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Multicenter Study
. 2021 Nov 23;224(Supple 5):S502-S516.
doi: 10.1093/infdis/jiab144.

Evaluation of Antimicrobial Susceptibility Profile in Salmonella Typhi and Salmonella Paratyphi A: Presenting the Current Scenario in India and Strategy for Future Management

Balaji Veeraraghavan  1 , Agila K Pragasam  1 , Pallab Ray  2 , Arti Kapil  3 , Savitha Nagaraj  4 , Sulochana Putli Bai Perumal  5 , Karnika Saigal  6 , Maria Thomas  7 , Madhu Gupta  2 , Temsunaro Rongsen-Chandola  8 , Dasaratha Ramaiah Jinka  9 , Jayanthi Shastri  10 , Anna P Alexander  11 , Roshine Mary Koshy  12 , Anuradha De  10 , Ashita Singh  13 , Sheena Evelyn Ebenezer  14 , Shanta Dutta  15 , Ashish Bavdekar  16 , Deepak More  8 , Sonali Sanghavi  16 , Raghuprakash Reddy Nayakanti  9 , Jobin J Jacob  1 , Anushree Amladi  1 , Shalini Anandan  1 , Baby S Abirami  1 , Yamuna D Bakthavatchalam  1 , Dhiviya P M Sethuvel  1 , Jacob John  1 , Gagandeep Kang  1
Affiliations
Multicenter Study

Evaluation of Antimicrobial Susceptibility Profile in Salmonella Typhi and Salmonella Paratyphi A: Presenting the Current Scenario in India and Strategy for Future Management

Balaji Veeraraghavan et al. J Infect Dis. .

Abstract

Background: Systematic studies to estimate the disease burden of typhoid and paratyphoid in India are limited. Therefore, a multicenter study on the Surveillance of Enteric Fever in India was carried out to estimate the incidence, clinical presentation, and antimicrobial resistance (AMR) trend. The data presented here represent the national burden of AMR in Salmonella Typhi and Salmonella Paratyphi A.

Methods: Antimicrobial susceptibility testing was performed for S. Typhi and S. Paratyphi A (n = 2373) isolates collected prospectively during a 2-year period from November 2017 to January 2020.

Results: Of 2373 Salmonella isolates, 2032 (85.6%) were identified as S. Typhi and 341 (14.4%) were S. Paratyphi A. Approximately 2% of S. Typhi were multidrug-resistant (MDR), whereas all 341 (100%) of S. Paratyphi A isolates were sensitive to the first-line antimicrobials. Among 98% of ciprofloxacin nonsusceptible isolates, resistance (minimum inhibitory concentration [MIC] >0.5 µg/mL) was higher in S. Typhi (37%) compared with S. Paratyphi A (20%). Azithromycin susceptibility was 99.9% and 100% with a mean MIC of 4.98 μg/mL for S. Typhi and 7.39 μg/mL for S. Paratyphi A respectively. Ceftriaxone was the only agent that retained 100% susceptibility. Moreover, beta-lactam/beta-lactamase inhibitors showed potent in vitro activity against the study isolates.

Conclusions: Data obtained from this systematic surveillance study confirms the declining trend of MDR Salmonella isolates from India. The higher prevalence of ciprofloxacin nonsusceptibility enforces to limit its use and adhere to the judicious usage of azithromycin and ceftriaxone for enteric fever management.

Keywords: India; antimicrobial resistance; ciprofloxacin; surveillance; typhoid fever.

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Figures

Figure 1.
Figure 1.
Map representing the study sites across India.
Figure 2.
Figure 2.
Bubble graph showing the distribution of minimum inhibitory concentration of (a) ciprofloxacin, (b) azithromycin, and (c) ceftriaxone for S. Typhi and S. Paratyphi A tested in this study.
Figure 3.
Figure 3.
Relationship between zone of inhibition and minimum inhibitory concentration (MIC) in invasive isolates of Salmonella Typhi and Salmonella Paratyphi A included in this study. (A) Scatter plot of disk diffusion (DD) and MIC value of 2032 S. Typhi isolates tested against ciprofloxacin. (B) Scatter plot of DD and MIC value of 341 S. Paratyphi A isolates tested against ciprofloxacin. (C) Scatter plot of DD and MIC value of 2032 S. Typhi isolates tested against azithromycin. (D) Scatter plot of DD and MIC value of 341 S. Paratyphi A isolates tested against azithromycin. (E) Scatter plot of DD and MIC value of 2032 S. Typhi isolates tested against ceftriaxone. (F) Scatter plot of DD and MIC value of 341 S. Paratyphi A isolates tested against ceftriaxone.
Figure 3.
Figure 3.
Relationship between zone of inhibition and minimum inhibitory concentration (MIC) in invasive isolates of Salmonella Typhi and Salmonella Paratyphi A included in this study. (A) Scatter plot of disk diffusion (DD) and MIC value of 2032 S. Typhi isolates tested against ciprofloxacin. (B) Scatter plot of DD and MIC value of 341 S. Paratyphi A isolates tested against ciprofloxacin. (C) Scatter plot of DD and MIC value of 2032 S. Typhi isolates tested against azithromycin. (D) Scatter plot of DD and MIC value of 341 S. Paratyphi A isolates tested against azithromycin. (E) Scatter plot of DD and MIC value of 2032 S. Typhi isolates tested against ceftriaxone. (F) Scatter plot of DD and MIC value of 341 S. Paratyphi A isolates tested against ceftriaxone.
Figure 3.
Figure 3.
Relationship between zone of inhibition and minimum inhibitory concentration (MIC) in invasive isolates of Salmonella Typhi and Salmonella Paratyphi A included in this study. (A) Scatter plot of disk diffusion (DD) and MIC value of 2032 S. Typhi isolates tested against ciprofloxacin. (B) Scatter plot of DD and MIC value of 341 S. Paratyphi A isolates tested against ciprofloxacin. (C) Scatter plot of DD and MIC value of 2032 S. Typhi isolates tested against azithromycin. (D) Scatter plot of DD and MIC value of 341 S. Paratyphi A isolates tested against azithromycin. (E) Scatter plot of DD and MIC value of 2032 S. Typhi isolates tested against ceftriaxone. (F) Scatter plot of DD and MIC value of 341 S. Paratyphi A isolates tested against ceftriaxone.
Figure 4.
Figure 4.
Histogram showing the distribution of minimum inhibitory concentration of (a) piperacillin/tazobactam, (b) cefepime/tazobactam, and (c) cefepime/zidebactam tested against Salmonella Typhi and Salmonella Paratyphi A.
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