title: Re-emergence of the susceptibility of the Salmonella spp. isolated from blood samples to conventional first line antibiotics.
abstract: BACKGROUND
  Enteric fever is an important public health problem in Nepal. Due to emergence of multidrug resistant strains of Salmonella spp. the conventional first-line drugs, ampicillin, chloramphenicol, and cotrimoxazole have not been used as empiric therapy for treatment of enteric fever for last two decades and there have been increased uses of fluoroquinolones as the drugs of choice. The aim of this study was to evaluate and analyze the antimicrobial susceptibility patterns of Salmonella spp.
  
  
  METHODS
  A total of 620 blood samples collected from the patients suspected of suffering from enteric fever were cultured using standard microbiological techniques. Antibiotic susceptibility testing of the Salmonella spp., was performed by Kirby Bauer disc diffusion technique following Clinical and Laboratory Standard Institute (CLSI) guidelines. Minimum inhibitory concentrations of ciprofloxacin, ofloxacin and nalidixic acid were determined by agar dilution method.
  
  
  RESULTS
  Of the total 83 Salmonella spp., 48 (57.83 %) were S. Typhi and 35 (42.26 %) were S. Paratyphi A. Among 83 Salmonella isolates, 98.8 % of the Salmonella spp. were susceptible to chloramphenicol and co-trimoxazole and about 97.6 % of the isolates were susceptible to ampicillin. Similarly, 69 (83.13 %) isolates were resistant to nalidixic acid. Only 16.9 % of the isolates were susceptible to ciprofloxacin. One S. Typhi isolate was multidrug resistant.
  
  
  CONCLUSIONS
  The present study revealed the decreased susceptibility of the S. Typhi and S. Paratyphi A to fluoroquinolones, proving them to be inappropriate for empirical therapy for the treatment of enteric fever in our setting. Further the higher susceptibility of the isolates to first line drugs, ampicillin, chloramphenicol, and cotrimoxazole suggests the possibility of using these drugs for empirical therapy.
authors.affiliation: Department of Microbiology, Goldengate International College, Battisputali, Kathmandu, Nepal.
authors.forename: Krishma Laxmi
authors.initials: KL
authors.lastname: Shrestha
authors.affiliation: Department of Microbiology, Grande International Hospital, Dhapasi, Kathmandu, Nepal.
authors.forename: Narayan Dutt
authors.initials: ND
authors.lastname: Pant
authors.affiliation: Department of Microbiology, Goldengate International College, Battisputali, Kathmandu, Nepal.
authors.forename: Raju
authors.initials: R
authors.lastname: Bhandari
authors.affiliation: Department of Microbiology, Goldengate International College, Battisputali, Kathmandu, Nepal.
authors.forename: Sabita
authors.initials: S
authors.lastname: Khatri
authors.affiliation: Department of Microbiology, Kathmandu Model Hospital, Kathmandu, Nepal.
authors.forename: Basudha
authors.initials: B
authors.lastname: Shrestha
authors.affiliation: Department of Microbiology, Goldengate International College, Battisputali, Kathmandu, Nepal.
authors.forename: Binod
authors.initials: B
authors.lastname: Lekhak
keywords: Antibiotic resistance; Enteric fever; First line antibiotics; Fluoroquinolones; Nepal; Salmonella spp.