Antimicrobial Susceptibility Pattern of Salmonella spp. Isolated from Enteric Fever Patients in Nepal

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.

Download Full-text

Epidemiological fectors and antibiotic susceptibility pattern of Salmonella spp

IP International Journal of Medical Microbiology and Tropical Diseases ◽

10.18231/j.ijmmtd.2021.030 ◽

2021 ◽

Vol 7 (3) ◽

pp. 137-140

Author(s):

Alpa Patel ◽

Nirmal Choraria

Keyword(s):

Nalidixic Acid ◽

Antimicrobial Susceptibility ◽

Antibiotic Susceptibility ◽

Enteric Fever ◽

Diffusion Method ◽

Drug Resistant ◽

Susceptibility Pattern ◽

Antibiotic Susceptibility Pattern ◽

Periodic Evaluation ◽

Susceptibility Patterns

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.

Download Full-text

Renaissance of Conventional First-Line Antibiotics inSalmonella entericaClinical Isolates: Assessment of MICs for Therapeutic Antimicrobials in Enteric Fever Cases from Nepal

BioMed Research International ◽

10.1155/2017/2868143 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Puspa Raj Khanal ◽

Deepa Satyal ◽

Anjeela Bhetwal ◽

Anjila Maharjan ◽

Shreena Shakya ◽

...

Keyword(s):

Minimum Inhibitory Concentration ◽

Antimicrobial Susceptibility ◽

Salmonella Enterica ◽

Enteric Fever ◽

Susceptibility Testing ◽

Inhibitory Concentration ◽

Antimicrobial Susceptibility Testing ◽

Clinical Isolates ◽

Disk Diffusion ◽

Blood Samples

Enteric fever caused bySalmonella entericais a life-threatening systemic illness of gastrointestinal tract especially in tropical countries. Antimicrobial therapy is generally indicated but resistance towards commonly used antibiotics has limited their therapeutic usefulness. Therefore, we aimed to determine the antimicrobial susceptibility pattern by minimum inhibitory concentration method of common therapeutic regimens againstSalmonella entericafrom enteric fever clinical cases.Salmonella entericaclinical isolates recovered from the patients with suspected enteric fever whose blood samples were submitted to microbiology laboratory of Manmohan Memorial Community Hospital, Kathmandu, from March 2016 to August 2016, were studied. These isolates were subjected to antimicrobial susceptibility testing against common therapeutic antimicrobials by Kirby-Bauer disk diffusion method. The minimum inhibitory concentration of ciprofloxacin, azithromycin, chloramphenicol, and cefixime was determined by Agar dilution method based on the latest CLSI protocol. A total of 88 isolates ofSalmonella entericawere recovered from blood samples of enteric fever cases. Out of them, 74 (84.09%) wereSalmonellaTyphi and 14 (15.91%) wereSalmonellaParatyphi A. On Kirby-Bauer disk diffusion antimicrobial susceptibility testing, entire isolates were susceptible to cotrimoxazole, cefixime, ceftriaxone, azithromycin, and chloramphenicol. Sixty-four (72.7%)Salmonella entericaisolates were nalidixic acid resistant and nonsusceptible to ciprofloxacin and levofloxacin. On MIC determination, fourSalmonellaisolates were ciprofloxacin resistant with MIC 1 µg/ml and two isolates were ciprofloxacin intermediate with MIC 0.5 µg/ml. The MIC range of azithromycin was from 0.125 µg/ml to 2.0 µg/ml, whereas that for chloramphenicol was 2.0 µg/ml–8.0 µg/ml and for cefixime was 0.0075–0.5 µg/ml, respectively. Despite global surge of antimicrobial resistance amongSalmonella entericaclinical isolates, the level of drug resistance in our study was not so high. However, higher level of NARST strains limits therapeutic use of fluoroquinolones and necessitates the routine monitoring of such resistance determinants in order to effectively and rationally manage enteric fever cases.

Download Full-text

Antimicrobial susceptibility pattern of Salmonella enterica, blood-stream isolates, among febrile children: a prospective study from Nepal

10.21203/rs.2.14544/v1 ◽

2019 ◽

Author(s):

Priyatam Khadka ◽

Januka Thapaliya ◽

Shovana Thapa

Keyword(s):

Nalidixic Acid ◽

Antimicrobial Susceptibility ◽

Salmonella Enterica ◽

Enteric Fever ◽

Disk Diffusion ◽

Diffusion Method ◽

Susceptibility Pattern ◽

First Line ◽

Disk Diffusion Test ◽

Antimicrobial Susceptibility Pattern

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

Download Full-text

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%).

Download Full-text

Antibiogram signatures of non-cholera causing Vibrio species recovered from environmental niches in Eastern Cape, South Africa.

10.21203/rs.3.rs-233720/v1 ◽

2021 ◽

Author(s):

Oluwakemi Victoria Ayodele ◽

Anthony Ifeanyi Okoh

Keyword(s):

Minimum Inhibitory Concentration ◽

Nalidixic Acid ◽

Vibrio Parahaemolyticus ◽

Inhibitory Concentration ◽

Vibrio Vulnificus ◽

Diffusion Method ◽

Morbidity Rate ◽

Antibiotic Resistant ◽

Mortality And Morbidity ◽

Vibrio Fluvialis

Abstract Background: The use of antibiotics globally has helped reduce mortality and morbidity rate due to its ability to effectively treat bacterial infections in both humans and animals. However, the menace of antimicrobial resistance has become a challenge to public health due to its increased mortality and morbidity rate. This study determined the antibiogram pattern of non-cholera causing Vibrio species against a panel of 11 antibiotics that are wildly used for treatment. Multiple antibiotic resistance phenotype, multiple antibiotic resistant indices and minimum inhibitory concentration (MIC) of test antibiotics were also determined.Results: Polymerase chain reaction (PCR) was used to confirm 100 isolates of Vibrio parahaemolyticus, 82 and 46 isolates of Vibrio vulnificus and Vibrio fluvialis respectively, collected from the culture collections of the Applied and Environmental Microbiology Research Group (AEMREG), University of Fort Hare. Thereafter, disc diffusion method was used to determine the antibiogram pattern of target non-cholera causing Vibrio species against a panel of 11 antibiotics that are of clinical importance. The highest rate of Vibrio parahaemolyticus resistance was observed against tetracycline (22 %) and nalidixic acid (16 %). Vibrio fluvialis also displayed highest rate of resistance against tetracycline (28 %) and nalidixic acid (28 %), while Vibrio vulnificus isolates exhibited highest rate resistance against imipenem (40 %) and tetracycline (22 %). A total of 38 MARP patterns were observed and the MAR indices ranged between 0.3 and 0.8. Against the resistant Vibrio parahaemolyticus and Vibrio fluvialis isolates, minimum inhibitory concentration ranged from 16 µg/ml to 2048 µg/ml for both tetracycline and nalidixic acid, while against Vibrio vulnificus isolates, minimum inhibitory concentration ranged from 8 µg/ml to 256 µg/ml for both imipenem and nalidixic acid. Conclusions: Results obtained from this study is an indication that antibiotic resistant bacteria that could pose as threat to health of humans and animals are present in the environment.

Download Full-text

Ciprofloxacin susceptibility of Salmonella enteric serovar Typhi and Paratyphi A from blood samples of suspected enteric fever patients

International Journal of Infection and Microbiology ◽

10.3126/ijim.v1i1.6938 ◽

2012 ◽

Vol 1 (1) ◽

pp. 9-13 ◽

Cited By ~ 3

Author(s):

D Adhikari ◽

D Acharya ◽

P Shrestha ◽

R Amatya

Keyword(s):

Salmonella Enterica ◽

Enteric Fever ◽

Diffusion Method ◽

Dilution Method ◽

Agar Dilution Method ◽

Disc Diffusion ◽

Salmonella Spp ◽

Blood Samples ◽

Antibiotic Susceptibility Test

INTRODUCTION: Enteric fever caused by Salmonella enterica serovars Typhi and Paratyphi A is the common clinical diagnosis among febrile patients presenting to hospital in Nepal. The aim of this study was to evaluate the ciprofloxacin (CIP) and other antibiotics susceptibility patterns of Salmonella enterica serovars Typhi and Paratyphi A from blood samples of suspected enteric fever patients visiting KIST Medical College, Kathmandu. MATERIALS AND METHODS: Antibiotic susceptibility test was performed by Kirby Bauer disc diffusion method as per CLSI guidelines whereas MIC determination of ciprofloxacin was performed by agar dilution method. RESULTS: Altogether 64 presumptive Salmonella spp. were isolated from 840 blood samples of suspected enteric fever patients, of which 41 were S. Typhi and 23 were S. Paratyphi A. All Salmonella spp. isolates were sensitive to ceftriaxone and ofloxacin whereas 4 isolates were resistant to ciprofloxacin. One isolates each of S. Typhi and S. Paratyphi A were multidrug resistant. Fifty five isolates of Salmonella spp. were resistant to nalidixic acid (NA) with higher rate in S. Paratyphi A (91.3%) compared to S. Typhi (82.9%). MIC determination of ciprofloxacin revealed that majority of the isolates were resistant to ciprofloxacin and 2 isolates were resistant with MIC value of 4 µg/ml and 8 µg/ml. Importantly, we found simultaneous presence of NA resistance and decreased susceptibility to CIP suggesting that resistance to NA is a reliable indicator of decreased CIP susceptibility. CONCLUSIONS: Disc diffusion test failed to detect the reduced susceptibility of ciprofloxacin. Hence the MIC determination of ciprofloxacin against Salmonella spp. isolates would be important. DOI: http://dx.doi.org/10.3126/ijim.v1i1.6938Int J Infect Microbiol 2012;1(1):9-13

Download Full-text

Antimicrobial resistance among blood culture isolates of Salmonella enterica in New Delhi

The Journal of Infection in Developing Countries ◽

10.3855/jidc.3030 ◽

2013 ◽

Vol 7 (11) ◽

pp. 788-795 ◽

Cited By ~ 14

Author(s):

Sarika Jain ◽

Tulsi Das Chugh

Keyword(s):

Antimicrobial Resistance ◽

Nalidixic Acid ◽

Antimicrobial Susceptibility ◽

Salmonella Enterica ◽

Enteric Fever ◽

Automated System ◽

Diffusion Method ◽

New Delhi ◽

Third Generation ◽

First Choice

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.

Download Full-text

The TO STUDY ANTIBIOTIC SUSCEPTIBILITY PATTERN OF STAPHYLOCOCCUS AUREUS ISOLATED FROM VARIOUS SKIN SAMPLES

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2019.v12i7.32868 ◽

2019 ◽

pp. 171-175

Author(s):

NEHA ◽

BHARTI MITTU ◽

ZARINA BEGUM ◽

HARJOT PAL KAUR

Keyword(s):

Staphylococcus Aureus ◽

Minimum Inhibitory Concentration ◽

Antibiotic Susceptibility ◽

Inhibitory Concentration ◽

The Body ◽

Diffusion Method ◽

Susceptibility Pattern ◽

Disk Diffusion Method ◽

Set Protocol ◽

Third Line

Objective: The study was carried out to check the antibiotic susceptibility profile of Staphylococcus aureus. Methods: In this study for the isolation of strain, skin swabs from different parts of the body were taken aseptically with the set protocol. The sensitivity patterns of S. aureus were explored with different antibiotics for the treatment of S. aureus infections. We have studied the susceptibility pattern of various antibiotics including present all line therapies and other antibiotics using disk-diffusion method. Results: It has been found that bacteria show the highest sensitivity toward third-line antibiotic tetracycline, trimethoprim, and minocycline. The different concentrations of these antibiotics were used to check the minimum inhibitory concentration and found to be effective even at the lower concentration of 0.01 mcg/disc. Furthermore, the minimum inhibitory concentration of each antibiotic has been calculated to find the most effective antibiotic at low concentration. The isolates are found to be highly resistant toward ampicillin, ciprofloxacin, and cefotaxime. Conclusion: The research concluded that the bacteria S. aureus are found to be more sensitive for chloramphenicol, kanamycin, and trimethoprim in first-line antibiotics, second-line antibiotics, and third-line antibiotics, respectively.

Download Full-text

A Study on High and Low level Drug Resistance Pattern Among Clinical Isolates of Enterococci .

Biomedical & Pharmacology Journal ◽

10.13005/bpj/2221 ◽

2021 ◽

Vol 14 (3) ◽

pp. 1189-1196

Author(s):

Reena Rajan ◽

D Karthikeyan

Keyword(s):

Drug Resistance ◽

Minimum Inhibitory Concentration ◽

Inhibitory Concentration ◽

Automated System ◽

Diffusion Method ◽

Low Level ◽

Drug Resistance Pattern ◽

Resistance To Penicillin ◽

High Level ◽

Level Resistance

Introduction: The combined abilities of colonisation and both inherent and acquired resistance have made Enterococci a significant human pathogen. Aims and Objectives: This study was done to determine the Minimum Inhibitory Concentration of various antibiotics against Enterococci and to correlate the phenotypic and genotypic characteristics of Enterococci with low level and high level drug resistance. Materials and Methods: A total of 774 isolates of Enterococci obtained from various clinical samples were subjected to antimicrobial susceptibility testing by Kirby Bauer Disk Diffusion method. The Minimum Inhibitory Concentration of various antibiotics were determined by Vitek 2 automated system, agar dilution and E test. Results: 15 out of 774 isolates showed the presence of vancomycin resistant genes by Multiplex PCR. 10 (90.91 %) isolates out of 11 E. faecalis with van A gene showed high level resistance to Penicillin (16-64 µg/ml). 8 (72.73 %) out of 11 isolates showed high level resistance to Gentamicin (512-1024 µg/ml). 6 (54.55 %) , out of 11 isolates were resistant to β lactams. One isolate of E. faecalis from urine with van B gene showed showed high level resistance to Penicillin (32 µg/ml), Linezolid (≥ 8µg/ml), high level resistance to Gentamicin (1024 µg/ml), Fluoroquinolones (≥ 8µg/ml) and Macrolides (≥ 8µg/ml). Conclusion: Isolates of Enterococci resistant to glycopeptides, penicillin, Betalactams and aminoglycosides have important clinical implications in the treatment for infection.

Download Full-text