Antibiotic Resistance among Salmonella Isolates - A Five-year Trend

Veenu Gupta; Harmandeep  Kaur; Rama  Gupta; Jyoti  Chaudhary; Menal  Gupta

Veenu Gupta MBBS, MD, Professor & Head, Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
Harmandeep Kaur MBBS, MD, Senior Resident, Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
Rama Gupta PHD, Professor, Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
Jyoti Chaudhary MBBS, MD, Associate Professor, Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
Menal Gupta MBBS, MD, Assistant Professor, Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Keywords: Antimicrobial Resistance, Enteric Fever, Emerging Ceftriaxone Resistance, Salmonella

Abstract

Introduction: In India, enteric fever is an endemic febrile illness, caused by Salmonella enterica serovar Typhi/ Paratyphi A, B, and C. The incidence of Salmonella enterica serovar Typhi/ Paratyphi isolates with
decreased susceptibility/ resistance to fluoroquinolones is very high, though these isolates have been reported to be sporadically resistant to third-generation cephalosporins. This retrospective study was planned
to analyse the trends of drug resistance along with the emergence of ceftriaxone resistance, if any, among Salmonella enterica isolates.
Materials and Methods: This retrospective study in a tertiary caremhospital over a span of five years (2018–2022). All the blood specimens were inoculated in blood culture bottles and were processed using
automated systems as per standard protocols. All the isolates obtained were identified and their antimicrobial susceptibility pattern was determined using VITEK 2.
Results: A total of 1083 S. enterica were isolated, of which, 779 (71%) were Salmonella Typhi, and 304 (29%) were Salmonella Paratyphi A.
The positivity of blood culture for Salmonella enterica varied from 0.7% to 1.3%. The distribution of S. Typhi (70%–80%) and S. Paratyphi (20%–30%) remained almost uniform during all the years. A significant
increase in ciprofloxacin resistance was observed in S. Typhi isolates in all the years. 0.7%–3.2% and 1.1%–1.4% of S. Typhi and S. Paratyphi A isolates, respectively, were found resistant to ceftriaxone over the years.
Conclusion: A high resistance to fluoroquinolone among S. Typhi and S. Paratyphi A isolates was observed with the emergence of ceftriaxone resistance and re-emergence of susceptibility to first-line medications.

How to cite this article:
Gupta V, Kaur H, Gupta R, Chaudhary J, Gupta M. Antibiotic Resistance among Salmonella Isolates - A Five-year Trend. J Commun Dis. 2023;55(3):7-13.

DOI: https://doi.org/10.24321/0019.5138.202331

References

Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organ. 2004;82(5):346-

[PubMed] [Google Scholar]

Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM. Epidemiology, clinical presentation, laboratory diagnosis, antimicrobial resistance, and antimicrobial management of invasive Salmonella infections. Clin Microbiol Rev. 2015;28(4):901-37. [PubMed] [Google Scholar]

Kanungo S, Dutta S, Sur D. Epidemiology of typhoid and paratyphoid fever in India. J Infect Dev Ctries.2008;2(6):454-60. [PubMed] [Google Scholar]

Threlfall EJ, Ward LR, Rowe B, Raghupathi S, Chandrasekaran V, Vandepitte J, Lemmens P. Widespread occurrence of multiple drug-resistant Salmonella typhi in India. Eur J Clin Microbiol Infect Dis. 1992;11(11):990-3. [PubMed] [Google Scholar]

Pang T, Bhutta ZA, Finlay BB, Altwegg M. Typhoid fever and other salmonellosis: a continuing challenge. Trends

Microbiol. 1995;3(7):253-4. [PubMed] [Google Scholar]

Feasey NA, Gaskell K, Wong V, Msefula C, Selemani G, Kumwenda S, Allain TJ, Mallewa J, Kennedy N,Bennett A, Nyirongo JO, Nyondo PA, Zulu MD, Parkhill J, Dougan G, Gordon MA, Heyderman RS. Rapid emergence of multidrug resistant, H58-lineage Salmonella typhi in Blantyre, Malawi. PLoS Negl Trop Dis. 2015;9(4):e0003748. [PubMed] [Google Scholar]

Hendriksen RS, Leekitcharoenphon P, Lukjancenko O, Lukwesa-Musyani C, Tambatamba B, Mwaba J, Kalonda A, Nakazwe R, Kwenda G, Jensen JD, Svendsen CA, Dittmann KK, Kaas RS, Cavaco LM, Aarestrup FM, Hasman H, Mwansa JC. Genomic signature of multidrugresistant Salmonella enterica serovar typhi isolates related to a massive outbreak in Zambia between 2010 and 2012. J Clin Microbiol. 2015;53(1):262-72. [PubMed] [Google Scholar]

Upadhyay R, Nadkar MY, Muruganathan A, Tiwaskar M, Amarapurkar D, Banka NH, Mehta KK, Sathyaprakash

BS. API recommendations for the management of typhoid fever. J Assoc Physicians India. 2015;63(11):77-96.[PubMed] [Google Scholar]

Brown NM, Millar MR, Frost JA, Rowe B. Ciprofloxacin resistance in Salmonella paratyphi A. J Antimicrob Chemother. 1994;33(6):1258-9. [PubMed] [Google Scholar]

Mehta A, Rodriques C, Joshi VR. Multiresistant salmonella organisms in India. JAMA. 1992;267(12):1614.

[PubMed] [Google Scholar]

Kaur D, Gupta R, Goyal O, Chhina RS. Fluoroquinolone resistance among Salmonella enterica serovar typhi

and paratyphi isolates in a tertiary care hospital in northern India. J Gastrointest Infect. 2018;8(1):12-5. [Google Scholar]

Qamar FN, Azmatullah A, Kazi AM, Khan E, Zaidi AK. A three-year review of antimicrobial resistance of

Salmonella enterica serovars typhi and paratyphi A in Pakistan. J Infect Dev Ctries. 2014;8(8):981-6. [PubMed]

[Google Scholar]

Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk

method. Am J Clin Pathol. 1966;45(4):493-6. [PubMed] [Google Scholar]

CLSI. Performance standards for antimicrobial susceptibility testing. 19th informational supplement.

M100-S19. Wayne (PA): Clinical and Laboratory Standards Institute; 2022.

Biswas M, Biswas S, Gupta B, Mascellino MT, Rakshit A, Chakraborty B. Changing paradigms in antibiotic

resistance in Salmonella species with focus on fluoroquinolone resistance: a 5-year retrospective study of enteric fever in a tertiary care hospital in Kolkata, India. Antibiotics (Basel). 2022;11(10):1308. [PubMed] [Google Scholar]

Manchanda V, Bhalla P, Sethi M, Sharma VK. Treatment of enteric fever in children on the basis of current trends of antimicrobial susceptibility of Salmonella enterica serovar typhi and paratyphi A. Indian J Med Microbiol. 2006;24(2):101-6. [PubMed] [Google Scholar]

Kumar S, Rizvi M, Berry N. Rising prevalence of enteric fever due to multidrug-resistant Salmonella: an

epidemiological study. J Med Microbiol. 2008;57(Pt 10):1247-50. [PubMed] [Google Scholar]

Chowta MN, Chowta NK. Study of clinical profile and antibiotic response in typhoid fever. Indian J Med Microbiol. 2005;23(2):125-7. [PubMed] [Google Scholar]

Nagshetty K, Channappa ST, Gaddad SM. Antimicrobial susceptibility of Salmonella Typhi in India. J Infect Dev

Ctries. 2010;4(2):70-3. [PubMed] [Google Scholar]

Gupta V, Singla N, Bansal N, Kaistha N, Chander J. Trends in the antibiotic resistance patterns of enteric

fever isolates – a three year report from a tertiary care centre. Malays J Med Sci. 2013;20(4):71-5. [PubMed [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]

Malini A, Barathy C, Madhusudan NS, Johnson C. Clinical and microbiological profile of enteric fever among

pediatric patients in a tertiary care center in South India: a cross-sectional study. J Clin Sci. 2020;17:74-9. [Google Scholar]

Threlfall EJ, Ward LR, Skinner JA, Smith HR, Lacey S. Ciprofloxacin-resistant Salmonella typhi and treatment

failure. Lancet. 1999;353(9164):1590-1. [PubMed] [Google Scholar]

Wain J, Hoa NT, Chinh NT, Vinh H, Everett MJ, Diep TS, Day NP, Solomon T, White NJ, Piddock LJ, Parry CM.

Quinolone-resistant Salmonella typhi in Viet Nam: molecular basis of resistance and clinical response to treatment. Clin Infect Dis. 1997;25(6):1404-10. [PubMed] [Google Scholar]

Mermin JH, Villar R, Carpenter J, Roberts L, Samaridden A, Gasanova L, Lomakina S, Bopp C, Hutwagner L, Mead P, Ross B, Mintz ED. A massive epidemic of multidrugresistant typhoid fever in Tajikistan associated

with consumption of municipal water. J Infect Dis. 1999;179(6):1416-22. [PubMed] [Google Scholar]

Harish BN, Menezes GA. Preserving efficacy of chloramphenicol against typhoid fever in a tertiary care hospital, India. Regional Health Forum, WHO South-East Asia Region. 2011;15(1):92-6. [Google Scholar]

Indian Network for Surveillance of Antimicrobial Resistance Group. Antibiogram of S. enteric serovar

typhi and S. enteric serovar paratyphi A: a multi-centre study from India. WHO South East Asia J Public Health.

;1(2):182-8. [Google Scholar]

Munir T, Lodhi M, Ansari JK, Andleeb S, Ahmed M. Extended spectrum beta lactamase producing cephalosporin resistant Salmonella Typhi, reported from Rawalpindi, Pakistan. J Pak Med Assoc. 2016;66(8):1035-6. [PubMed] [Google Scholar]

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):24-9. [Google Scholar]

Dutta S, Das S, Mitra U, Jain P, Roy I, Ganguly SS, Ray U, Dutta P, Paul DK. Antimicrobial resistance, virulence profiles and molecular subtypes of Salmonella enterica serovars typhi and paratyphi A blood isolates from Kolkata, India during 2009-2013. PLoS One. 2014;9(8):e101347. [PubMed] [Google Scholar]