AUTHORS
Aftab Ullah, Muhammad Shabil, Saud A Abdulsamad, Asif Jan, Abdulghani A Naeem, Haseen Ullah, Mudasir Khattak, Zaki Ullah
ABSTRACT
Background
Antibiotic resistance to Salmonella is a significant threat to public health globally, particularly in low- and middle-income countries like Pakistan. This study reviews the existing literature to determine the pooled prevalence of antibiotic resistance among Salmonella typhi and Salmonella paratyphi strains across Pakistan in the past decade, including the emergence of extended-spectrum beta-lactamase (ESBL).
Methods
Six databases were searched for studies published from January 2014 to December 2024. Studies were screened for relevance, and data on antibiotic susceptibility among human S. typhi and S. paratyphi isolates were extracted. Their quality was assessed using the Joanna Briggs Institute checklist. The random-effects model was employed using the R statistical software (V 4.4) to calculate the pooled resistance rates.
Results
Thirty-one studies met the inclusion criteria after full-text screening. The analysis revealed significant resistance rates to commonly used antibiotics for S. typhi, including nalidixic acid (92%; confidence interval [CI]: 88–95%), ampicillin (80%; CI: 66–89%), ciprofloxacin (64%; CI: 48–77%), azithromycin (7%; CI: 3–16%), and meropenem (2%; CI: 1–3%), with notable variations across different cities, and for S. paratyphi, such as nalidixic acid (91%; CI: 82–96%), ampicillin (34%; CI: 21–50%), ciprofloxacin (51%; CI: 25–77%), azithromycin (4%; CI: 1–12%), and meropenem (2%; CI: 1–5%) resistance, respectively. In S. typhi, 29% and 25% of patients were found to have multidrug resistance (MDR; CI: 21–41%) and extensive drug resistance (XDR; CI: 12–44%), respectively. S. paratyphi with MDR (9%; CI: 2–28%) and XDR (2%; CI: 1–7%).
Conclusion
The findings revealed the alarming prevalence of antibiotic-resistant Salmonella in Pakistan and the need for updated treatment guidelines. Public health strategies must focus on improving antibiotic use and developing alternative treatment options to mitigate the rising threat of resistant Salmonella strains. Continued research, policy intervention, and national and international cooperation are essential to safeguard public health and ensure effective management of enteric fever.
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