Antimicrobial Resistance Pattern and Clinical Spectrum of Blood Culture-Proven Typhoid Fever in Children

Abstract

Background: Enteric fever remains a major cause of morbidity in children in endemic, resource-limited settings, and emerging antimicrobial resistance (AMR) threatens effective treatment. This study describes the clinical spectrum and AMR pattern of blood culture-proven typhoid fever in children at a tertiary care center. Materials and Methods: This retrospective observational study included culture-positive typhoid cases admitted to the pediatrics department of a tertiary care center from January 2023 to 2025. Demographic, clinical, and laboratory data were obtained from hospital records, and case definitions and treatment protocols followed the Indian Academy of Pediatrics protocol. Statistical analysis was performed using the Statistical Package for the Social Sciences version 20. Results: Of 64 blood culture-proven cases, 90.6% were due to Salmonella. Typhi and 9.4% to S. Paratyphi, with equal sex distribution and 40% of cases in children under 5 years. Fever was the most common presentation (95%), followed by vomiting (56%), abdominal pain (46%), diarrhea (19%), cough (17%), convulsions (6.5%), and respiratory distress (3.5%). The Widal test was positive in 35.4% of cases. Complications occurred in 17.1% of children, most commonly hepatitis (6.4%) and shock (4.6%). Resistance was observed too floxacin (25.4%), ampicillin (4.7%), co-trimoxazole (3.17%), ceftriaxone (3.17%), and azithromycin (1.8%); multidrug-resistant strains were seen in 3.1% and extensively drug-resistant strains in 1.56% of cases. Conclusion: Typhoid fever continues to cause significant morbidity in children, with high ofloxacin resistance but a notable decline in resistance to first-line drugs, raising the possibility of their future reuse. Continued antimicrobial surveillance is warranted to guide empirical treatment and detect emerging resistant strains.