背景伤寒在发展中国家提出了重大挑战,由于抗生素的广泛流行和过度使用,抗生素耐药菌株的出现加剧了这种情况。这项研究旨在评估从白沙瓦两家著名的三级医院住院患者的血液培养中分离出的沙门氏菌的抗菌谱。巴基斯坦:开伯尔教学医院(KTH)和Hayatabad医疗中心(HMC)。通过检查这些配置文件,该研究旨在为伤寒管理背景下抗生素耐药性的演变提供有价值的见解。材料和方法这项回顾性横断面研究利用了白沙瓦两家医院收集的数据,KTH和HMC。根据沙门氏菌阳性的血液培养物确定了肠热病例。这项研究包括人口统计信息,季节性流行,以及2017年至2023年期间提交的3,137例病例的抗菌谱图。结果3137例患者中,男性占大多数,占63%(2044例)。特别值得注意的是1至24岁儿童和青少年的病例聚集。发病率在夏季和春季达到高峰,从四月到九月。就伤寒沙门氏菌分离株而言,对一线抗生素如阿莫西林/克拉维酸有相当大的耐药性(80.1%),复方新诺明/甲氧苄啶-磺胺甲恶唑(66.6%),和氯霉素(86.9%),以及头孢曲松(79.7%)和环丙沙星(51.6%)。相反,某些抗生素表现出更高的敏感性,包括美罗培南(97.8%),多利培南(99.5%),亚胺培南(97.7%),厄他培南(96.5%),多粘菌素B(99.4%),粘菌素(98.1%),和替加环素(97.3%)。尽管样本量有限,只有214个样本,磷霉素显示出93.4%的显着敏感性。阿米卡星和庆大霉素的敏感性分别为90.7%和81.5%,分别。然而,阿奇霉素的敏感性令人担忧,占66.5%。沙门氏菌的抗菌图谱表现出明显而剧烈的变化。结论总之,这项研究揭示了男性伤寒患病率较高,在夏季和春季观察到明显的季节性高峰。受影响最大的年龄组为1至24岁。沙门氏菌分离株对常规一线抗生素表现出明显的耐药性,环丙沙星和第三代头孢菌素。与阿米卡星相比,阿奇霉素的敏感性较低,庆大霉素,和磷霉素.该研究提倡阿米卡星的经验使用,庆大霉素,磷霉素,和美罗培南在巴基斯坦治疗伤寒。紧急措施,包括常规的沙门氏菌抗菌谱监测,抗生素管理,公共卫生教育,和沙门氏菌疫苗接种计划,被认为对初级疾病预防至关重要。
Background Typhoid fever presents a significant challenge in developing nations, exacerbated by the emergence of antibiotic-resistant strains due to widespread prevalence and overuse of antibiotics. This study seeks to assess the antibiogram profiles of Salmonella species isolated from blood cultures of patients hospitalized at two prominent tertiary care hospitals in Peshawar, Pakistan: Khyber Teaching Hospital (KTH) and Hayatabad Medical Complex (HMC). By examining these profiles, the research aims to provide valuable insights into the evolving landscape of antibiotic resistance in the context of typhoid fever management. Materials and Methods This retrospective cross-sectional study utilized data gathered from two hospitals in Peshawar, KTH and HMC. Cases of enteric fever were identified based on positive blood cultures for Salmonella species. The study encompasses demographic information, seasonal prevalence, and antibiogram profiles of 3,137 cases that were presented between 2017 and 2023. Results Among the total 3,137 cases, males accounted for the majority, comprising 63% (2,044 cases). Particularly notable was the clustering of cases among children and adolescents aged one to 24 years. The incidence peaked during the months of summer and spring, from April to September. In terms of Salmonella Typhi isolates, considerable resistance was noted against first-line antibiotics such as amoxicillin/clavulanate (80.1%), co-trimoxazole/trimethoprim-sulfamethoxazole (66.6%), and chloramphenicol (86.9%), as well as against ceftriaxone (79.7%) and ciprofloxacin (51.6%). Conversely, certain antibiotics displayed higher sensitivity patterns, including meropenem (97.8%), doripenem (99.5%), imipenem (97.7%), ertapenem (96.5%), polymyxin B (99.4%), colistin (98.1%), and tigecycline (97.3%). Despite a limited sample size of 214 specimens,
fosfomycin demonstrated a remarkable sensitivity of 93.4%. Sensitivities of amikacin and gentamicin were 90.7% and 81.5%, respectively. However, the sensitivity of azithromycin was concerning, standing at 66.5%. The antibiogram pattern for Salmonella exhibited significant and drastic changes. Conclusion In conclusion, this study sheds light on a higher prevalence of typhoid fever among males, with a notable seasonal peak observed during the summer and spring months. The age group most affected spans from one to 24 years. Salmonella isolates displayed significant resistance to conventional first-line antibiotics, alongside ciprofloxacin and third-generation cephalosporins. Azithromycin exhibited lower sensitivity compared to amikacin, gentamicin, and
fosfomycin. The research advocates for the empirical use of amikacin, gentamicin,
fosfomycin, and meropenem in the treatment of typhoid fever in Pakistan. Urgent measures, including regular Salmonella antibiogram surveillance, antibiotic stewardship, public health education, and Salmonella vaccination programs, are deemed crucial for primary disease prevention.