EXTENSIVELY DRUG-RESISTANT ENTERIC FEVER IN CHILDREN: SURGING THREATS OF ANTIMICROBIAL RESISTANCE AND POSSIBLE SOLUTIONS
DOI:
https://doi.org/10.55519/JAMC-03-11769Keywords:
antimicrobial, drug resistance, ceftriaxoneAbstract
Background: Enteric fever is an infectious disease caused by Salmonella enterica including Salmonella Typhi and Paratyphi A and is associated with potentially serious outcomes, especially in developing countries. The study was conducted with the aim to present the clinical features, laboratory characteristics and antibiotic susceptibility in patients with culture-proven extensively drug-resistant (XDR) enteric fever and to explore drug combinations as a possible solution for the growing problem of antimicrobial resistance. Methods: This descriptive cross-sectional study was conducted in the Paediatric unit of Ayub teaching hospital. Patients admitted with culture-proven XDR enteric fever were included. Patient characteristics were documented on a predesigned proforma. Response to antimicrobial agents including ceftriaxone and levofloxacin, azithromycin and meropenem and meropenem alone was assessed. Data was entered and analyzed using SPSS version 26. Results: A total of 53 patients participated in this study. The majority of patients 36 (67.9%) were male and above 5 years of age(n=38,71.7%). The mean age of the participants was 7.08±3.02 years. The major presenting features included fever, anorexia and pain abdomen in 53 (100%), 51 (96.2%) and 41 (77.4%) respectively. The mean duration of symptoms prior to hospitalization was 8.92±3.361 days. Of the total patients, 32(60.4%) responded to the initial therapy with ceftriaxone and levofloxacin, 11(20.8%) patients responded to meropenem alone and 10 (18.9%) patients responded to meropenem and azithromycin in combination. There was no statistically significant difference in mean duration to show response in patients receiving either of the treatments (p=0.484). Conclusion: Paediatric patients with XDR enteric fever mainly presented with fever, anorexia and pain abdomen and showed good response to therapy with the combination of ceftriaxone and levofloxacin inspite of the apparent resistance on blood culture and sensitivityReferences
Browne AJ, Kashef Hamadani BH, Kumaran EA, Rao P, Longbottom J, Harriss E,et al. Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis. BMC Med 2020;18(1):1–22.
mondiale de la Santé O, World Health Organization. Typhoid vaccines: WHO position paper–March 2018–Vaccins antityphoïdiques: note de synthèse de l’OMS–mars 2018. Wkly Epidemiol Rec Relevé Épidémiologique Hebd 2018;93(13):153–72.
Tanveer M, Ahmed A, Siddiqui A, Rehman IU, Hashmi FK. War against COVID-19: looming threat of XDR typhoid battle in Pakistan. Public Health 2021;198:e15–6.
Rana MS, Usman M, Alam MM, Ikram A, Salman M. Overlapping clinical manifestations of COVID-19 with endemic infectious diseases in Pakistan: a looming threat of multiple lethal combinations. Infect Ecol Epidemiol 2021;11(1):1873494.
Mogasale V, Maskery B, Ochiai RL, Lee JS, Mogasale VV, Ramani E, et al. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment. Lancet Glob Health 2014;2(10):e570–80.
Antillón M, Warren JL, Crawford FW, Weinberger DM, Kürüm E, Pak GD, et al. The burden of typhoid fever in low- and middle-income countries: A meta-regression approach. PLoS Negl Trop Dis 2017;11(2):e0005376.
Levine MM. Chapter 61: Typhoid fever vaccines. In: Plotkin’s Vaccines, Seventh Edition: 2017; p.1114–44.
Chukwubuike KE. Profile of abdominal surgical complications of Enteric fever in children in a developing country. Sudan J Med Sci 2020;15(3):270–80.
Azmatullah A, Qamar FN, Thaver D, Zaidi AK, Bhutta ZA. Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever. J Glob Health 2015;5(2):020407.
Klemm EJ, Shakoor S, Page AJ, Qamar FN, Judge K, Saeed DK, et al. Emergence of an extensively drug-resistant Salmonella enterica serovar Typhi clone harboring a promiscuous plasmid encoding resistance to fluoroquinolones and third-generation cephalosporins. mBio 2018;9(1):e00105–18.
CDC. Extensively drug-resistant typhoid fever in Pakistan. [Internet]. 2018 [cited 2018 5 July]; Available from: https://wwwnc.cdc.gov/travel/notices/alert/xdr-typhoid-feverpakistan
mondiale de la Santé O. World Health Organization = Organisation mondiale de la Santé. Weekly Epidemiological Record, 2018, vol. 93, 13 [full issue]. Wkly Epidemiol Rec Relevé Épidémiologique Hebd 2018;93(13):153–72.
Qamar FN, Yousafzai MT, Sultana S, Baig A, Shakoor S, Hirani F,et al. A retrospective study of laboratory-based enteric fever surveillance, Pakistan, 2012–2014. J Infect Dis 2018;218(suppl_4):S201–5.
Qureshi S, Naveed AB, Yousafzai MT, Ahmad K, Ansari S, Lohana H, et al. Response of extensively drug resistant Salmonella Typhi to treatment with meropenem and azithromycin, in Pakistan. PLoS Negl Trop Dis 2020;14(10):e0008682.
Britto C, Pollard AJ, Voysey M, Blohmke CJ. An appraisal of the clinical features of pediatric enteric fever: systematic review and meta-analysis of the age-stratified disease occurrence. Clin Infect Dis 2017;64(11):1604–11.
Chaudhry AR, Kazi MY, Usman M, Ayub R. Frequency of leukocytosis in culture proven enteric fever in children. Prof Med J 2022;29(6):823–8.
Kleine CE, Schlabe S, Hischebeth GTR, Molitor E, Pfeifer Y, Wasmuth JC, et al. Successful Therapy of a Multidrug-Resistant Extended-Spectrum beta-Lactamase-Producing and Fluoroquinolone-Resistant Salmonella enterica Subspecies enterica Serovar Typhi Infection Using Combination Therapy of Meropenem and Fosfomycin. Clin Infect Dis 2017;65:1754–6.
Godbole GS, Day MR, Murthy S, Chattaway MA, Nair S. First Report of CTX-M-15 Salmonella Typhi From England. Clin Infect Dis 2018;66:1976–7.
Capoor MR, Rawat D, Nair D, Hasan AS, Deb M, Aggarwal P, et al. In vitro activity of azithromycin, newer quinolones and cephalosporins in ciprofloxacin-resistant Salmonella causing enteric fever. J Med Microbiol 2007;56(11):1490–4.
Nelwan R, Lie KC, Hadisaputro S, Suwandoyo E, Yusuf SN, Sudjana P, et al. A single blind comparative randomized non-inferior multicenter study for efficacy and safety of levofloxacin versus ciprofloxacin in the treatment of uncomplicated typhoid fever. Adv Microbiol 2013;3(1):122–7.
Wu X, Li Z, Li X, Tian Y, Fan Y, Yu C, et al. Synergistic effects of antimicrobial peptide DP7 combined with antibiotics against multidrug-resistant bacteria. Drug Des Devel Ther 2017;11:939–46.
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