Salmonella enterica IN BLOOD SAMPLES OF PATIENTS CLINICALLY SUSPECTED OF ENTERIC FEVER IN SHANKARAPUR HOSPITAL 

Abstract

Enteric fever (Typhoid and Paratyphoid fever) continues to be major public health
problem in under-developed countries including Nepal. Since the antimicrobial
susceptibility profile of the organism may be changing over the time, current knowledge
on antimicrobial susceptibility profile is essential for appropriate therapy. ESBL
producing bacteria may not be detected by routine disk diffusion susceptibility test
leading to inappropriate use of antibiotics and treatment failure. The aim of this study
was to isolate Salmonella enterica in blood of the suspected enteric fever patients visiting
Shankarapur Hospital as well as identification of MDR, ESBL producing and NAR
strains in the population. A cross-sectional study was carried out from February 2010 to
October 2010. A total 512 samples were processed for culture and sensitivity as well as
leukocyte counting and hemoglobin percentage. Out of the total 512 blood cultures
samples, only 49 (9.57%) showed bacterial growth. The growth of Salmonella enterica
(n=45, 8.78%) was significantly higher (p < 0.05) among the total bacterial isolates. Non-
Salmonella included Streptococcus pneumoniae (n=3) and Staphylococcus aureus (n=1).
The isolation of the Salmonella in the age group less than 30 years was significantly
higher (p<0.05). The isolation rate of Salmonella from the male patients (6.83%) was not
found significantly different (p>0.05) from the female patients (11.11%), however, the
growth rate was found significantly higher (p<0.05) in out-patient sample (9.09%) than in
in-patient sample (7.44%). Four (12.1%) out of thirty three Salmonella enterica (all
serovar Typhi) were MDR where as three (24.2%) out of thirty three Salmonella enterica
(all serovar Typhi) were NAR. Interestingly, all NAR strains appeared susceptible to
Ciprofloxacin and Ofloxacin in in-vitro susceptibility test. Three (9.1%) S. enterica
serovar Typhi were found to be ESBL producer while all were susceptible to Imipenem
and Meropenem. This study revealed that there is an increase in number of NAR
Salmonella. Also there is increasing resistance to many antibiotics.