Clinical Spectrum, Laboratory Profile, and Antimicrobial Resistance in Pediatric Enteric Fever: A Cross-Sectional Study from Lahore, Pakistan
DOI:
https://doi.org/10.66984/jsmdc.v12.i01.oa.03Keywords:
Enteric fever, Salmonella typhi, Blood culture, Antimicrobial ResistanceAbstract
Objective: To assess the clinical presentation, laboratory abnormalities, and antimicrobial response patterns among children diagnosed with enteric fever.
Methodology: This cross-sectional analytical study was conducted at the Department of Pediatrics, Ittefaq Hospital (Trust), Lahore from January to June 2025. Ethical approval was obtained from the Institutional Review Committee. Informed written consent was sought from parents/guardians of study participants. A sample size of 131 was calculated and children suspected of enteric fever were enrolled using non-probability consecutive sampling technique. Demographic and clinical data was documented. Blood samples were obtained aseptically before antimicrobial therapy and processed for Salmonella typhi identification and antimicrobial susceptibility. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0.
Results: The median age of 131 children was 7.0 years [inter-quartile range (IQR) 3.0-9.0]. Blood culture was positive for Salmonella typhi in 75(57.3%) cases including 42(32.1%) multidrug-resistant (MDR) and 33(25.2%) extensively drug-resistant (XDR) strains. Abdominal pain (p=0.004) and constipation (p=0.010) were more frequent in XDR cases. Leukopenia occurred only in XDR cases (p=0.009), and raised C-reactive protein (CRP) was more common in MDR (85.7%) and XDR (90.9%) samples compared to no growth samples (p <0.001).
Conclusion: Salmonella typhi was identified in over half of the cases with a high proportion of MDR and XDR strains. Abdominal pain, constipation, and leukopenia were significantly more common among XDR patients compared to MDR patients. C-reactive protein was significantly elevated in both MDR and XDR cases, while erythrocyte sedimentation rate (ESR) showed no association. Multidrug-resistant strains showed sensitivity to ceftriaxone and XDR strains to azithromycin & carbapenems.
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