Antibiotic Resistance Patterns in Pediatric Typhoid Cases in Combined Military Hospital Peshawar

Authors

  • Muhammad Saeed Department of Paediatrics, CMH Peshawar, Pakistan
  • Syed Awais ull Hassan Shah Department of Paediatrics, CMH Peshawar, Pakistan
  • Hina Waheed Department of Paediatrics, CMH Peshawar, Pakistan
  • Aamir Rahman Department of Paediatrics, CMH Peshawar, Pakistan
  • Mashhood Hamza KRL Hospital, Islamabad, Pakistan
  • Basit Javed Department of Paediatrics, CMH Peshawar, Pakistan

DOI:

https://doi.org/10.70749/ijbr.v3i6.2152

Keywords:

Typhoid fever, Antibiotic resistance pattern, Salmonella typhi, Children.

Abstract

Background and Aim: Poor public health infrastructure and low socioeconomic indicators are the primary contributors to the prevalence of typhoid fever. Currently, Pakistan is facing the challenges of severe outbreak of typhoid fever, resulting in increased rates of illness and fatalities, particularly among the pediatric population. The aim of the current study was to investigate the antibiotic resistant patterns in pediatric typhoid cases. Patients and Methods: A cross-sectional study investigated 173 typhoid cases at the Department of Pediatrics, Combined Military Hospital, Peshawar from July 2024 to February 2025. Children aged 1 day to 12 years of either gender with prior history of fever and positively diagnosed typhoid fever were enrolled. A self-structured questionnaire designed for data collection such as age, gender, socioeconomic status, and drinking water status. Symptoms of typhoid fever were recorded. Blood sample taken from each children and tested for antibiotic susceptibility. Data analysis was done using SPSS version 26. Results: Out of 173 typhoid cases, there were 106 (61.3%) male and 67 (38.7%) female children. Salmonella typhi was identified in 156 (90.2%) of the patients, while Salmonella paratyphi was found in 17 (8.8%) of the cases. Significant determinants for the acquisition of salmonella infection included youth (68.2%), male sex (61.3%), middle to low socioeconomic status (80.9%), and the intake of untreated water (78%). Moreover, a notable prevalence of extended drug resistance found in 70.5% of the affected individuals. The majority of the isolates demonstrated sensitivity to meropenem and azithromycin, with rates of 95.8% and 94.3%, respectively. Resistance to ceftriaxone was widespread affecting various age groups: 1 day-3 years (96%), 4-7 years (90%), and 8-12 years (100%), with a notable predominance in males (57%).  Conclusion: The probability of extended drug-resistant typhoid fever increased among children aged 1 day to 3 years, males, and individuals from lower socioeconomic backgrounds. Consumption of untreated water recognized as a significant factor contributing to this issue. It is essential to implement measures across all healthcare levels to ensure the responsible use of antibiotics.

Downloads

Download data is not yet available.

References

1. Amber W, Fatima I, Khalid Q, Hameed H, Khan IM. Zulfqar R. Antibiotic Resistance Pattern of Salmonella Species in Children in a Tertiary Care Hospital. J. Rwp. Med. College. 30 2021; 25(3): 366- 70.

https://doi.org/10.37939/jrmc.v25i3.1594

2. Laghari GS, Hussain Z, Hussain SZM, Kumar H, Uddin SMM, Haq A. Antimicrobial Susceptibility Patterns of Salmonella Species in Southern Pakistan. Cureus. 2019 3;11(4):e4379.

https://doi.org/10.7759/cureus.4379

3. Ali Shah SA, Nadeem M, Syed SA, Fatima Abidi ST, Khan N, Bano N. Antimicrobial Sensitivity Pattern of Salmonella Typhi: Emergence of Resistant Strains. Cureus. 2020;12(11):e11778.

https://doi.org/10.7759/cureus.11778

4. Wong W, Rawahi H Al, Patel S, Yau Y, Eshaghi A, Zittermann S, et al. The first Canadian pediatric case of extensively drug-resistant Salmonella Typhi originating from an outbreak in Pakistan and its implication for empiric antimicrobial choices. ID Cases. 2018; 15:e00492.

https://doi.org/10.1016/j.idcr.2019.e00492

5. Saeed N, Usman M, Khan EA. An Overview of Extensively Drug-resistant Salmonella Typhi from a Tertiary Care Hospital in Pakistan. Cureus. 2019;11(9):e5663.

https://doi.org/10.7759/cureus.5663

6. Ali A, Ali HA, Shah FH. Pattern of antimicrobial drug resistance of Salmonella Typhi and Paratyphi A in a Teaching Hospital in Islamabad. J Pak Med Assoc. 2017;67(3):375–9.

7. Sina A, Malik L. Emergence of Multi-Resistant Enteric Infection In A Pediatric Unit Of Karachi, Pakistan. J Pak Med Assoc. 2018;68(12):1848–50.

8. Rasheed MK, Hasan SS, Babar ZU, Ahmed SI. Extensively drug-resistant typhoid fever in Pakistan. Lancet Infect Dis. 2019 ;19(3):242-3.

https://doi.org/10.1016/s1473-3099(19)30051-9

9. Siddiqui H, Jahan F, Siddiqui MA. Pattern of Anti-microbial Drug Resistance in Childhood Typhoid Fever in a Selected Hospital in Karachi, Pakistan. Asian J Res Infect Dis. 2019;2(1):1–9.

https://doi.org/10.9734/ajrid/2019/v2i130092

10. Anwar T, Rais H, Jamil MF, Amir MR, Altaf A, Safdar S, Khan H. Extended drug resistance in children with typhoid fever. Professional Med J 2020; 27(3):581-587.

https://doi.org/10.29309/TPMJ/2020.27.3.3695.

11. Qamar FN, Yousafzai MT, Khalid M, Kazi AM, Lohana H, Karim S, Khan A, Hotwani A, Qureshi S, Kabir F, Aziz F. Outbreak investigation of ceftriaxone-resistant Salmonella enterica serotype Typhi and its risk factors among the general population in Hyderabad, Pakistan: a matched case-control study. The Lancet Infectious Diseases. 2018 Dec 1;18(12):1368-76.

https://doi.org/10.1016/s1473-3099(18)30483-3

12. Aziz S, Malik L. Emergence of Multi-Resistant Enteric Infection In A Paediatric Unit Of Karachi, Pakistan. Age. 2018;5:2-84.

13. Naheed A, Ram PK, Brooks WA, Hossain MA, Parsons MB, Talukder KA, Mintz E, Luby S, Breiman RF. Burden of typhoid and paratyphoid fever in a densely populated urban community, Dhaka, Bangladesh. International Journal of Infectious Diseases. 2010 Sep 1;14:e93-9.

https://doi.org/10.1016/j.ijid.2009.11.023

14. Williams PC, Isaacs D, Berkley JA. Antimicrobial resistance among children in sub-Saharan Africa. The Lancet Infectious Diseases. 2018 Feb 1;18(2):e33-44.

https://doi.org/10.1016/s1473-3099(17)30467-x

15. Rasheed MK, hasan SS, ahmed SI. extensively drug-resistant typhoid fever in Pakistan. lancet Infect dis. 2019;19:242-3.Medline:30833059.

https://doi.org/10.1016/S1473-3099(19)30051-9

16. Stanaway Jd, Reiner RC, Blacker BF, goldberg eM, Khalil Ia, troeger Ce, et al. the global burden of typhoid and paratyphoid fevers: a systematic analysis for the global Burden of disease Study 2017. lancet Infect dis. 2019;19:369-81. Medline:30792131.

https://doi.org/10.1016/S1473-3099(18)30685-6.

17. Akram J, Khan aS, Khan ha, gilani Sa, akram SJ, ahmad FJ, et al. extensively drug-resistant (XdR) typhoid: evolution, prevention, and its management. BioMed Res Int. 2020; 2020:6432580. Medline:32462008.

https://doi.org/10.1155/2020/6432580

18. Ali Shah Sa, Nadeem M, Syed Sa, Fatima abidi St, Khan N, Bano N, et al. antimicrobial sensitivity pattern of salmonella typhi: emergence of resistant strains. Cureus. 2020;12:e11778. Medline:33409025.

https://doi.org/10.7759/cureus.11778

19. Khan M, Shamim S. Understanding the mechanism of antimicrobial resistance and pathogenesis of Salmonella enterica Serovar typhi. Microorganisms. 2022;10:2006. Medline:36296282.

https://doi.org/10.3390/microorganisms10102006

20. da Silva Ke, tanmoy aM, Pragasam aK, Iqbal J, Sajib MSI, Mutreja a, et al. the international and intercontinental spread and expansion of antimicrobial-resistant Salmonella typhi: a genomic epidemiology study. lancet Microbe. 2022;3:e567-77. Medline:35750070.

https://doi.org/10.1016/S2666-5247(22)00093-3.

21. Siddiqui h, Jahan F, Siddiqui Ma. Pattern of anti-microbial drug resistance in childhood typhoid fever in a selected hospital in Karachi, Pakistan. asian J Res Infect dis. 2019;2:1-9.

https://doi.org/10.9734/ajrid/2019/v2i130092.

22. Sinha B, Rongsen-Chandola t, goyal N, arya a, Kumar CM, Chakravarty a, et al. Incidence of enteric fever in a pediatric cohort in North India: comparison with estimates from 20 years earlier. the Journal of Infectious diseases. 2021;224(Supplement_5):S558-S67.

https://doi.org/10.1093/infdis/jiab046

23. Qamar FN, Yousafzai Mt, Khalid M, Kazi aM, lohana h, Karim S, et al. outbreak investigation of ceftriaxone-resistant Salmonella enterica serotype typhi and its risk factors among the general population in hyderabad, Pakistan: a matched case-control study. lancet Infect dis. 2018;18:1368-76. Medline:30507460.

https://doi.org/10.1016/S1473-3099(18)30483-3.

24. Rahman B, Wasfy M, Maksoud M, hanna N, dueger e, house B. Multi-drug resistance and reduced susceptibility to ciprofloxacin among Salmonella enterica serovar typhi isolates from the Middle east and Central asia. New Microbes New Infect. 2014;2:88-92. Medline:25356352.

https://doi.org/10.1002/nmi2.46

25. Tahir MJ, Zaman M, Saf J, asghar MS, tariq W, ahmed F, et al. Knowledge, attitudes, and practices of the general population of Pakistan regarding typhoid conjugate vaccine: findings of a cross-sectional study. Front Public health. 2023;11:1151936. Medline:37333546.

https://doi.org/10.3389/fpubh.2023.1151936

Downloads

Published

2025-06-30

How to Cite

Saeed, M., Shah, S. A. ull H., Waheed, H., Rahman, A., Hamza, M., & Javed, B. (2025). Antibiotic Resistance Patterns in Pediatric Typhoid Cases in Combined Military Hospital Peshawar. Indus Journal of Bioscience Research, 3(6), 1010-1013. https://doi.org/10.70749/ijbr.v3i6.2152