title: Increase in isolation of extended spectrum beta lactamase producing multidrug resistant non typhoidal Salmonellae in Pakistan.
abstract: BACKGROUND
  Increasing resistance to quinolones and ceftriaxone in non typhoidal Salmonellae is a global concern. Resistance to quinolone and 3rd generation cephalosporin amongst non typhoidal Salmonellae (NTS) from Pakistan has been reported in this study.
  
  
  METHODS
  Retrospective analysis of laboratory data was conducted (1990-2006). NTS were isolated and identified from clinical samples using standard microbiological techniques. Antimicrobial susceptibility testing was performed by Kirby Bauer. Extended spectrum beta lactamase production (ESBL) was detected using combined disc method. Ciprofloxacin sensitivity was detected by nalidixic acid screening method. Minimum inhibitory concentration (MIC) of ciprofloxacin was determined by agar dilution method. Statistical analysis was performed using SPSS version 13.
  
  
  RESULTS
  Analysis of 1967 NTS isolates showed a significant increase in ciprofloxacin resistance from 23% in 2002 to 50.5% in 2006, with increased mean MIC values from 0.6 to 1.3 ug/mL. Ceftriaxone resistant NTS also increased and ESBL production was seen in 98.7% isolates. These isolates exhibited high resistance against amoxicillin clavulanic acid (57%), gentamicin (69%), amikacin (44%) and piperacillin tazobactam (30%). No resistance to carbapenem was seen. Ceftriaxone resistance was significantly higher in children <1 year, in invasive isolates and in Salmonella Typhimurium.
  
  
  CONCLUSIONS
  Increase in quinolone and ceftriaxone NTS is a serious threat to public health requiring continuous surveillance and use of appropriate screening tests for laboratory detection.
authors.affiliation: Department of Pathology and Microbiology, Aga Khan University, Karachi, Pakistan. kausar.jabeen@aku.edu
authors.forename: Kauser
authors.initials: K
authors.lastname: Jabeen
authors.forename: Afia
authors.initials: A
authors.lastname: Zafar
authors.forename: Seema
authors.initials: S
authors.lastname: Irfan
authors.forename: Erum
authors.initials: E
authors.lastname: Khan
authors.forename: Vikram
authors.initials: V
authors.lastname: Mehraj
authors.forename: Rumina
authors.initials: R
authors.lastname: Hasan
mesh_terms: D001426:Bacterial Proteins / Q000096:biosynthesis*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012475:Salmonella / Q000201:enzymology* / Q000302:isolation & purification; D012480:Salmonella Infections / Q000453:epidemiology* / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases
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