Emergence of Extensive Drug Resistance Typhoid in Hospitalized Covid-19 Patients in South Punjab, Pakistan

Introduction: In Pakistan, one of the main causes of mortality and morbidity is typhoid fever. Notably, extended drug-resistant (XDR) typhoid has been misdiagnosed widely due to many physicians continued use of Widal and Typhi-dot as serological tests for diagnosis during the COVID-19 pandemic. There were increased cases of extensively drug-resistant typhoid due to the use of extended drugs during the COVID-19 pandemic without confirming the antimicrobial susceptibility of Salmonella typhi. Methodology: In this study, 118 patient blood samples after the COVID-19 pandemic was analyzed by automated blood culture through BacT/ALERT 3D, and antimicrobials susceptibility was performed. And compared with the antimicrobial susceptibility before the COVID-19 pandemic samples of the same patients. Results: Out of 118 blood cultures of Post-COVID-19 isolates, 34 cultures were positive for Salmonella typhi. On antibiotic susceptibility test profiling of these 34 isolates, 44.12% were extensive drug-resistant (XDR), 38.24% were multidrug-resistant (MDR), 8.82% were non-MDR, non-XDR and 8.82% were resistant to all antibiotics. While in Pre-COVID-19 isolates 21.74% were XDR, 60.87% were MDR, 17.39% were non-MDR, non-XDR and 0.0% were resistant to all antibiotics. There were an increased XDR typhoid ratio as compared to MDR typhoid in Post-COVID-19 isolates. Conclusions: There is an increased emergence of XDR typhoid cases in Post-COVID-19 isolates of Salmonella typhi as compared to the Pre-COVID-19 Salmonella typhi isolates. Moreover, implementing antimicrobial susceptibility profiling and proper diagnosis before using any antibiotic against Salmonella typhi prevent the XDR typhoid outbreak in the near future.