitivity ◽

Culture Positive

Aim: Bloodstream infections are a major cause of morbidity and mortality worldwide. The prevalence of causative microorganisms varies from one geographical region to another. This study was aimed at determining the etiological agents prevalent in our environment and their susceptibility profile. Study design: This is a retrospective study carried out at the University of Calabar Teaching Hospital, Calabar, Nigeria. Methodology: Blood culture results of patients documented over a two-year period were retrieved and analyzed. Blood culture positive isolates were detected using conventional method and Oxoid signal blood culture systems. Antimicrobial sensitivity tests were carried out by Kirby-Bauer disc diffusion method. Methicillin resistance in Staphylococcus aureus and coagulase negative Staphylococcus species (CoNS) was detected by disk diffusion method using 30 µg cefoxitin disk. ESBL production was detected by phenotypic confirmatory disc diffusion test (PCDDT) and the double disc synergy test (DDST). Results: A total of 413 blood culture antimicrobial susceptibility test results were analyzed, of which 116 (28.09%) were identified as culture positive. Sixty-nine (59%) of the positive isolates were from female patients. Out of 116 positive cultures, 58.62% (68/116) were Gram positive organisms, 40.52% (47/116) were Gram negative organisms, non albicans Candida accounted for 0.86% (1/116). Staphylococcus aureus (n=41, 35.3%) was the predominant isolate and showed high sensitivity to levofloxacin (100%), Linezolid (100%) and Amikacin (100%). Twelve isolates of S. aureus were methicillin resistant, while 1 isolate was inducible clindamycin resistant. Of the 116 isolates identified in this study, forty-three (43) were multidrug resistant with highest number of multidrug resistant isolates from Staphylococcus aureus (n=20). 21.28% (n=10) of the Gram-negative isolates were positive for extended spectrum beta lactamases. Conclusion: A high rate of antimicrobial resistance is observed among microorganisms causing blood stream infections. This emphasizes the need for antimicrobial sensitivity testing in the management of blood stream infections.

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