Aslam Aqsa, Ahmed Kharal Sahibzada, Aslam Maria, Raza Almas
Microbiology, National University of Medical Sciences, Rawalpindi, PAK.
Family Medicine, Forrest Family Practice, Bunbury, AUS.
Cureus. 2021 Jan 12;13(1):e12664. doi: 10.7759/cureus.12664.
Enteric fever or typhoid fever is a major public health issue affecting greater than 27 million individuals globally and is responsible for greater than 200,000 deaths per year. Due to the extensive overuse of antimicrobials, the world is moving toward a pre-antibiotic era. The emergence and transmission of antibiotic-resistant species are a global threat and a serious concern in developing countries such as Pakistan. This study aimed to determine the trends in antimicrobial resistance (AMR) of typhoidal strains of in a tertiary care hospital in Pakistan.
It was a descriptive, cross-sectional study conducted in the pathology department of Sharif City Hospital, Lahore, after approval by the ethical committee of the institution. A total of 50 blood culture specimens positive for and from January 2019 to March 2020 were included by the non-probability consecutive sampling technique. The samples were processed by conventional bacteriological methods for isolation and identification. The antimicrobial susceptibility testing was done by the Kirby-Bauer disc diffusion method as recommended by the Clinical and Laboratory Standard Institute (CLSI). The statistical package for social sciences (SPSS, IBM Corp., Armonk, NY) version 25 was used for data entry and analysis.
Among the first-line drugs (ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole), 70% of strains were resistant, and only 30% strains were sensitive to them. Among the cephalosporins, 52% strains were sensitive to ceftriaxone, and 48% strains were sensitive to ceftazidime, cefotaxime, and cefepime. Twenty-four percent of strains were sensitive to ciprofloxacin. Only 50% of strains were sensitive to ampicillin-sulbactam, and 92% of strains were sensitive to piperacillin-tazobactam. All the strains were 100% sensitive to imipenem and meropenem; 96% of strains were sensitive to co-amoxiclav, doxycycline, and azithromycin. The frequency of multidrug-resistant (MDR) and extensively drug-resistant (XDR) species was 16% and 54%.
The increasing frequency of MDR and XDR species in Pakistan is a major concern. A significant percentage of the typhoidal strains of is resistant to the first-line (16%) and second-line (54%) antibiotics. Carbapenems and azithromycin are the last resort of therapy in such cases.
肠热症或伤寒热是一个重大的公共卫生问题，全球超过2700万人受其影响，每年导致超过20万人死亡。由于抗菌药物的广泛过度使用，世界正走向一个抗生素前时代。抗生素耐药菌株的出现和传播是一个全球威胁，在巴基斯坦等发展中国家是一个严重问题。本研究旨在确定巴基斯坦一家三级护理医院中伤寒菌株的抗菌药物耐药性（AMR）趋势。
这是一项描述性横断面研究，在拉合尔谢里夫市医院病理科进行，经该机构伦理委员会批准。采用非概率连续抽样技术，纳入了2019年1月至2020年3月期间50份血培养标本，这些标本对伤寒杆菌呈阳性。样本通过常规细菌学方法进行处理以进行分离和鉴定。抗菌药物敏感性试验按照临床和实验室标准协会（CLSI）的建议采用 Kirby-Bauer 纸片扩散法进行。使用社会科学统计软件包（SPSS，IBM公司，纽约州阿蒙克）第25版进行数据录入和分析。
在一线药物（氨苄西林、氯霉素和甲氧苄啶 - 磺胺甲恶唑）中，70%的菌株耐药，只有30%的菌株对其敏感。在头孢菌素中，52%的菌株对头孢曲松敏感，48%的菌株对头孢他啶、头孢噻肟和头孢吡肟敏感。24%的菌株对环丙沙星敏感。只有50%的菌株对氨苄西林 - 舒巴坦敏感，92%的菌株对哌拉西林 - 他唑巴坦敏感。所有菌株对亚胺培南和美罗培南100%敏感；96% 的菌株对阿莫西林克拉维酸、多西环素和阿奇霉素敏感。多重耐药（MDR）和广泛耐药（XDR）伤寒杆菌菌株的频率分别为16%和54%。
巴基斯坦MDR和XDR伤寒杆菌菌株频率的增加是一个主要问题。相当比例的伤寒杆菌菌株对一线（16%）和二线（54%）抗生素耐药。在这种情况下，碳青霉烯类和阿奇霉素是最后的治疗手段。
