Extensively Drug-Resistant (XDR) Enteric Fever in Children

Background: Typhoid and paratyphoid fevers are caused by Salmonella enterica subspecies serovars typhi (Salmonella typhi and Paratyphi) and the term enteric fever is generally used to describe both. This study was done to determine the frequency of extensively drug-resistant (XDR) in children diagnosed with enteric fever at a tertiary care hospital. Methods: This cross-sectional study was conducted at the Department of Pediatric Medicine, Liaquat National Hospital, Karachi, Pakistan, from April 2023 to September 2023. A total of 122 children aged between 2-12 years with an axillary body temperature >38.4 oC for at least 4 days were analyzed. Non-probability convenient sampling method was adopted. Venous blood (3-5 ml) was drawn and sent for confirmation of XDR enteric fever. Effect modifiers were stratified concerning the frequency of XDR enteric fever, and post-stratification, a chi-square test was applied to take p<0.05 as significant. Results: Out of a total of 122 children, 67 (54.9%) were boys. The mean age was 6.14±2.82 years. Blood culture was found positive for Salmonella typhi in 82 (67.2%) children. In a total of 82 patients with positive blood cultures for enteric fever, XDR was identified in 43 (52.4%) children. Relatively higher duration of fever was significantly associated with positive blood culture cases for Salmonella typhi ((>14 days, p=0.020), and XDR cases (p=0.031). Comparison of mean length of hospital stay (7.27±1.68 vs. 7.77±2.2 days, p=0.103) did not reveal any significant differences among study participants. Conclusion: A very high prevalence of XDR was found among children diagnosed with enteric fever.