Journal Article

Trends in antimicrobial resistance amongst Salmonella Paratyphi A isolates in Bangladesh: 1999–2021

Rahman, Hafizur, Sarkar, Anik, Islam, Nazrul, Hanif, Mohammed, Munira, Sira J., Sajib, Mohammad S. I., Rahman, Md. Asadur, Luby, Stephen P., Garrett, Denise O., Shahidullah, Mohammod, Hooda, Yogesh, Saha, Senjuti, Das, Dipu, Alam, Md. Jahangir, Tanmoy, Arif M., Amin, Md. Ruhul, Saha, Samir K.

2023

Overview

Typhoid and paratyphoid remain common bloodstream infections in areas with suboptimal water and sanitation infrastructure. Paratyphoid, caused by Salmonella Paratyphi A, is less prevalent than typhoid and its antimicrobial resistance (AMR) trends are less documented. Empirical treatment for paratyphoid is commonly based on the knowledge of susceptibility of Salmonella Typhi, which causes typhoid. Hence, with rising drug resistance in Salmonella Typhi, last-line antibiotics like ceftriaxone and azithromycin are prescribed for both typhoid and paratyphoid. However, unlike for typhoid, there is no vaccine to prevent paratyphoid. Here, we report 23-year AMR trends of Salmonella Paratyphi A in Bangladesh. From 1999 to 2021, we conducted enteric fever surveillance in two major pediatric hospitals and three clinics in Dhaka, Bangladesh. Blood cultures were performed at the discretion of the treating physicians; cases were confirmed by culture, serological and biochemical tests. Antimicrobial susceptibility was determined following CLSI guidelines. Over 23 years, we identified 2,725 blood culture-confirmed paratyphoid cases. Over 97% of the isolates were susceptible to ampicillin, chloramphenicol, and cotrimoxazole, and no isolate was resistant to all three. No resistance to ceftriaxone was recorded, and >99% of the isolates were sensitive to azithromycin. A slight increase in minimum inhibitory concentration (MIC) is noticed for ceftriaxone but the current average MIC is 32-fold lower than the resistance cut-off. Over 99% of the isolates exhibited decreased susceptibility to ciprofloxacin. Salmonella Paratyphi A has remained susceptible to most antibiotics, unlike Salmonella Typhi, despite widespread usage of many antibiotics in Bangladesh. The data can guide evidence-based policy decisions for empirical treatment of paratyphoid fever, especially in the post typhoid vaccine era, and with the availability of new paratyphoid diagnostics.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Ampicillin / Anti-Bacterial Agents - pharmacology / Anti-Bacterial Agents - therapeutic use / Antibiotics / Antimicrobial agents / Antimicrobial resistance / Azithromycin / Azithromycin - pharmacology / Azithromycin - therapeutic use / Bacterial infections / Bangladesh - epidemiology / Biochemical tests / Blood / Blood culture / Care and treatment / Ceftriaxone / Ceftriaxone - pharmacology / Child / Children's hospitals / Childrens health / Chloramphenicol / Chloromycetin / Ciprofloxacin / Contamination / Cotrimoxazole / Drug resistance / Drug resistance in microorganisms / Drug Resistance, Bacterial / Electronic records / Epidemiology / Evidence-based medicine / Fever / Health aspects / Health services / Humans / Infection / Laboratories / Management / Medical examination / Microbial Sensitivity Tests / Minimum inhibitory concentration / Paratyphoid fever / Paratyphoid Fever - epidemiology / Patient outcomes / Pediatrics / Penicillin / Salmonella / Salmonella paratyphi A / Salmonella Typhi / Sanitation / Trends / Typhoid / Typhoid fever / Typhoid Fever - drug therapy / Typhoid Fever - epidemiology / Vaccines / Water