The frightening disease burden of blood culture proven XDR Typhoidal isolates in pediatric population in a tertiary care hospital in Islamabad; Time to implement a holistic approach countrywide

Background: Typhoid fever is a deadly enteric bacterial infection and millions of people all over the globe are endangered of acquiring it. Since the first outbreak of XDR typhoid in Pakistan in 2016, the ever-rising resistance of typhoid has become a major threat faced by the pediatric population of Pakistan. There is a dearth of available data in children harboring this extensively drug resistant pathogen countrywide. The objective of this study is to highlight the alarmingly increasing prevalence of XDR S. typhi in pediatric population in Federal territory in Pakistan. Material and Methods: This Cross-sectional study was conducted at Microbiology Lab, Children Hospital, PIMS from June 2022 to May 2023. Blood culture samples of children (with strong clinical suspicion of typhoid) ranging one till 12 years (both genders). Result: Out of a total of 245 typhoid suspected blood culture samples, 153 (62%) samples yielded growth of typhoidal Salmonella isolates with 109 (71 %) isolates proved as XDR Salmonella Typhi ,35 (23%) as MDR Salmonella Typhi and the rest 09 cases (6 %) were Salmonella paratyphi A. There was a male predominance of 96(63%) and the rest 57(37%) were females. Age range most commonly affected was 5-8 years followed by 9-12 yrs. There was 100% susceptibility to Meropenem in XDR typhoid cases and 99% XDR cases were susceptible to Azithromycin. Conclusion: We concluded that there is widespread existence of MDR/ XDR S.typhi in pediatric population in federal territory as well as all over Pakistan but there is scarcity of documented data nationwide. Hence, our study signifies that a holistic approach should be implemented along with continuous ongoing surveillance to combat this frightening MDR/ XDR disease burden in this particular population. Key Words: Salmonella Typhi, Extensively Drug Resistant (XDR), Typhoidal isolates