Emerging Trends of Antimicrobial Resistance in Salmonella Typhi and Paratyphi A: A Three-Year Surveillance Report from Khyber Pakhtunkhwa, Pakistan

Objective: To analyze drug resistance patterns in Salmonella isolates from Khyber Pakhtunkhwa (KPK) based on three-year surveillance data from Tehsil Head Quarter (THQ) Hospital, Dogar Central, Kurram, Pakistan. Study design: It is a retrospective and descriptive study based on laboratory surveillance data. Place and duration of study: The study was conducted at the THQ Hospital Laboratory. Data were extracted from laboratory sites located in KPK province from January 2019 to December 2022. Methodology: Blood culture and sensitivity data (2019-2024) were reviewed for resistance trends in S. Typhi and S. Paratyphi A. Result: A total of 621 isolations were reported, including 562 S. Typhi and 59 S. Paratyphi A. Ciprofloxacin (100%), ceftriaxone (92%), cefixime (92%), ampicillin (95%), chloramphenicol (90%), and trimethoprim-sulfamethoxazole (81%) were the antibiotics against which S. Typhi showed high resistance. S. Typhi showed minimal resistance to azithromycin (0.2%) and continued to be susceptible to meropenem (0% resistance). Conversely, S. Paratyphi A isolates showed 100% fluoroquinolone resistance but no resistance to first-line medications. Conclusion: In Pakistan, the emergence of extensively drug-resistant (XDR) S. Typhi is a serious treatment challenge. Urgent needs include increasing immunization coverage, regulating sensible antibiotic usage, and strengthening surveillance.