Clinical outcomes, environmental exposure factors, and antibiotic resistance patterns of extensively drug-resistant (XDR) typhoid fever in Pakistan: A prospective observational study.

BACKGROUND

Extensively drug-resistant (XDR) typhoid fever is a major public health concern in Pakistan, with limited treatment options and rising morbidity. There is a limited amount of evidence available on the role of the environmental factors that may impact the severity of the disease in adults.

OBJECTIVES

To evaluate clinical outcomes, antimicrobial resistance patterns, and environmental factors associated with disease severity among adults with XDR typhoid fever in Northern Punjab, Pakistan.

DESIGN

Prospective observational study.

METHODS

A prospective observational study was conducted from January 2024 to January 2025 at a tertiary care hospital in Northern Punjab. The enrollment occurred among adult patients (18- 60 years) with blood culture-confirmed XDR Salmonella enterica serovar Typhi infection using consecutive sampling. Clinical characteristics, susceptibility to antimicrobials, and environmental exposure were recorded. Severity of the disease was defined based on clinically significant complications and adverse outcomes. The chi-square test and Fisher exact test were used to analyze the associations, followed by multivariable logistic regression analysis to adjust for potential confounders.

RESULTS

Among 110 patients, meropenem (98.2%) and azithromycin (96.4%) showed the highest antimicrobial susceptibility. Contaminated drinking water, poor sanitation, street food and season of diagnosis were also significantly associated with severe disease (p<0.05).

CONCLUSION

XDR typhoid fever in Northern Punjab was characterized by extensive antimicrobial resistance, while poor sanitation, contaminated drinking water, street food consumption, and season of diagnosis were significantly associated with severe disease. There is an immediate need to strengthen water, sanitation, antibiotic stewardship, and vaccination strategies.

REGISTRATION: Not applicable.