Clinical Characteristics and Resistance Patterns of Extensively Drug-Resistant Salmonella Typhi in the Pediatric Population of Pakistan: A Prospective Study.

OBJECTIVES

To describe the demographics, clinical characteristics, antimicrobial resistance profiles, and treatment responses of pediatric XDR Salmonella Typhi in Northern Punjab, Pakistan, and assess their association with disease severity.

INTRODUCTION

XDR Salmonella enterica serovar Typhi poses a major pediatric health challenge in Pakistan due to limited treatment options, relapse risk, and contaminated water exposure.

METHODS

A prospective cohort study was conducted at POF Hospital, Northern Punjab (January 2024-January 2025), enrolling 65 children (1-12 years) with culture-confirmed XDR S. Typhi. Clinical, laboratory, and treatment data were analyzed using Chi-square tests.

RESULTS

Most patients (60%) were aged 5 to 10 years; vomiting (69.2%) and headache (47.7%) were frequent. All isolates were resistant to ceftriaxone, ciprofloxacin, and first-line agents; meropenem and azithromycin remained 100% and 96.9% susceptible. Severe disease was associated with delayed fever clearance (P < .001) and longer hospitalization (P < .05).

CONCLUSION

XDR typhoid demands strengthened stewardship, vaccination, and water safety.