ANTIMICROBIAL SUSCEPTIBILITY IN CULTURE POSITIVE ENTERIC FEVER

Author(s):  
Dr. Manish Kulshrestha ◽  
Dr. Anjali Kulshrestha

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%).

2013 ◽  
Vol 7 (11) ◽  
pp. 788-795 ◽  
Author(s):  
Sarika Jain ◽  
Tulsi Das Chugh

Introduction: Enteric fever is a global public health problem, especially in developing countries. Antimicrobial resistance is a major issue enteric fever management. This study examined current pattern of antimicrobial susceptibility among Salmonella enterica isolates from enteric fever cases at a tertiary care centre in New Delhi, India. Methodology: Blood cultures from patients with enteric fever during January 2010- July 2012 were processed using the BACTEC automated system. Antimicrobial susceptibility was tested using Kirby Bauer’s disc diffusion method and/or Phoenix 100 automated system. Results: Of 344 isolates of Salmonella enterica, 266 (77.3%) were S. Typhi, 77 (22.4%) were S. Paratyphi A, and one (0.3%) was S. Paratyphi B. Resistance to nalidixic acid (NAR) (96.7%) was most common, followed by ciprofloxacin (37.9%), and azithromycin (7.3%). Multi-drug resistance was observed only in S. Typhi (3.4%). Among NAR strains, 61.8% were sensitive, 11.1% were moderately sensitive, and 23.9% were resistant to ciprofloxacin (0.8%, 57.4%, and 37.9% respectively according to revised CLSI breakpoint criteria for ciprofloxacin). Resistance to third-generation cephalosporin was found in seven (2%) strains of S. enterica. Conclusion: Increasing rates of nalidixic acid, fluoroquinolone and azithromycin resistance among S. enterica, particularly in S. Paratyphi A strains, is of concern, as S. Paratyphi A infection is becoming increasingly common and is not prevented by current vaccinations. Our results favour use of cefexime or possibly chloramphenicol as first choice for uncomplicated enteric fever. MICs for third-generation cephalosporins and susceptibility pattern must be closely monitored in view of its emerging resistance among Salmonella enterica.


2019 ◽  
Author(s):  
Priyatam Khadka ◽  
Januka Thapaliya ◽  
Shovana Thapa

Abstract Background Still, in developing the children are being treated empirically and irrationally with accessible antibiotic without susceptibility testing and minimal lethal dose calculations, defying the probable MDR (multi-drug resistance) isolates. This study was undertaken in the febrile children to determine the antimicrobial susceptibility pattern of Salmonella enterica against commonly prescribed antibiotics. Method All isolates were identified by biotyping and serotyping standard protocols then tested against antibiotics by modified Kirby disk-diffusion method. Minimum Inhibitory Concentration (MIC) of isolates were determined by agar dilution method and compared with disk diffusion results and on nalidixic-acid sensitive/resistant strains. Result Among 1815 enteric-fever-suspects, 90(4.9%) isolates of Salmonella enterica [serovar: 62(68.8%) Salmonella Typhi and 28 (31.1%) Salmonella Paratyphi A] were recovered. The incidence of infection was higher among male, age group 5 to 9, and patient from the out-patient department (OPD). On disk-diffusion test most isolates, were sensitive against first-line drugs, cephalosporins, and macrolides. However, against quinolone, a huge percentile i.e. 93.3%, of isolates were resistant [including 58 Typhi and 26 Paratyphi serovar], and nearly 14% against fluoroquinolones. When MIC breakpoint was adjusted 4µg/ml for azithromycin, ≥1 µg/ml for ciprofloxacin, 2µg/ml for ofloxacin, 8µg/ml for nalidixic acid, 1µg/ml for cefixime, higher sensitivity and specificity achieved while screening decreased susceptibility. Among tested antibiotics, low rate of resistant strain observed on MIC of azithromycin. Also, higher resistance against fluoroquinolones observed on NARS strain. Conclusion Higher susceptibility of Salmonella enterica to first-line drugs (the conventional antityphoidal drugs), third-generation cephalosporins, and azithromycin; advocates for its reconsideration in the implicated therapy. However, lower susceptibility against fluoroquinolones among nalidixic-acid resistant Salmonella (NARS) strain negates its empirical use in children. Keywords Enteric fever, Nepal, children, Salmonella enterica


Author(s):  
Bassey Ewa Ekeng ◽  
Ubleni Ettah Emanghe ◽  
Bernard Ekpan Monjol ◽  
Anthony Achizie Iwuafor ◽  
Ernest Afu Ochang ◽  
...  

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.


2012 ◽  
Vol 10 (2) ◽  
pp. 1-3 ◽  
Author(s):  
Raina Chaudhary ◽  
Khagendra Sijapati ◽  
Sunil Kumar Singh

Introduction: Enteric fever is the commonest public health problem in developing countries like Nepal. Multi Drug Resistant Salmonella isolates are in vitro susceptible to Quinolone but exhibited a higher Minimum Inhibitory Concentration in vivo. Such phenomenon can be demonstrated by simple disc diffusion test of Nalidixic Acid which shows resistance. This study is conducted to determine prevalence of Nalidixic Acid Resistant Salmonella with their anti biotic sensitivity pattern at Shree Birendra Hospital, Chauni, kathmandu. Method: Of total 3945 blood samples from the patients suspected to have enteric fever were collected during the period of January 2011 to August 2011. Then it was mixed with Brain Heart Infusion , further processed according to standard methodology and their anti microbial susceptibility was performed by Kirby-Bauer disc diffusion method. Results: From 3945 samples, 280 (7.09%) showed positi ve growth, 114 (40.7%) Salmonella enterica serotype Typhi and 166 (59.2%) Salmonella enterica serotype Paratyphi A. a total of 221 (78.92%) were Nalidixic Acid Resistant Salmonella, all these strains were sensitive to Ciprofloxcin and Ofloxacin in disc diffusion test. Conclusion: Study showed a higher frequency of Nalidixic Acid Resistant Salmonella among the patients. screening of Nalidixic Acid disc diffusion test must be done as routine work for determination of low level resistance of Quinolone so as to decide the drug for the treatment of enteric fever. DOI: http://dx.doi.org/10.3126/mjsbh.v10i2.6453 Medical Journal of Shree Birendra Hospital July-Dec 2011 10(2) 1-3


2014 ◽  
Vol 77 (9) ◽  
pp. 1481-1486 ◽  
Author(s):  
MIGMA DORJI TAMANG ◽  
MAMATA GURUNG ◽  
HYANG-MI NAM ◽  
DONG CHAN MOON ◽  
GEUM-CHAN JANG ◽  
...  

This study compared the antimicrobial susceptibility and prevalence of virulence genes in Salmonella enterica Typhimurium isolated from healthy and diseased pigs in Korea. A total of 456 Salmonella Typhimurium isolated from healthy (n = 238) and diseased (n = 218) pigs between 1998 and 2011 were investigated. In total, 93.4% of the Salmonella Typhimurium isolates were resistant to at least one antimicrobial agent tested. The isolates were most often resistant to tetracycline (85.7%), followed by streptomycin (83.6%), nalidixic acid (67.3%), ampicillin (49.3%), chloramphenicol (42.8%), and gentamicin (37.1%). Moreover, multidrug resistance phenotype and resistance to ampicillin, florfenicol, gentamicin, nalidixic acid, neomycin, streptomycin, and tetracycline were significantly higher (P < 0.01) among Salmonella Typhimurium isolates from the diseased pigs compared with those from the healthy pigs. The most common resistance pattern observed in both groups of isolates was streptomycin-tetracycline. Overall, more than 96% of the isolates tested possessed invA, spiA, msgA, sipB, prgH, spaN, tolC, lpfC, sifA, sitC, and sopB virulence genes. The prevalence of orgA, pagC, and iroN were 50.2, 74.1, and 91.0%, respectively, whereas isolates carrying cdtB (1.5%), pefA (7.0%), and spvB (14.9%) were identified much less frequently. Furthermore, the prevalence of invA, lpfC, orgA, pagC, and iroN was significantly higher (P < 0.01) among the isolates from the diseased pigs than in isolates from the healthy pigs. Our results demonstrated that, among diseased pigs, there was significantly higher resistance to some antimicrobials and greater prevalence of some virulence genes than in healthy pigs, indicating the role these factors play in pathogenesis. Multidrug-resistant Salmonella isolates that carry virulence-associated genes are potentially more dangerous and constitute a public health concern. Thus, continuous surveillance of antimicrobial resistance and virulence characteristics in Salmonella is essential.


2012 ◽  
Vol 4 (02) ◽  
pp. 074-077 ◽  
Author(s):  
Anup Kumar Shetty ◽  
Ichlampady Nagaraj Shetty ◽  
Zevita Venisha Furtado ◽  
Beena Antony ◽  
Rekha Boloor

ABSTRACT Background: Enteric fever is caused by the serotypes Salmonella Typhi, Salmonella Paratyphi A, Salmonella Paratyphi B and Salmonella Paratyphi C. After emergence of multidrug resistant Salmonellae Ciprofloxacin, a fluorquinolone antibiotic was the first-line therapy. Treatment failure was observed with Ciprofloxacin soon and such strains showed in-vitro resistance to Nalidixic acid. Recent reports suggest re-emergence of Chloramphenicol sensitive strains and increasing Nalidixic acid resistance. This study is aimed at detecting the current trend in the antibiogram of Salmonella isolates from blood culture in coastal Karnataka, with an emphasis on antibiotic susceptibility of Nalidixic acid and Chloramphenicol and evaluate, if there is a need to modify the strategies in the antibiotic therapy for enteric fever. Materials and Methods: Blood samples received for culture in the laboratory between June 2009 and August 2011 was cultured in Brain Heart infusion broth, bile broth or in a commercial BACTEC culture media. The growth from blood cultures were processed for identification and antibiotic susceptibility as per standard methods. Antibiotic susceptibility for Ampicillin, Trimethoprim-sulphamethoxazole, Chloramphenicol, Ciprofloxacin, Ceftriaxone and Nalidixic acid were noted. Results: Out of 9053 blood culture specimens received, Salmonella was isolated from 103 specimens. There were 85 Salmonella Typhi isolates, 16 Salmonella Paratyphi A and two Salmonella Paratyphi B. Salmonella Typhi and Salmonella Paratyphi A showed the highest resistance to Nalidixic acid. Salmonella Typhi showed highest susceptibility to Ceftriaxone and Salmonella Paratyphi A to trimethoprim-sulphamethoxazole and Chloramphenicol. Two isolates were multidrug resistant. One Salmonella Paratyphi A was resistant to Ceftriaxone. Conclusion: Routine screening of Nalidixic acid susceptibility is practical to predict fluorquinolone resistance in Salmonella and preventing therapeutic failure while treating with it. It is worthwhile to consider replacing fluorquinolones with Chloramphenicol or Ceftriaxone as the first line of therapy for enteric fever. Periodic analysis of Salmonella antibiogram should be done to formulate the best possible treatment strategies.


2014 ◽  
Vol 3 (1) ◽  
pp. 19-21
Author(s):  
A Chhetri ◽  
A Manandhar ◽  
Y Shah ◽  
RC Simkhada ◽  
R Paudyal ◽  
...  

Background: Increasing antibiotic resistance of bacteria is a global problem. Fluoroquinolones are recommended as first line therapy for children and adults infected with Salmonella enterica serovar Typhi and Paratyphi A. The purpose of this study was to compare the antibiotic susceptibility pattern of different classes of antibiotics with levofloxacin from blood samples of suspected enteric fever patients visiting Birhospital, Kathmandu. Methods: Antibiotic susceptibility test was performed by Kirby-Bauerdisc diffusion method as per Clinical Laboratory Standards Institute guideline. Results: Among 50 isolates of Salmonella enterica, 39 (78%) were S.Typhi and 11 (22%) were S. Paratyphi A. All the isolates were tested against antibiotics, and all isolates were found sensitive to chloramphenicol and ceftriaxone whereas 3 isolates of S. Typhi were resistant to ciprofloxacin and 1 was resistant to levofloxacin. Fluoroquinolone resistant S. ParatyphiA was not observed. Among the 10 (20%) multi drug resistant isolates, only 1 isolate was resistant to levofloxacin which was S. Typhi. Both S.Typhi (96.7%) and S. Paratyphi A (89.4%) were resistant to Nalidixic acid. Conclusion: High level of nalidixic acid resistance and even some fluoroquinolone resistance showed that the treatment of the enteric fever cannot be relied on the fluoroquinolones. Nepal Journal of Medical Sciences | Volume 03 | Number 01 | January-June 2014 | Page 19-21 DOI: http://dx.doi.org/10.3126/njms.v3i1.10344


2020 ◽  
Vol 7 ◽  
pp. 31-36
Author(s):  
Dhirendra Niroula ◽  
Jyotsna Shrestha ◽  
Supriya Sharma ◽  
Anjana Singh

Objectives: The study aimed to assess the antibiotic susceptibility profile of Salmonella spp isolated from patients suspected of enteric fever. Methods: This cross-sectional prospective study was carried out from April to June, 2014among 484 patients clinically suspected of enteric fever visiting Bir Hospital, Kathmandu, Nepal. Blood sample collected from each patient was processed for culture in bile broth. Identification of Salmonella spp was done by conventional microbiological techniques including colony characteristics, Gram's staining and biochemical tests. Antibiotic susceptibility testing of identified isolates was done by Kirby-Bauer disk diffusion method following the 2014 CLS I guideline. Results: Out of 484 blood samples, 36 (7.43%) cases showed the growth of Salmonella spp; of which 27 (75%) were Salmonella enterica serovar Typhi (ST) and 9 (25%) were Salmonella enterica Paratyphi A (SPA). Among the Salmonella isolates, 5.55% were multidrug resistant and 41.66% were fluoroquinolone resistant. More than 80% of isolates were sensitive to chloramphenicol, amoxicillin, and cotrimoxazole whereas 58%, 50% and 6% of isolates were sensitive to fluoroquinolone antibiotics i.e. ciprofloxacin, ofloxacin and nalidixic acid respectively. All the isolates were susceptible to ceftazidime. All SPA and 89% of ST were sensitive to azithromycin. Conclusion: Higher percentage of susceptible isolates to chloramphenicol, cotrimoxazole, and amoxicillin suggests the reconsideration of these antibiotics for the treatment of enteric fever. Azithromycin can be considered as drug of choice for the treatment of enteric fever.  


2021 ◽  
Vol 13 (2) ◽  
pp. 388-400
Author(s):  
Anu Maharjan ◽  
Binod Dhungel ◽  
Anup Bastola ◽  
Upendra Thapa Shrestha ◽  
Nabaraj Adhikari ◽  
...  

Introduction: Enteric fever, a systemic infection caused by Salmonella enterica Typhi and S. enterica Paratyphi is one of the most common infections in developing countries such as Nepal. Aside from irrational practices of antibiotic use, mutations in chromosomal genes encoding DNA gyrase and Topoisomerase IV and by plasmid mediated quinolone resistant (PMQR) genes are suggested mechanisms for the development of resistance to nalidixic acid and reduced susceptibility to ciprofloxacin. Regardless of high endemicity of enteric fever in Nepal, there is paucity of studies on prevalence and drug-resistance of the pathogen. Therefore, this study aimed to assess the antibiotic susceptibility pattern of Salmonella isolates and determine the minimum inhibitory concentration of ciprofloxacin. Methods: A total of 1298 blood samples were obtained from patients with suspected enteric fever, attending Sukraraj Tropical and Infectious Disease Hospital (STIDH) during March–August, 2019. Blood samples were inoculated immediately into BACTEC culture bottles and further processed for isolation and identification of Salmonella Typhi and S. Paratyphi. Axenic cultures of the isolates were further subjected to antimicrobial susceptibility testing (AST) by using the modified Kirby–Bauer disc diffusion method based on the guidelines by CLSI. The minimum inhibitory concentration (MIC) of ciprofloxacin was determined by agar-dilution method. Results: Out of 1298 blood cultures, 40 (3.1%) were positive for Salmonella spp. among which 29 (72.5%) isolates were S. Typhi and 11 (27.5%) isolates were S. Paratyphi A. In AST, 12.5% (5/40), 15% (6/40) and 20% (8/40) of the Salmonella isolates were susceptible to nalidixic acid, ofloxacin and levofloxacin, respectively, whereas none of the isolates were susceptible to ciprofloxacin. The MIC value for ciprofloxacin ranged from 0.06-16 µg/mL in which, respectively, 5% (2/40) and 52.5% (21/40) of the isolates were susceptible and resistant to ciprofloxacin. None of the isolates showed multidrug-resistance (MDR) in this study. Conclusion: This study showed high prevalence of quinolone-resistant Salmonella spp., while there was marked re-emergence of susceptibilities to traditional first option drugs. Hence, conventional first-line-drugs and third-generation cephalosporins may find potential usage as the empirical drugs for enteric fever. Although our reporting was free of MDR strains, extensive surveillance, augmentation of diagnostic facilities and treatment protocol aided by AST report are recommended for addressing the escalating drug-resistance in the country.


Author(s):  
Alpa Patel ◽  
Nirmal Choraria

serovars Typhi and Paratyphi are known to cause enteric fever. Multidrug resistance in and has emerged as a cause of concern. To evaluate antimicrobial susceptibility patterns of Salmonella enteric serovar Typhi () and obtained from blood culture.: All isolates obtained from blood cultures of clinically suspected cases of enteric fever coming to microbiology laboratory, Nirmal hospital, from January 2015 to September 2017 were included in the study. Antimicrobial susceptibility patterns were determined using commercial antimicrobial disks chloramphenicol (30 μg), nalidixic acid (30 μg), ampicillin (10 μg), azithromycin (15 μg), cotrimoxazole (1.25/23.75 μg), ciprofloxacin (5 μg), and ceftriaxone (30 μg). Antimicrobial susceptibility testing was performed in accordance with the Clinical and Laboratory Standards Institute (CLSI) guidelines of respective year by KirbyBauer disc diffusion method.: Total 330 isolates of salmonella are there out of that 298 is . 32 are Salmonella para A, while 1 is of Salmonella para B. Enteric fever cases pick month are April, May, June and July. Sensitivity to first line drugs are > 80%, Nalidixic acid resistant Salmonella (NARS) are 79%, while Multi drug resistant (resistant to ampicillin, chloramphenicol and co-trimoxazole all three)Salmonella are 3%.: Periodic evaluation of antibiotic susceptibility pattern is necessary to see changing pattern of antibiotics. Evaluation of Nalidixic acid resistant Salmonella and periodic evaluation of multi drug resistant Salmonella is also important as emergence of MDR strain is observed in our study.


Sign in / Sign up

Export Citation Format

Share Document