title: Multidrug-resistant and extended-spectrum beta-lactamase (ESBL)-producing Salmonella enterica (serotypes Typhi and Paratyphi A) from blood isolates in Nepal: surveillance of resistance and a search for newer alternatives.
abstract: OBJECTIVE
  We evaluated the prevalence of multidrug resistance (MDR) and production of extended spectrum beta-lactamase (ESBL) by Salmonella enterica (serotypes Typhi and Paratyphi A) in a teaching hospital in Nepal. The MDR strains of S. enterica were also tested for susceptibility to newer antibiotics.
  
  
  METHODS
  Blood cultures were obtained from 4105 patients with febrile illnesses. Isolates of S. enterica were serotyped and antibiotic susceptibility testing was carried out using disk diffusion (Kirby-Bauer) and E-tests. ESBL screening and phenotype confirmation were done following National Committee for Clinical Laboratory Standards (NCCLS) recommendations for Escherichia coli.
  
  
  RESULTS
  A total of 541 isolates of S. enterica serotypes Typhi (47%) and Paratyphi A (53%) were grown. Twenty-eight isolates (5%) of S. enterica were resistant to two or more antibiotics (MDR isolates), with a greater prevalence among serotype Paratyphi A (7%). All ESBL producers (three isolates) were serotype Paratyphi A. Most of the MDR S. enterica showed reduced susceptibility to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ofloxacin, and ciprofloxacin, and had good susceptibility to extended-spectrum cephalosporins and carbapenems. Among the fluoroquinolones, gatifloxacin demonstrated better in vitro activity compared to levofloxacin, ciprofloxacin, and ofloxacin.
  
  
  CONCLUSIONS
  A greater prevalence of S. enterica serotype Paratyphi A with higher rates of multidrug resistance and ESBL production is concerning for natives as well as travelers in Nepal since the current typhoid vaccines do not provide protection against this serotype.
authors.affiliation: Department of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
authors.forename: Bharat M
authors.initials: BM
authors.lastname: Pokharel
authors.forename: Janak
authors.initials: J
authors.lastname: Koirala
authors.forename: Rajan K
authors.initials: RK
authors.lastname: Dahal
authors.forename: Shyam K
authors.initials: SK
authors.lastname: Mishra
authors.forename: Prem K
authors.initials: PK
authors.lastname: Khadga
authors.forename: N R
authors.initials: NR
authors.lastname: Tuladhar
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000382:microbiology*; D015780:Carbapenems / Q000494:pharmacology; D002511:Cephalosporins / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial; D024841:Fluoroquinolones / Q000494:pharmacology; D006784:Hospitals, Teaching; D006801:Humans; D008826:Microbial Sensitivity Tests; D009390:Nepal; D010284:Paratyphoid Fever / Q000382:microbiology*; D012480:Salmonella Infections / Q000382:microbiology*; D012482:Salmonella paratyphi A / Q000187:drug effects* / Q000302:isolation & purification / Q000378:metabolism; D012486:Salmonella typhimurium / Q000187:drug effects* / Q000302:isolation & purification / Q000378:metabolism; D018571:Sentinel Surveillance; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D024841:Fluoroquinolones; D001618:beta-Lactamases