Cephalosporin-resistant Typhoid Fever: A Report of Two Cases with a Unique Isolate from a Tertiary Care Hospital in Delhi

JOURNAL TITLE: Pediatric Infectious Disease

Author
1. Shyam Kukreja
2. Tapisha Gupta
ISSN
DOI
10.5005/jp-journals-10081-1205
Volume
1
Issue
2
Publishing Year
2019
Pages
2
Author Affiliations
    1. Department of Pediatrics, Max Super Speciality Hospital, Delhi, India
    1. Max Balaji Hospital, Delhi, India
    2. Max Super Speciality Hospital, New Delhi, India
    3. Max Superspecialty Hospital, New Delhi, India
  • Article keywords
    Blood culture, Drug-resistant typhoid, Enteric fever, Indian report

    Abstract

    Typhoid fever is endemic in our country and is the commonest bacterial bloodstream infection in South Asia.1 Multidrug-resistant typhoid fever (MDRTF) is defined as typhoid fever caused by Salmonella enterica serovar Typhi strains (S. Typhi), which are resistant to the first-line recommended drugs, i.e., chloramphenicol, ampicillin, and trimethoprim–sulfamethoxazole. Extensively drug-resistant typhoid fever (XDRTF) is defined as Salmonella Typhi/Paratyphi resistant to first line antibiotics (ampicillin, chloramphenicol and cotrimoxazole) and also to fluoroquinolone and ceftriaxone. Pakistan has an ongoing epidemic of extensively drug resistant (XDR) typhoid, which is a cause for alarm. Prior to this XDR typhoid epidemic, which started in 2016, only 17 cases of ceftriaxone resistance were reported in the world literature. Four out of these 17 were cases of XDR typhoid reported in Iraq, Bangladesh, India, and Pakistan.2 We report two cases of cephalosporin resistant typhoid fever from North India in the pediatric age group and discuss the clinical presentation and treatment. These two isolates were resistant to four drugs (ampicillin, chloramphenicol, fluoroquinolone, and ceftriaxone) but sensitive to chloramphenicol.

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