CLINICAL PROFILE AND ANTIMICROBIAL RESISTANCE PATTERNS IN PAEDIATRIC ENTERIC FEVER

Abstract

Background:

Enteric fever is one of the biggest causes of morbidities in the children especially where there is poor sanitation. The growing spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Salmonella strains makes its management more complicated and a major health problem to the population.

Objective: To identify the clinical picture and antimicrobial resistance patterns of culture-confirmed enteric fever among pediatric patients.

Methods: The proposed cross-sectional study was carried out within the Department of Pediatrics for a period of six months from December 2024 to May 2025. The patients who were included were pediatric patients who had blood culture-confirmed Salmonella Typhi or Paratyphi infection and were aged 15 years or less. A structured proforma was used to gather data regarding demographics, clinical features, and laboratory results. The susceptibility test was done by CLSI standards. The SPSS package version 27 was used to analyze data. The continuous variables were represented as mean plus standard deviation or median plus interquartile range, and the categorical variables were in form of frequencies and percentages. Clinical features were correlated with resistance patterns by Chi-square or Fisher exact test with a p-value of below 0.05 being regarded as significant.

Results: There were 378 enrolled children whose mean age was 8.1 +3.4 years; 56% were male. Salmonella Typhi was found to cause 88.1 percent of the isolates. All patients had fever; 63 and 51 per cent reported abdominal pain and vomiting, respectively. Hepatomegaly and splenomegaly were observed in 41% and 32% respectively and 19% had both of them. Strains of MDR were identified in 14.8 percent of cases with XDR strains identified in 43.4. There was a high resistance to first-line antibiotics and fluoroquinolones, but azithromycin (91.8%) and meropenem (98.9) were both very effective. Prolonged fever and organomegaly were significantly related to XDR infections (p < 0.05).

Conclusion: XDR Salmonella strains continue to become the cause of pediatric enteric fever, which restricts the possibilities of empirical treatment. Constant monitoring, therapy based on resistance, antimicrobial stewardship, immunization, and enhanced sanitation are the key to achieve disease burden reduction and restrict the transmission of resistant infections among children.