Thesis Report.

ABSTRACT:

Background: Enteric fever continues to be an important public health problem who live in settlements devoid of proper sanitation and clean water supply especially in developing countries of the tropical region including Nepal. In addition, antimicrobial resistance creates a major challenge in the management of the disease. This study extracts ciprofloxacin resistance towards Salmonella enterica serotypetyphi and Salmonella enterica serotype paratyphi A isolated from typhoid fever cases.

Method: A cross-sectional study was conducted in 82 Salmonella enterica isolates tested against 12 antibiotics by Kirby-Bauer disk diffusion method, and the results were interpreted according to the criteria suggested by the Clinical and Laboratory Standards Institute(CLSI).

Results: A total of 82 cases of enteric fever associated with Salmonella enterica were confirmed by blood culture. Out of them, 69.5% were caused by Salmonella enterica serotype typhi and 30.5% by Salmonella enterica serotype paratyphi A. Of 82 isolates, 36.5% isolates were susceptible to all antibiotics. On Kirby-Bauer disk diffusion antimicrobial susceptibility testing, Salmonella enterica isolates were highly susceptible(100%)to cefexime, cefotaxime,ceftriaxone,cefepime, cotrimoxazole, ampicillin, amoxycillin and tazobactum-piperacillin. The rates of Ciprofloxacin resistance in Salmonella typhi and Salmonella paratyphi A were 56.1% and 52.0% respectively. Similarly, the rates of Azithromycin, Chloramphenicol and Gentamicin resistance in both serovars (S.typhi and S.paratyphi A) were (5.7%, 26.1%), (6.5%, 5.3%) and (25%, 50%) respectively.

Conclusion: A large proportion of Salmonella typhi and Salmonella paratyphi A isolates showed reduced susceptibility to ciprofloxacin. The reduced susceptibility to ciprofloxacin has restricted their routine empirical use. Third generation cephalosporins are the safest drugs for empirical use but ampicillin,cotrimoxazole and chloramphenicol can be effective alternatives.

Keywords: Salmonellatyphi, SalmonellaparatyphiA, Antimicrobial
resiatance,Ciprofloxacin