FREQUENCY AND OUTCOME OF EXTENSIVELY DRUG RESISTANCE (XDR) ENTERIC FEVER ADMITTED IN CITY HOSPITAL KHAIRPUR MIRS

Abstract

Background: Extensively Drug-Resistant (XDR) Typhoid fever, caused by Salmonella Typhi, has emerged as a major public health threat in Pakistan since 2016. With limited treatment options and increasing resistance to frontline antibiotics, XDR Typhoid poses significant challenges, particularly in children.

Objective: To determine the frequency and outcome of XDR enteric fever in children admitted to the Department of Pediatrics, KMC Hospital Khairpur Mirs.

Methods: A cross-sectional study was conducted over six months in 116 children (aged 2–10 years) admitted with enteric fever not responding to antibiotics. Diagnosis was confirmed by blood culture. Demographic, clinical, and laboratory data were collected. Antimicrobial susceptibility was tested against standard antibiotics. Data were analyzed in SPSS v25 using descriptive and chi-square tests; p<0.05 was considered significant.

Results: Among 116 children, 68 (58.6%) were male and 48 (41.4%) female, with mean age 6.4±2.1 years. Out of 116 blood cultures, 92 (79.3%) yielded growth of S. Typhi, while 24 (20.7%) showed no growth. Of these 92 isolates, 65 (70.7%) were classified as XDR and 27 (29.3%) as MDR. Resistance pattern showed universal resistance to ampicillin, co-trimoxazole, chloramphenicol, fluoroquinolones, and third-generation cephalosporins. All XDR isolates remained sensitive to carbapenems (100%) and azithromycin (92.3%), while 7.7% demonstrated azithromycin resistance. Clinical recovery with azithromycin monotherapy was seen in 54/65 (83.1%) of XDR cases, while 11 (16.9%) required escalation to meropenem/tigecycline. No mortality was recorded; complications occurred in 9 (13.8%) children, including hepatitis, intestinal perforation, and sepsis.

Conclusion: XDR enteric fever was found in more than two-thirds of culture-positive cases. While azithromycin remains largely effective, emerging resistance is alarming. Strengthening antimicrobial stewardship, improving water sanitation, and expanding TCV immunization are critical to controlling XDR Typhoid