Prevalence of Enteric Fever in Febrile Patients: Clinico-Bacteriological and Antimicrobial Profile in South Delhi, India

Objectives The main objective of this study is to determine the prevalence and clinical presentation of Salmonella Typhi and Paratyphi bacteremia in cases of suspected enteric fever, and their antimicrobial-resistance pattern. Material and methods Blood specimens were collected for culture from suspected enteric fever patients, along with relevant clinical history and examination results. Culture was performed using the Automated Bac T/Alert 3D (bioMérieux, Marcy-l'Étoile, France) blood culture system. When flagged positive, isolation was done on Blood agar and MacConkey agar, followed by identification using standard bacteriological operating procedures, along with Vitek 2 (bioMérieux, Marcy-l'Étoile, France) and serotyping. Antimicrobial susceptibility testing was done by Vitek 2, and additionally by the disc diffusion method. Results Of 16,052 blood samples, 5.66% (n = 909) were positive, of which 46.64% (n = 424) were typhoidal Salmonella (S. Typhi and S. Paratyphi). Of these, 83.25% (n = 353) isolates were S. Typhi and 16.74% (n = 71) were S. Paratyphi A and B. Predominant clinical features included fever 100% (n = 424), vomiting/nausea 66.98% (n = 284), abdominal pain 68.86% (n = 291), and diarrhea 67.92% (n = 288). Typical features, i.e., rash, were noticed in only 2.59% (n = 11) of cases, whereas coated tongue was observed in 37.73% (n = 160) of patients. Among isolates of S. Typhi (n = 353), multi-drug resistance (MDR) was noted in 3.68% (n = 13) of isolates; resistance rates of 9.06% (n = 32), 4.53% (n = 16), and 3.68% (n = 13) were noted for ampicillin, chloramphenicol, and co-trimoxazole, respectively. No resistance was observed for ceftriaxone or carbapenems. Azithromycin resistance was noted in 2.83% (n = 10) of S. Typhi isolates. None of the S. Paratyphi isolates were MDR. High resistance to ciprofloxacin was observed among Salmonella isolates, with 72.23% (n = 255) and 88.73% (n = 63) noted for S. Typhi and S. Paratyphi, respectively. Conclusion Among the total bacteremia cases, almost half were due to typhoidal Salmonella, which highlights the importance of blood culture for all suspected enteric fever cases. As fever and abdominal pain were the predominant symptoms among the confirmed cases of enteric fever in this study, these symptoms overlap with those of other conditions causing fever. This makes specific testing for enteric fever very important for accurate diagnosis, which can help avoid complications and support complete treatment, thereby preventing carrier states and antimicrobial resistance (AMR). AMR among typhoidal isolates is becoming a major threat to management, with increasing resistance to commonly used antimicrobials. Routine surveillance is essential to understand the locally prevalent antibiogram patterns.