Current antibiogram pattern of Salmonella typhi and paratyphi isolates and response to treatment in a tertiary care centre

Abstract

Objective: The objective of this study is to study the current antibiotic sensitivity pattern of Salmonella typhi and paratyphi isolates and the clinical response of children with culture positive enteric fever (EF) to the specific antibiotic used as suggested by the sensitivity pattern. Materials and Methods: This is a retrospective study analyzing the records of 197 children treated for blood culture positive EF during 3 years from January 2013 to December 2015. Antibiogram pattern of S. typhi/paratyphi and response pattern to the antibiotic used as per antibiogram were analyzed. Kirby Bauer’s disc diffusion method was used for antibiotic sensitivity using closed-loop stripping analysis standards. Temperature charts of the patients analyzed for response pattern
of fever to the antibiotic started. Results: 197 culture positive cases were included in the study (S. typhi=190 and paratyphi=7). Sensitivity pattern to 9 out of 10 antibiotics tested was high and was low only to nalidixic acid (6.3%). There were 184 (93.4%) children whose antibiogram showed high sensitivity to cephalosporins and were treated with intravenous ceftriaxone (Group 1). The majority of children in this group (172/184, 93.5%) became afebrile by 7 days of therapy. 13 (6.6%) children whose antibiogram showed resistance to cephalosporins were treated with intravenous ciprofloxacin (Group 2). 9 of this group became afebrile by 7 days. 12 children from Group 1 and 4 children from Group 2 were considered as either reduced susceptibility or resistance to
respective antibiotics and were treated with either azithromycin or piperacillin-tazobactam over the next 5-7 days successfully. Conclusion: Appropriate diagnosis using blood cultures and using 3rd generation cephalosporins as the first line of the drug in treating children with EF can reduce the duration of treatment, promote better compliance, reduce relapse rates, and may help decrease multi-drug resistant S.typhi/partyphi strains in the community..