title: Enteric fever in Karachi: current antibiotic susceptibility of Salmonellae isolates.
abstract: OBJECTIVE
  To determine the current sensitivity and resistance profile of Salmonellae (S.) isolates in a laboratory setting.
  
  
  METHODS
  An observational study.
  
  
  METHODS
  Dr. Essa`s Laboratory and Diagnostic Centre, Karachi, Pakistan, from November 2008 - October 2010.
  
  
  METHODS
  Isolates from blood culture specimens of 481 bacteraemic patients were identified using conventional biochemical tests. Salmonellae was confirmed with specific antisera and their antibiograms determined by Kirby-Bauer Disc Diffusion method using 12 relevant antibiotics. Inclusions of the study were bacteraemia documented in all blood samples positive for S. typhi, S. paratyphi-A and B. Exclusions were all samples other than blood and blood samples negative for S. typhi and S. paratyphi-A and B during the same period. Multidrug resistance (MDR) of isolates was defined as the isolates showing resistance to all conventional anti-typhoid medicines i.e., Chloramphenicol, Ampicillin and Co-trimoxazole.
  
  
  RESULTS
  Specimens (n=217) yielded 131 Salmonellae typhi (60.36%), 71 S. paratyphi-A (32.71%), and 15 S. paratyphi-B (6.9%); these were sensitive to the Quinolones [Enoxacin: 94.96% (n=91), Ciprofloxacin, 96.47% (n=182), Ofloxacin: 95.74% (n=203)], and Cephalosporins [Cefixime: 96.62% (n=202), Cefotaxime: 99.17% (n=206), Ceftriaxone: 98.79% (n=208)]. Resistance to Amoxicillin was 96.48% (n=128) and 29.91% (n=78) to Co-trimoxazole. About 62.64% (n=136) of the isolates were MDR strains.
  
  
  CONCLUSIONS
  Ciprofloxacin is currently a suitable empirical choice in presumed enteric fever cases, but culture and sensitivity analysis should be encouraged and results incorporated in prescription strategy. Increasing frequency of S. paratyphi-A isolates possibly suggests incomplete coverage employing monovalent vaccine.
authors.affiliation: Department of Pathology, Dow Medical College, DUHS, North Nazimabad, Karachi. farhanessa@gmail.com
authors.forename: Farhan Essa
authors.initials: FE
authors.lastname: Abdullah
authors.forename: Faryal
authors.initials: F
authors.lastname: Haider
authors.forename: Kanwal
authors.initials: K
authors.lastname: Fatima
authors.forename: Saboohi
authors.initials: S
authors.lastname: Irfan
authors.forename: Mir Saud
authors.initials: MS
authors.lastname: Iqbal
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D012482:Salmonella paratyphi A / Q000187:drug effects* / Q000302:isolation & purification; D012485:Salmonella typhi / Q000187:drug effects* / Q000302:isolation & purification; D014435:Typhoid Fever / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents