PEDIATRIC ENTERIC SALMONELLA IN PESHAWAR, PAKISTAN: HIGH FIRST-LINE AND THIRD-GENERATION CEPHALOSPORIN RESISTANCE IN A 2024 TERTIARY-CARE HOSPITAL SURVEILLANCE COHORT

Abstract

Enteric fever has continued to be a significant pediatric bloodstream infection in low- and middle-income countries where the ability of antimicrobials to treat this infection continues to be undermined by the rising resistance of the organism. A cross-sectional study was carried out with 704 patients (pediatric) who were admitted to the Pediatric Unit of Hayatabad Medical Complex, Peshawar between January and December 2024. Blood samples underwent culture in tryptone soya broth and subculture on MacConkey agar followed by biochemical tests and serological confirmation and antimicrobial agent tests by the KirbyBauer disk diffusion test on MuellerHinton agar. Among 704 patients, 447 were male and 257 were female. The recorded isolates comprised S. Typhi in 526 patients (74.71%), S. Paratyphi in 110 (15.62%), and other Salmonella species in 68 (9.65%). S. Typhi showed substantial resistance to amoxicillin (96.83% in males; 96.73% in females), ampicillin (95.56% and 97.75%, respectively), cefotaxime (93.50% and 91.66%), and ceftriaxone (90.21% and 95.23%). Resistance to chloramphenicol and cefepime was also high. Carbapenems, tigecycline, colistin, and polymyxin-B remained largely active. Overall MDR was recorded in 141 of 704 patients (20.02%), including 95 of 447 males (21.25%) and 46 of 257 females (17.89%). MDR ranged from 17.24% to 22.48% across sex-specific age groups. The high prevalence of S. Typhi, marked resistance to first-line agents and third-generation cephalosporins, and substantial MDR burden demonstrate a serious therapeutic and public-health challenge in pediatric patients in Peshawar.