Extensively Drug-Resistant Salmonella typhi XDR Infection at Rawalpindi Medical University and Allied Hospitals

  • Kausar Izhar RMU
  • Kiran Ahmed
  • Maryyam Rehan
  • Muhammad Umar
  • Nadeem Ikram
  • Naeem Akhter
Keywords: XDR Salmonella typhi, Antibiotics susceptibility, Kirby Bauer disk diffusion.


Objective: To evaluate the prevalence of extensively drug-resistant Salmonella typhi (XDR) in RMU Allied Hospitals.

Study Design: A descriptive cross-sectional study.

Material and Methods: It is a cross-sectional, prospective study conducted at RMU Allied Hospitals from January 2019–December 2019. Blood culture samples were received in the pathology lab, they were collected by simple random sampling and processed by conventional incubation. Antibiotic susceptibility of the isolates was done on Muller Hinton agar using modified Kirby Bauer disk diffusion method and antibiotic zone diameters were measured according to CLSI guidelines.

Results: Out of the total 8045 cultures, 911 (11%) showed growth, among which 179 (20%) were Salmonella typhi and 135 (15%) XDR Salmonella. Meropenem revealed the highest sensitivity, Chloramphenicol, and Augmentin revealed the highest resistance.

Conclusion: Blood culture results revealed Salmonella typhi 20% with a significant number of XDR Salmonella 15%. Antibiotics susceptibility pattern exhibits Meropenem and Azithromycin as the only antibiotics for XDR Salmonella. Salmonella typhi infection has a significantly high prevalence among children as compared to adults. (p=0.0017) Injudicious use of antibiotics is one of the important aspects of the occurrence of antibiotic-resistant Salmonella.


[1] https://www.news-medical.net/health/Typhoid-Fever-History.aspx
[2] Crump JA, Luby SP, Mintz ED, “The global burden of typhoid fever. Bull world Health Organ” [2004]; 82:346-53. DOI:10.1590/S0042-96862004000500008
[3] Qamar FN, Azmatullah A, Kazi A. A three year review of antimicrobial resistance of Salmonella enterica serovars Typhi and Paratyphi A in Pakistan. J Infect Dev Ctries. 2014; 8: 981-6. DOI:10.3855/jidc.3817
[4] Typhoid fever – Islamic Republic of Pakistan. World Health Organization; 2018 27 December 2018; https://www.who.int/csr/don/27-december-2018-typhoid-pakistan/en/ 2018

[5] Field Epidemiology & Disease Surveillance Division (FE&DSD); October 2018 - February 2019, May;2019;https://www.nih.org.pk/wp-content/uploads/2018/10/43rd-Issue-SAAL-October-2018.pdf 2019, DOI: 10.7759/cureus.5663
[6] Chatham-Stephens K, Medalla F, Hughes M, et al, Emergence of extensively drug-resistant Salmonella Typhi infections among travelers to or from Pakistan - United States, 2016-2018. Morb Mortal Wkly Rep. 2019;68:11–13. DOI: http://dx.doi.org/10.15585/mmwr.mm6801a3

[7] Wong W, Rawahi HA, Patel S. The first Canadian pediatric case of extensively drug-resistant Salmonella Typhi originating from an outbreak in Pakistan and its implication for empiric antimicrobial choices. 2019;15:0. doi: 10.1016/j.idcr.2019.e00492

[8] Wong M.H.Y., Yan M., Chan E. W. C. Emergence of Clinical Salmonella enterica Serovar Typhimurium Isolates with Concurrent Resistance to Ciprofloxacin, Ceftriaxone, and Azithromycin. doi: 10.1128/AAC.02770-13

[9] Hussain A., Satti L., Hanif F. Typhoidal Salmonella strains in Pakistan: an impending threat of extensively drug-resistant Salmonella Typhi, European Journal of Clinical Microbiology & Infectious Diseases volume 38, pages2145–2149(2019) DOI: 10.1007/s10096-019-03658-0

[10] Hameed S., Izhar M., Basheer A. An Update on Isolation of Extensively Drug Resistant (XDR) Salmonella enterica from Blood Cultures in a Tertiary Care Centre. Proceedings S.Z.P.G.M.I. Vol: 33(4): pp. 20-24, 2019. PSZMC-726-33-4-2019
[11] Saeed N, Usman M, Khan EA Khan. An Overview of Extensively Drug-resistant Salmonella Typhi from a Tertiary Care Hospital in Pakistan. DOI: 10.7759/cureus.5663

[12]World Health Organization Regional Office for Eastern Mediterranean. Weekly epidemiological monitor: disease outbreaks in Eastern Mediterranean Region (EMR), Cairo, Egypt.
[13] Qamar FN, Yousafzai MT, Khalid M. Outbreak investigation of ceftriaxone-resistant Salmonella enterica serotype Typhi and its risk factors among the general population in Hyderabad, Pakistan. The Lancet Infection Diseases. 2018;12:1368- 76. doi: 10.1016/S1473-3099(18)30483-3
[14] Levine M.M., Simon R. The gathering storm: Is untreatable typhoid fever on the way? American society of Microbiology 2018;2;482-88. doi: 10.1128/mBio.00482-18
[16] Wajid M, Awan AB, Saleemi MK, Weinreich J. Multiple Drug Resistance and Virulence Profiling of Salmonella enterica Serovars Typhimurium and Enteritidis from Poultry Farms of Faisalabad, Pakistan. Microbdrug Resist 2019; 25:133-42. DOI: 10.1089/mdr.2018.0121
[17] Mashiatullah A., Chaudhary M. Z., Khan M. S., Javed T. “Coliform bacterial pollution in Rawal Lake, Islamabad and its feeding streams. Nucleus, 2010: 47-35–40.

[18] Das JK, Hasan R, Zafar A. Trends, associations, and antimicrobial resistance of Salmonella typhi and paratyphi in Pakistan. Am J Trop Med Hyg, 2018;99:48-54. doi: 10.4269/ajtmh.18-0145

[19] Ali A., Ali H.A., Shah F.H., Zahid A., Aslam H. Pattern of antimicrobial drug resistance of Salmonella Typhi and Paratyphi A in a teaching hospital in Islamabad. J. Pak. Med. Assoc.,2017; 67: 375-79.

[20] Munir T, Lodhi M, Ansari JK, Andleeb S, Ahmed M. Extended Spectrum Beta Lactamase producing Cephalosporin resistant Salmonella Typhi, reported from Rawalpindi, Pakistan. J Pak Med Assoc, 2016; 66: 1035-37.

[21] Mehmood K, Chaudhary MT, Aslam HF, Ahmad M. Prevalence of S.typhi in blend cultures-antimicrobial sensivity and incidence of ESBL in MDR isolates. JRMC, 2014;18:41-44

[22] Wong VK, Baker S, Pic Kard DJ, Parkhill J, Page AJ. Phylogeographyical analysis of the dominant multidrug-resistant H58 clade of Salmonella typhi identifies inter & intracontenentail transmission events. Nat Genet, 2015; 47:632-39. doi: 10.1038/ng.3281

[23] Khan, K. Lu Y, Saeed MA. Prevalent fecal contamination in drinking water resources and potential health risks in Swat, Pakistan. Journal of Environmental Sci, 2018; 72:1-12. doi: 10.1016/j.jes.2017.12.008
[24] Shah SQ, Colquhoun DJ, Nikuli HL, Sørum H. Prevalence of antibiotic resistance genes in the bacterial flora of integrated fish farming environments of Pakistan and Tanzania. Environ Sci Technol 46:8672–79. DOI: 10.1021/es3018607
[25] Daud MK, Nafees M, Ali S. Drinking water quality status and contamination in Pakistan. Biomed Res Int. 2017:1–18. doi.org/10.1155/2017/7908183

[26] Aypak A, Çelik AK, Aypak C, Çikman Ö. Multidrug resistant typhoid fever outbreak in Ercek Village-Van, Eastern Anatolia, Turkey: clinical profiles, sensitivity patterns and response to antimicrobials. Trop Doct. 2010; 40: 160-2. https://doi.org/10.1258%2Ftd.2010.090438

[27] Rasheed MK, Hasan SS, Babar ZU, Ahmed SI. Extensively drug-resistant typhoid fever in Pakistan. Lancet Infect Dis. 2019;19:242–243. doi: 10.1016/S1473-3099(19)30051-9
[28] Burki T. Typhoid conjugate vaccine gets WHO prequalification. Lancet Infect Dis. 2018;18:258. DOI: 10.1016/S1473-3099(18)30087-2
How to Cite
Izhar K, Ahmed K, Rehan M, Umar M, Ikram N, Akhter N. Extensively Drug-Resistant Salmonella typhi XDR Infection at Rawalpindi Medical University and Allied Hospitals. JRMC [Internet]. 30Dec.2020 [cited 2Oct.2022];24(4):406-11. Available from: http://www.journalrmc.com/index.php/JRMC/article/view/1493

Most read articles by the same author(s)

1 2 > >>