Concerning Trend in Ceftriaxone Minimum Inhibitory Concentration (MIC): Implications for the Treatment of Enteric Fever
Introduction: Salmonella typhi and paratyphi - related enteric fever still poses serious health risks to people all over the world. Ceftriaxone and azithromycin were recommended as the preferred treatments for enteric fever following the emergence of fluoroquinolone resistance. Several reports of ceftriaxone resistance have also been reported, hence accurate medication susceptibility tracking is essential to maintain the empiric management of enteric fever. This study’s objective is to determine the MIC of ceftriaxone in order to help clinicians prescribe the right dosage and stop the emergence of resistance.
Material and Methods: The investigation was carried out in 800 bedded hospital in Ghaziabad using a cross-sectional prospective design. A total of 228 Salmonella isolates were included in this investigation. The isolates’ antibiotic susceptibility was assessed using the Kirby Bauer disc diffusion method, and the ceftriaxone MIC was calculated using the Broth Micro-Dilution (BMD) method.
Result: Of the 228 Salmonella species that were isolated, 64 (28.07%) were Salmonella paratyphi A, and 164 (71.92%) were Salmonella typhi. Ceftriaxone resistance was found in 33 (20.12%) Salmonella typhi strains while it was found in 14 (21.87%) S. paratyphi A strains. 0.125 µg/ml was the ceftriaxone MIC50 value for S. typhi as well as for paratyphi A but the MIC90 value was 8 µg/ml in S. typhi and 4 µg/ml in S. paratyphi A isolates.
Conclusion: This investigation revealed a concerning rise in the MIC to ceftriaxone and the reemergence of sensitivity to first-line medications.
How to cite this article:
Kaira SS, Makkar A, Gupta G. Concerning Trend in Ceftriaxone Minimum Inhibitory Concentration (MIC): Implications for the Treatment of Enteric Fever. J Commun Dis. 2023;55(1):24-29.
Bhat SK, Ravichandran K, Kanungo R. Rising minimum inhibitory concentration of azithromycin: a therapeutic challenge in treating enteric fever. J Clin Diagn Res. 2022;16(3):DC06-DC09. [Google Scholar]
Kokare RS, Bari AK, Pereira JV, Patel K, Poojary A. Minimum Inhibitory Concentration (MIC) of ceftriaxone and azithromycin for blood culture isolates of Salmonella enterica spp. J Infect Dev Ctries. 2021;15(4):538-43. [PubMed] [Google Scholar]
Misra R, Prasad KN. Antimicrobial susceptibility to azithromycin among Salmonella enterica Typhi and Paratyphi A isolates from India. J Med Microbiol. 2016;65(12):1536-9. [PubMed] [Google Scholar]
Cuypers WL, Jacobs J, Wong V, Klemm EJ, Deborggraeve S, Puyvelde SV. Fluoroquinolone resistance in Salmonella: insights by whole-genome sequencing. Microb Genom. 2018;4(7). [PubMed] [Google Scholar]
National treatment guidelines for antimicrobial use in infectious diseases 2016. National Centre for Disease Control, Directorate General of Health Services Ministry of Health & Family Welfare Government of India.
Patel SR, Bharti S, Pratap CB, Nath G. Drug resistance pattern in the recent isolates of Salmonella Typhi with special reference to cephalosporins and azithromycin in the Gangetic Plain. J Clin Diagn Res. 2017;11(6):DM01-DM03. [PubMed] [Google Scholar]
Clinical and Laboratory Standards Institute (CLSI). M100. Performance standards for antimicrobial susceptibility testing. 32nd ed. 2021.
Andrews JM. Determination of minimum inhibitory concentrations. J Antimicrob Chemother. 2001;48(Suppl 1):5-16. [PubMed] [Google Scholar]
Mahapatra A, Patro S, Choudhury S, Padhee A, Das R. Emerging enteric fever due to switching biotype of Salmonella (paratyphi A) in Eastern Odisha. Indian J Pathol Microbiol. 2016;59(3):327-9. [PubMed] [Google Scholar]
Kumar AP, Jose BP. Study on recent trends in antibiogram of enteric fever pathogens in a tertiary care centre in South India. J Med Sci Clin Res. 2018;6(5):80-6.
Narasanna R, Chavadi M, Chandrakanth K. Prevalence of multidrug-resistant Salmonella typhi in typhoid patients and detection of blaCTX-M2 and blaCTX-M9 genes in cefotaxime-mediated extended spectrum β-lactamase producing Salmonella typhi isolates. Biomed Res. 2018;29(14):3015-21. [Google Scholar]
Taneja J, Khatter S, Paul M, Pandey A, Kaur I. Antimicrobial resistance in Typhoidal Salmonella in a tertiary care teaching centre in North India. J Commun Dis. 2021;53(1):1-4. [Google Scholar]
Behl P, Gupta V, Sachdev A, Guglani V, Chander J. Patterns in antimicrobial susceptibility of Salmonellae isolated at a tertiary care hospital in northern India. Indian J Med Res. 2017;145(1):124-8. [PubMed] [Google Scholar]
Sharma P, Dahiya S, Manral N, Kumari B, Kumar S, Pandey S, Sood S, Das BK, Kapil A. Changing trends of culture-positive typhoid fever and antimicrobial susceptibility in a tertiary care North Indian Hospital over the last decade. Indian J Med Microbiol. 2018;36(1):70. [PubMed] [Google Scholar]
Akram J, Khan AS, Khan HA, Gilani SA, Akram SJ, Ahmad FJ, Mehboob R. Extensively drug-resistant (XDR) typhoid: evolution, prevention, and its management. Biomed Res Int. 2020;2020:6432580. [PubMed] [Google Scholar]
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