DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20150478
Published: 2017-02-05

Antimicrobial resistance pattern of Salmonella enterica servars in Southern Delhi

Rachna Tewari, Saltanat Jamal, Mridu Dudeja

Abstract


Background: Enteric fever is predominantly caused by serovars Typhi and Paratyphi of Salmonella enterica. Recently upsurge in multidrug resistant typhoid fever has become a major public health concern in developing countries. This study was conducted to determine the sensitivity pattern of S. Typhi and S. Paratyphi in Southern Delhi.

Methods: A total of 98 Salmonella species were isolated over a period of two years between March 2012 – March 2014. Diagnosis of patients was based on clinical features, blood culture and serology. Blood samples were collected and incubated in BacT alert 3D system. Identification was done and antibiotic susceptibility was done by conventional methods and cross checked by Vitek 2 compact system.

Results: Of the 98 isolates 87 (88.7 %) were S. Typhi and 11 (11.22%) were S. Paratyphi. Out of 87 samples from which S. Typhi was isolated (68) 78% were male and (19) 21.8% were female patients and they belonged to all age groups. Fever was present in all patients. In this study high resistance was found for both S. Typhi and S. Paratyphi respectively for third generation cephalosporins ( 35.6%, 54.5%), good  sensitivity  for macrolides (90.8% & 100%) and average sensitivity for ofloxacin (81.6% & 63.7%).  Ampicillin and chloramphenicol shows lesser resistance i.e. (11.5% & 18.1%) and (12.6% and 27.2%). 3.5% and 0% resistance was found for imipinem and  tigecycline was found 100% sensitive for both S. Typhi and S. Paratyphi, used rarely in treatment of typhoid fever. None of the strains were found sensitive to all drugs.

Conclusion: Typhoid bacilli keeps changing its antimicrobial susceptibility pattern. Currently newer drugs like tigecyclline, imipenem and macrolide are showing great response. Primary drugs are showing less resistance may be due to their infrequent usage whereas cephalosporins are showing high resistance towards typhoid bacilli. For better treatment it is important to know the recent susceptibility trend of the area.


Keywords


Antibiotic sensitivity, Salmonella Typhi, Enteric fever

Full Text:

PDF

References


Saberwal U, Chaudhary U, Saini S. Multi drug resistant Salmonella Typhi in Haryana in 1980-90. Indian J Med Res. 1992;95:12-3.

Jesudason MV, John TJ, Plasmid mediated multidrug resistance in Salmonella Typhi. Indian J Med Res. 1992:95:66-7.

Butt T, Ahmad RN, Mahmood A, Zaidi S. Ciprofloxacin treatment failure in typhoid fever case, Pakistan. Emerg Infect Dis. 2003:9:1621-2.

Murti RB, Rajyalakshami K, Bhaskaran CS. Resistance to salmonella typhi to chloramphenicol. Part 1A, Prelimnary report. J Clin Pathol. 1962;15:544-6.

Anderson ES, Smith HR. Chloramphenicol resistance in the typhoid bacillus. Br Med J. 1972;3:329-31.

Pariker CK, Vimla KN. Transfrable chloramphenicol reistance in Salmonella typhi. Nature. 1972;239:109-10.

Salmonella and Shigella incidence data from Medical Colleges in India. Bull NICD. 1977; April- june and July- September.

Kumar R, Aneja KR, Punia AK, Roy P, Sharma M, et al. Changing pattern of biophage and drug resistance of Salmonella typhi in Ludhiyana during 1980-99. Indian J Med Res. 2001;113:175-80.

Saha MR, Dutta S, Niyogi SK, Dutta S, Mitra U, et al. Decreasing trend in the occurrence of Salmonella enterica serovar Typhiamongst the hospitalize children in Kolkata, India during 1990 -2000. Indian J Med Res. 2002;115:46-8.

Mathai D, Kudvu GC, Keystone JS, Jesudasson MV, Lalitha MK. Short Course ciprofloxacin therapy for enteric fever. J Assoc Physicians India. 1993;41:428-30.

Madhulika U, Harish BN, Parija SC. Current pattern in antimicrobial susceptibility of salmonella Typhi isolate in Pondicherry. Indian J Med Res. 2004;120: 111-4.

Sen B, Dutta S, Sur D, Munna B, Deb AK, et al . Phage typing, biotyping and antimicrobial resistance profile of Salmonella enteric serovar Typhi from Kolkata. Indian J Med Res. 2007;125:685-8.

Roy P, Rawat D, Malik S. A case of extended spectrum beta-lactamase producing Salmonella enterica serotype paratyphi A from India. Indian J Pathol Microbiol. 2015;58:113-4.

Sudeepa Kumar M, Vijaykumar GS, Prakash R, Prashanth HV, Raveesh PM, et al. Salmonella typhi and paratyphi A in Tertiary Care. J Clin Diagn Res. 2013;7(12):2724-6.

Hafsa A, Hussain M, Fakruddin M. Prevalence and antibiotic susceptibility patterns of blood stream Salmonella infections in a tertiary care hospital, Dhaka. J Med Sci. 2013;13(5):363-6.

Parande MA, Patil CG, Rayate MV, Lukde MU. Epidemiological profile of enteric fever cases admitted in scsmgh, solapur. Natl J Community Med. 2011;2(1):91–5.

Walia M, Gaind R, Paul P, Mehta R, Aggarwal P, Kalaivani M, et al. Age related clinical and microbiological characteristics of enteric fever in India. Trans R Soc Trop Med Hyg. 2006;100:942-48.

Kanungo S, Dutta S, Sur D. Epidemiology of Typhoid and paratyphoid fever in India. J Infect Developing Countries. 2008;2(6):454-60.

Cooke FJ, Wain J. The emergence of antibiotic resistance in typhoid fever. Travel Med Infect Dis. 2004;2:67-74.

Basnyat B, Maskey A, Zimmerman M. Emerging trends in enteric fever in Nepal–—9124 cases confirmed by blood culture 1993— 2003. 9th Congress of the International Society of Travel Medicine, Lisbon, Portugal, 2005 (abstract No. FC01.02).

Rao RS, Sundararaj R, Subramanian S, Shankar V, Morti SA, Kapoor SC. A study of drug resistance among Salmonella typhi and Salmonella paratyphi A in an endemic area 1977—79. Trans R Soc Trop Med Hyg. 1981;75:21—4.

Pato-Mesola VV, Donaldo MES. Antimicrobial susceptibility of Salmonella typhi isolates from government and private hospitalsin Cebu City. Phil J Microbiol Infect Di.s 1997;26:5—8.

Rao PS, Rajasekhar V, Verghese GK, Shivananda PG. Emergence of multidrug-resistant Salmonella typhi in rural Southern India. Am J Trop Med Hyg. 1993;48:108—11.

Manish Chandey and A.S. Multani, A Comparative Study of Efficacy and Safety of Azithromycin and Ofloxacin in Uncomplicated Typhoid Fever. J Clin Diagnc Res. 2012;6(10):1736-9

Toro CS, Lobos SR, Calderon I, Rodriguez M, Mora GC. Clinical isolate of a porinless Salmonella typhi resistant to high levels of chloramphenicol. Antimicrob Agents Chemother. 1990;34:1715-9.

Jaspal Kaur, Resistance and Therapeutics in Typhoidal Salmonellae. J Clin Diagnc Res. 2013;7(3):576-5

Deodhar L, Bhave S, Agarwal A. ‘Bacteriophage typing of multi drug resistant Salmonella Typhi in paediatric patients’. Bombay Hospital Journal. 1993;35:114-15.

Nagshetty K, Channappa ST, Gaddad SM. Antimicrobial susceptibility of Salmonella Typhi in India. J Infect Dev Ctries. 2010;4(2):070-3.

Gautam V, Gupta N, Chaudhary U and Uma D.R.2002. Sensitivity pattern of salmonella serotypes in Northern India. Braz J Infect Dis. 6(6).Salvodar Dec.

Momtaz O, Wasfy R, Tharwat f, Ismail f, Mansour H, Joseph l, et al. Trends of multiple drug resistance among salmonella serotype typhi Isolates a 14 year period in Egypt. Clin Infect dis. 35:1265-8.

Bhart Kishore G, Andrade At, Karadesai SG, Hemashettar BM, Patil S. Antimicrobial susceptibility of Salmonella Typhi to quinolones and cephalosporins. Indian J Med Res. 1998;107:247-51.

Bhattacharya SS, Das Usha. Occurrence of Salmonella Typhi infection in Rourkela, Orissa. Indian J Med Res. 2000:111:75-6.

Chowta MN, Chowta NK. Study of clinical profile and antibiotic response in typhoid. Indian J Med Microbiology. 2005;23:125-7.

Sood S, Kapil A, Das B, Jain Y, Kabra SK. Reemergence of chloramphenicol sensitive Salmonella Typhi. The Lancet. 1999;53:1241-2.

Bhave S, Agarwal A. ‘Bacteriophage typing of multi drug resistant Salmonella Typhi in paediatric patients’. Bombay Hospital Journal. 1993;35:114-5.

Asna SM, Haq JA, Rahman M. Nalidixic acid resistant Salmonella enterica serover typhi with decreased susceptibility to ciprofloxacin caused treatment failure: a report from Bangladesh. Jpn J Infect Dis. 2003;56:32-3.

Rodrigues C, Shennai S, Mehta A. Enteric fever in Mumbai, India: the good news and the bad news. Clin nfect Dis. 2003;36:535.

Rai S, Jain S, Prasad KN, Ghoshal U, Dhole TN. Rationale of azithromycin prescribing practices for enteric fever in India. Indian J Med Microbiol. 2012;30:30-3.

Capoor MR, Nair D, Hasan AS, Aggarwal P, Gupta B. Typhoid fever: Narrowing therapeutic options in India. Southeast Asian J Trop Med Public Health. 2006;37:1170-4.

Gupta V, Kaur J, Chander J. An increase in enteric fever cases due to Salmonella Paratyphi A in and around Chandigarh. Indian J Med Res. 2009;129:95-8.

Krishnan P, Stalin M, Balasubramanian S. Changing trends in antimicrobial resistance of Salmonella enterica serovar Typhi and Salmonella enterica serovar Paratyphi A in Chennai. Indian J Pathol Microbiol. 2009;52:505-8.

Kapil A, Renuka, Das B. Nalidixic acid susceptibility test to screen ciprofloxacin resistance in Salmonella Typhi. Indian J Med Res. 2002;115:49-54.

Girish R, Kumar A, Khan S, Dinesh KR, Karim S. Revised Ciprofloxacin Breakpoints for Salmonella: Is it Time to Write an Obituary? J Clin Diagn Res. 2013;7(11):2467-9.

Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. CLSI document (M100-S16) 26, Clinical and Laboratory Standard Institute: Wayne, Pennsylvania. 2007.

Menezes GA, Harish BN, Khan MA, Goessens WHF, Hays JP. Antimicrobial resistance in Salmonella Typhi. Clin Microbiol Infection. 2012;18(3).

Pokharel BM, Koirala J, Dahal RK, Mishra SK, Khadga PK, Tuladhar NR. Multidrug-resistant and extended-spectrumbeta-lactamase (ESBL)-producing Salmonella enterica (serotypes Typhi and Paratyphi A) from blood isolates in Nepal: surveillance of resistance and a search for newer alternatives. Int J Infect Dis. 2006;10:434—8.