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VOLUME 8 , ISSUE 1 ( December, 2018 ) > List of Articles


Fluoroquinolone Resistance among Salmonella enterica Serovar Typhi and Paratyphi Isolates in a Tertiary Care Hospital in Northern India

Omesh Goyal, Deepinder Kaur, Rajoo S Chhina, Rama Gupta

Keywords : Ciprofloxacin, Enteric fever, Levofloxacin, Salmonella

Citation Information : Goyal O, Kaur D, Chhina RS, Gupta R. Fluoroquinolone Resistance among Salmonella enterica Serovar Typhi and Paratyphi Isolates in a Tertiary Care Hospital in Northern India. J Gastrointest Infect 2018; 8 (1):12-15.

DOI: 10.5005/jp-journals-10068-0014

License: CC BY-NC 4.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Background and objectives: Enteric fever, caused by Salmonella enterica serovar S. Typhi and enterica serovar Paratyphi A, B and C is a major health problem worldwide. A progressive increase in antibiotic resistance has been reported among these organisms recently. This study aimed to estimate the prevalence of fluoroquinolone resistance among S. Typhi and S. Paratyphi isolates from a tertiary care hospital in northern India. Materials and methods: This retrospective study included Salmonella isolates obtained from the blood samples received in microbiology laboratory from January to December 2017. Blood specimens were processed using an automated blood culture system (BACTEC 9240/Bac-T-Alert). Antimicrobial susceptibility testing to ciprofloxacin and levofloxacin was performed using a fully automated Vitek-2 system. Results: A total of 376 Salmonella enterica isolates were obtained; 294 (78.2%) were identified as S. Typhi, and 82 (21.8%) as S. Paratyphi A. Incidence of ciprofloxacin-resistant strains of S. Typhi was 67.3% and that of S. Paratyphi A was 97.6%. Another 32.6% of S. Typhi and 2.4% S. Paratyphi A isolates showed decreased susceptibility to ciprofloxacin (MICs 0.25 -0.5 ìg/mL). For levofloxacin, 25.8% of S. Typhi and 51.2% of S. Paratyphi A were resistant. Another 73.5% of S. Typhi and 48.8% of S. Paratyphi A isolates showed decreased susceptibility to levofloxacin (MICs 0.25–1 ìg/mL). Interpretation and conclusion: The incidence of S. Typhi and S. Paratyphi A isolates showing resistance or reduced susceptibility towards fluoroquinolone is very high in northern India.

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  1. Arora RK, Gupta A, Joshi NM, Kataria VK, Lall P, Anand AC. Multidrug resistant typhoid fever: study of an outbreak in Calcutta. Indian pediatrics. 1992 Jan;29(1):61-66.
  2. Zavala Trujillo I, Quiroz C, Gutierrez MA, Arias J and Renteria M. Fluoroquinolones in the treatment of typhoid fever and the carrier state. Eur J Clin Microbiol Infect Dis 1991;10:334-341.
  3. Arora D, Singh R, Kaur M, Ahi RS. A changing pattern in antimicrobial susceptibility of Salmonella enterica serotype isolated in North India. African J Microbiol Res 2010;4(3):197-203.
  4. Mehta PJ, Hakim A, Kamath S. The changing faces of salmonellosis. J Assoc Physicians India. 1992;40:713-715.
  5. Kanungo S, Dutta S, Sur D. Epidemiology of typhoid and paratyphoid fever in India. J Infect Dev Ctries 2008;2:454- 460.
  6. Capoor MR, Nair D, Hasan AS, Aggarwal P, Gupta B. Typhoid fever: Narrowing therapeutic options in India. Southeast Asian J Trop Med Public Health 2006;37:1170-1174.
  7. Jesudason M V, Jacob John T. Multi-resistant Salmonella typhi in India. Lancet 1990;336:252.
  8. Threlfall E J, Ward L R, Rowe B, Raghupathi S, Chandrasekaran V, Vandepitte J, et al. Widespread occurrence of multiple drug-resistant Salmonella typhi in India. Eur J Clin Microbiol Infect Dis 1992;11:990-993.
  9. Pang T, Bhutta Z A, Finlay B B, Altwegg M. Typhoid fever and other salmonellosis: a continuing challenge. Trends Microbiol 1995;3:253-255.
  10. Gulati S, Marwaha R K, Singhi S, Ayyagari A, Kumar L. Third generation cephalosporins in multi-drug resistant typhoid fever. Indian Pediatr 1992;29:513–516.
  11. Mathai D, Kudwa G C, Keystone J S, Kozarsky P E, Jesudason M V, Lalitha M K, et al. Short course of ciprofloxacin in enteric fever. J Assoc Physicians India 1993;41:7428–7430.
  12. Mehta A, Rodriques C, Joshi VR. Multiresistant Salmonella organisms in India. JAMA 1992;267:1614-1615.
  13. Umasankar S, Wall RA, Berger J. A case of ciprofloxacinresistant typhoid fever. Commun Dis Rep CDR Rev 1992; 2:R139-140.
  14. Chandra R, Srinivasan S, Nalini P, Rao S. Multidrug resistant enteric fever. J Trop Med Hyg 1992;95:284-287.
  15. Biswal N, Mathai B, Bhatia BD, Srinivasan S. Use of ciprofloxacin and its resistance in typhoid fever. Indian Pediatr 1994; 31:229-230.
  16. Daga MK, Sarin K, Sarkar R. A study of culture positive multidrug resistant enteric fever—changing pattern and emerging resistance to ciprofloxacin. J Assoc Physicians India 1994; 42:599-600.
  17. Rowe B, Ward LR, Threlfall EJ. Ciprofloxacin-resistant Salmonella typhi in the UK. Lancet 1995;346:1302.
  18. Gautam V, Gupta NK, Chaudhary U, Arora DR. Sensitivity pattern of Salmonella serotypes in Northern India. Braz J Infect Dis. 2002;6:281-287.
  19. Hirose K, Tamura K, Sagara H, Watanabe H. Antibiotic susceptibilities of Salmonella enterica Serovar Typhi and S. enterica Serovar Paratyphi A isolated from patients in Japan. Antimicrob Agents Chemother. 2001;45:956-958.
  20. Asperilla MO, Smego RA Jr, Scott LK. Quinolone antibiotics in the treatment of Salmonella infections. Rev Infect Dis 1990; 12:873-889.
  21. Upadhyay R, Nadka MY, Muruganathan A, Tiwaskar M, Amarapurkar D, Banka NH, et al. API Recommendations for the Management of Typhoid Fever. J Assoc Physicians India. 2015 Nov;63(11):77-96.
  22. Brown NM, Millar MR, Frost JA, Rowe B. Ciprofloxacin resistance in Salmonella paratyphi A. J Antimicrob Chemother. 1994;33:1258-1259.
  23. Divyashree S, Nabarro LE, Veeraraghavan B, Rupali P. Enteric fever in India: current scenario and future directions. Trop Med Int Health. 2016 Oct;21(10):1255-1262.
  24. Threlfall EJ, Ward LR, Skinner JA, Smith HR, Lacey S. Ciprofloxacin resistant Salmonella typhi and treatment failure. Lancet 1999;353:1590–1591.
  25. Wain J, Hoa NT, Chinh NT, Vinh H, Everett MJ, Diep TS, et al. Quinolone resistant Salmonella typhi in Vietnam: molecular basis of resistance and clinical response to treatment. Clin Infect Dis 1997;25:1404–1410.
  26. Mermin JH, Villar R, Carpenter J, Roberts L, Samaridden A, Gasanova L, et al. A massive epidemic of multidrug-resistant typhoid fever in Tajikistan associated with consumption of municipal water. J Infect Dis. 1999;179:1416-1422.
  27. Sharma P, Dahiya S, Manral N, Kumari B, Kumar S, Pandey S, et al. Changing trends of culture-positive typhoid fever and antimicrobial susceptibility in a tertiary care North Indian Hospital over the last decade. Indian J Med Microbiol 2018;36:70-76
  28. Balaji V, Kapil A, Shastri J, Pragasam AK, Gole G, Choudhari S, et al. Longitudinal Typhoid Fever Trends in India from 2000 to
  29. Am J Trop Med Hyg. 2018 Sep;99(3_Suppl):34-40.
  30. Arjyal A, Basnyat B, Nhan HT, Koirala S, Giri A, Joshi N, et al. Gatifloxacin versus ceftriaxone for uncomplicated enteric fever in Nepal: an open-label, two-centre, randomised controlled trial. Lancet Infect Dis. 2016 May;16(5):535-545.
  31. Britto CD, Wong VK, Dougan G, Pollard AJ. A systematic review of antimicrobial resistance in Salmonella enterica serovar Typhi, the etiological agent of typhoid. PLoSNegl Trop Dis. 2018 Oct 11;12(10):e0006779.
  32. Vaishnavi C, Kochhar R, Singh G, Kumar S, Singh S, Singh K. Epidemiology of typhoid carriers among blood donors and patients with biliary, gastrointestinal and other related diseases. Microbiol Immunol. 2005;49(2):107-112.
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