Bindu Poonia - Army College of Medical Sciences and Base Hospital, New Delhi, India
Inam Danish Khan - Army College of Medical Sciences and Base Hospital, New Delhi, India
Anuradha Makkar - Army College of Medical Sciences and Base Hospital, New Delhi, India
KS Rajmohan - Army College of Medical Sciences and Base Hospital, New Delhi, India
Deepak Kumar - Army College of Medical Sciences and Base Hospital, New Delhi, India
Amandeep Malik - Army College of Medical Sciences and Base Hospital, New Delhi, India
Shilpi Gupta - Graded Specialist Microbiology, Military Hospital Bhopal, New Delhi, India
Priyanka Banerjee - Army College of Medical Sciences and Base Hospital, New Delhi, India
Pragyan Swagatika Panda - Army College of Medical Sciences and Base Hospital, New Delhi, India
Rajiv Mohan Gupta - Army Hospital Research and Referral, New Delhi, India

Introduction: Typhoidal Salmonella causes an invasive infection resulting in ۲۰۰ ۰۰۰ deaths among ۲۰ million patients annually. Typhoid remains a public health problem in Southeast Asia, the Indian subcontinent, Africa, and South America. Traveler’s diarrhea caused by Salmonella is common in Asia. Outbreaks of typhoidal Salmonella resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole in the ۱۹۹۰s pushed therapy to ciprofloxacin which was replaced by ceftriaxone due to fluoroquinolone resistance. Methods: This prospective study characterizes demographical, etiological, and resistance patterns in typhoidal Salmonella at a ۱۰۰۰-bed teaching hospital in New Delhi, India. Two hundred inpatients in pediatrics, obstetrics-gynecology, medicine, intensive care, and OPD in whom Salmonella bacteremia was detected were characterized by routine and automated microbiology techniques. Results: The mean age of patients in this study was ۲۱.۴ years. Overall, ۷۱% of patients suffered from Salmonella Typhi followed by ۲۶% from Salmonella Paratyphi A. Four cases of Salmonella resistance to ampicillin, trimethoprim-sulfamethoxazole, and chloramphenicol were encountered. A high degree of partial and complete resistance to fluoroquinolones was seen among Salmonella Typhi, Salmonella Paratyphi A, and Salmonella Paratyphi B cases. Resistance to ciprofloxacin was ۴۸% among Salmonella Typhi and ۱۰۰% among Salmonella Paratyphi A cases. Only ۱۸% of Salmonella Typhi cases were completely resistant to quinolones, while ۷۹% were partially resistant. A total of ۹۲% of Salmonella Paratyphi A cases were partially resistant to quinolones. Four Salmonella cases were resistant to ceftriaxone. Conclusion: Salmonella Typhi remains the predominant serotype, followed by Salmonella Paratyphi A. The high prevalence of quinolone resistance in Salmonella Typhi and Salmonella Paratyphi A is a serious problem limiting empirical therapy to non-quinolone-based therapy such as ceftriaxone. Multidrug-resistant Salmonella is an emerging problem requiring active surveillance among residents and travelers presenting with tropical fever.

Salmonella, Typhoid, Multidrug Resistance, Fluoroquinolone Resistance, Traveler’s Diarrhea