Current antimicrobial susceptibility pattern among blood culture isolates of Salmonella enterica serovar Typhi in Muzaffarabad, Pakistan

  • Mumtaz Ahmad Khan AJK Medical College, Muzaffarabad, Pakistan.
  • Jamila Farid Associate Professor, Department of Pathology, Ayub Medical College, Abbotabad
  • Muhammad Idris Associate Professor, Department of Pathology, Ayub Medical College, Abbotabad
  • Muhammad Ijaz Khan, Raja Professor of Surgery, Azad Jammu & Kashmir Medical College, Muzaffarabad
  • Sehrish Mumtaz House Office, Abbas Institute of Medical Sciences Muzaffarabad
Keywords: S. Typhi, MDR, XDR, Drug resistance, Multidrug resistant, Extensively drug resistant


Background: Antibiotic resistance is a major problem in Salmonella enterica serovar Typhi (S Typhi). The resistance has developed to three first line drugs (ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole) in early 1980s, and labelled as multidrug resistant (MDR). The aim of this study was to determine the current susceptibility pattern of S Typhi in our setup. Method: This prospective study was carried out in Department of Microbiology, Abbas Institute of Medical Sciences, Muzaffarabad from January 2018 to December 2019. All blood culture samples from febrile patients were inoculated in Oxoid Signal blood culture system (Remel, Lenexa KS) and incubated at 37 °C. Positive culture bottles were sub cultured on blood agar and MacConkey agar, and incubated for overnight at 37 °C. The isolates were identified as S Typhi by colony morphology, serotyping, and biochemical tests using API 20E. Susceptibility testing was performed using the Modified Kirby Bauer disk diffusion method. All XDR isolates were confirmed by determining MICs of ciprofloxacin and ceftriaxone by using the E-test strips. Results: A total of 360 blood culture specimens were submitted, 146 (40.5%) specimens yielded growth of S Typhi. The resistance rates of S Typhi for ampicillin, chloramphenicol and trimethoprim-sulfamethoxazole were 82%, 88% and 89% respectively. Percentage of MDR isolates in S Typhi was found very high (108, 74% isolates). High rate of resistance (78, 53% isolates) was found to ciprofloxacin. Frequency of XDR isolates in S Typhi was high (40, 27% isolates). All isolates were found sensitive to azithromycin and meropenem.

Pak J Physiol 2020;16(3):14–7


Qamar FN, Azmatullah A, Kazi AM, Khan E, Zaidi AK. A three-year review of antimicrobial resistance of Salmonella enterica Serovars Typhi and Paratyphi A in Pakistan. J Infect Dev Ctries 2014;8(8):981–6.

Klemm EJ, Shakoor S, Page AJ, Qamar FN, Judge K, Saeed DK, et al. Emergence of an extensively drug-resistant Salmonella enterica serovar typhi clone harboring a promiscuous plasmid encoding resistance to fluoroquinolones and third-generation cephalosporins. mBio 2018;9(1):e00105–18.

Mirza SA, Khan MA. Low-level quinolone-resistance in multi-drug resistant typhoid. J Coll Physicians Surg Pak 2008;18(1):13–6.

Ugboko H, De N. Mechanisms of antibiotic resistance in salmonella typhi. Int J Curr Microbiol App Sci 2014;3:461–76.

Rodrigues C, Kapil A, Sharma A, Ragupathi N, Inbabathan F, Veeraraghavan B, et al. Whole-genome shotgun sequencing of cephalosporin-resistant Salmonella enterica Serovar Typhi. Genome Announc 2017;5(10):e01639–16.

Hussain A, Satti L, Hanif F, Zehra NM, Nadeem S, Bangash TM, et al. Typhoidal Salmonella strains in Pakistan: an impending threat of extensively drug-resistant Salmonella Typhi. Eur J Clin Microbiol Infect Dis 2019;38(11):2145–9.

Typhoid fever ―Islamic Republic of Pakistan. Available at: [Cited: Apr 2019].

Das JK, Hasan R, Zafar A, Ahmed I, Ikram A, Nizamudin S, et al. Trends, associations, and antimicrobial resistance of Salmonella Typhi and Paratyphi in Pakistan. Am J Trop Med Hyg 2018;99(Suppl 3):48–54

Yousafzai MT, Qamar FN, Shakoor S, Saleem K, Lohana H, Karim S, et al. Ceftriaxone-resistant Salmonella typhi outbreak in Hyderabad city of Sindh, Pakistan: high time for the introduction of typhoid conjugate vaccine. Clin Infect Dis 2019;68(Suppl 1):S16–21.

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.

Chatham-Stephens K, Medalla F, Hughes M, Grace GD, Aubert RD, Caidi H, et al. Emergence of extensively drug-resistant Salmonella Typhi infections among travelers to or from Pakistan-United States, 2016−2018. Morb Mortal Wkly Rep 2019;68:11–13.

CLSI. Performance standards for antimicrobial susceptibility testing. (28th ed). document CLSI supplement M100. Wayne PA: Clinical and Laboratory Standards Institute; 2018.

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.

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

Shrestha KL, Pant ND, Bhandari R, Khatri S, Shrestha B, Lekhak B. Re-emergence of the susceptibility of the Salmonella spp. isolated from blood samples to conventional first line antibiotics. Antimicrob Resist Infect Control 2016;5(1):22.

Mutai WC, Muigai AW, Waiyaki P, Kariuki S. Multi-drug resistant Salmonella enterica serovar Typhi isolates with reduced susceptibility to ciprofloxacin in Kenya. BMC Microbiol 2018;18(1):187.

Britto CD, Wong VK, Dougan G, Pollard AJ. A systematic review of antimicrobial resistance in Salmonella enterica serovar Typhi, the etiological agent of typhoid. PLoS Negl Trop Dis 2018;12(10):e0006779.

Khatun H, Islam SB, Naila NN, Islam SA, Nahar B, Alam NH, et al. Clinical profile, antibiotic susceptibility pattern of bacterial isolates and factors associated with complications in culture-proven typhoid patients admitted to an urban hospital in Bangladesh. Tropical Med Int Health 2018;23:359–66.

Bhetwal A, Maharjan A, Khanal PR, Parajuli NP. Enteric fever caused by Salmonella enterica Serovars with reduced susceptibility of fluoroquinolones at a community based teaching Hospital of Nepal. Int J Microbiol 2017;2017:2869458.

Jacoby GA. Mechanisms of resistance to quinolones. Clin Infect Dis 2005;41(Suppl 2):S120–6.

Aziz S, Malik L. Emergence of multi-resistant enteric infection in a Pediatric unit of Karachi, Pakistan. J Pak Med Assoc 2018;68(12):1848–50.


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Khan M, Farid J, Idris M, Khan M, Mumtaz S. Current antimicrobial susceptibility pattern among blood culture isolates of Salmonella enterica serovar Typhi in Muzaffarabad, Pakistan. PJP [Internet]. 30Sep.2020 [cited 11Apr.2021];16(3):14-7. Available from: