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Prevalence and trends in the antimicrobial susceptibility pattern of Salmonella enterica serovars Typhi and Paratyphi A among children in a pediatric tertiary care hospital in South India over a period of ten years: a retrospective study

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Abstract

The aim of this study was to determine the prevalence and trends in the antimicrobial resistance of typhoidal salmonellae in children and adolescents at a pediatric tertiary care hospital in South India. Typhoidal salmonellae were isolated from 483 of the 77,713 blood cultures received during the ten-year study period (2007–2016). Isolates were speciated by conventional biochemical reactions and serotyping. Antimicrobial susceptibility testing was performed and interpreted according to the British Society for Antimicrobial Chemotherapy (BSAC)/European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. The overall blood culture isolation rates of Salmonella enterica serovars Typhi and Paratyphi A in children were 0.5% (408 cases) and 0.1% (73 cases), respectively, with the highest isolation rates in school [299 (61.9%)] and preschool children [113 (23.4%)]. A decreasing prevalence of enteric fever was seen from 2012 to 2015, with a sudden surge in 2016. From 2011 onwards, a high fluoroquinolone resistance (90–100%) was observed. Multidrug resistance was observed in only four (0.9%) S. Typhi isolates. 100% susceptibility to third-generation cephalosporins and azithromycin was noted. Enteric fever as seen in a pediatric tertiary care hospital in India affects children and adolescents of all age groups, with greater isolation rates in school children, followed by those in preschool years, calling for targeted interventions against these age groups. The study findings support the use of third-generation cephalosporins and azithromycin as first-line therapy and ampicillin and co-trimoxazole as step-down therapy in pediatric enteric fever. However, continued local surveillance should be done to detect antimicrobial resistance trends to optimize treatment.

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Acknowledgments

The authors thank Surender Reddy and all the other laboratory technical staff at the Rainbow Hospital for Women and Children for their help in the data collection.

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Authors and Affiliations

  1. Department of Clinical Microbiology and Serology, Global Hospitals, 6-1-1070/1 to 4, Lakdi-ka-pul, Hyderabad, Telangana, 500004, India

    R. N. Iyer & R. R. Jangam

  2. Department of Clinical Microbiology and Serology, Rainbow Hospital for Women and Children, Hyderabad, Telangana, India

    R. N. Iyer & A. Jacinth

  3. Department of Pediatrics, Rainbow Hospital for Women and Children, Hyderabad, Telangana, India

    A. Venkatalakshmi & F. B. Nahdi

Authors
  1. R. N. Iyer
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  2. R. R. Jangam
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  3. A. Jacinth
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  4. A. Venkatalakshmi
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  5. F. B. Nahdi
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Contributions

Iyer RN conceived and supervised the study. Iyer RN, Jangam RR, and Jacinth A analyzed and interpreted the data. Iyer RN and Jangam RR wrote the manuscript. Iyer RN, Venkatalakshmi A, and Nahdi FB reviewed and approved the final version of the study.

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Correspondence to R. R. Jangam.

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The authors have no funding to disclose.

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The authors declare no conflicts of interest in relation to this study.

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For this type of retrospective study, formal consent is not required.

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Iyer, R.N., Jangam, R.R., Jacinth, A. et al. Prevalence and trends in the antimicrobial susceptibility pattern of Salmonella enterica serovars Typhi and Paratyphi A among children in a pediatric tertiary care hospital in South India over a period of ten years: a retrospective study. Eur J Clin Microbiol Infect Dis 36, 2399–2404 (2017). https://doi.org/10.1007/s10096-017-3073-x

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  • DOI: https://doi.org/10.1007/s10096-017-3073-x

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