Antibiotic resistance trends and diagnostic accuracy of Typhi Dot and Widal in enteric fever: a 2023-24 single-centre study from North India
DOI:
https://doi.org/10.18203/2320-6012.ijrms20262329Keywords:
Blood culture, Enteric fever, Salmonella typhi, Typhi dot, WIDAL testAbstract
Background: Antimicrobial resistance (AMR) in enteric fever is an emerging public health challenge in India. Early and accurate diagnosis, along with appropriate antibiotic therapy, is essential for reducing disease-related morbidity.
Methods: This retrospective, single-center observational study included all culture-confirmed enteric fever cases diagnosed at Moolchand K.R. Hospital, New Delhi, between August 2023 and September 2024. A total sample size of 45 patients with positive blood cultures for Salmonella Typhi or Salmonella Paratyphi was analyzed. Antimicrobial susceptibility testing was performed using the VITEK 2 compact system with GN and AST-N cards. Diagnostic performance of WIDAL and Typhi Dot tests was evaluated descriptively using blood culture as the reference standard.
Results: Forty-five culture-confirmed cases were analyzed (mean age 22.6±14.5 years; 51.1% female). S. Typhi accounted for 75.6% (34/45) isolates, while S. Paratyphi represented 24.4% (11/45). WIDAL was positive in 20.0% (9/45) cases and demonstrated a sensitivity of 20.6% (7/34), missing 79.4% of confirmed S. Typhi infections. Typhi Dot testing was performed in 25 patients, and all results were negative. Third-generation cephalosporins showed high susceptibility (97.8%), whereas resistance to fluoroquinolones was common. Multidrug resistance was identified in 2.2% (1/45) of isolates.
Conclusions: S. Typhi remained the predominant pathogen. Third-generation cephalosporins continue to be effective, although emerging multidrug resistance warrants ongoing surveillance and antimicrobial stewardship. Blood culture remains the diagnostic gold standard, while WIDAL and Typhi Dot demonstrated limited clinical utility.
References
Gashaw T, Jambo A. Typhoid in less developed countries: A major public health concern. In: Šostar Turk S, Rozman U, editors. Hygiene and Health in Developing Countries Recent Advances. IntechOpen; 2022.
Olopoenia LA, King AL. Widal agglutination test - 100 years later: still plagued by controversy. Postgrad Med J. 2000;76(892):80-4.
House D, Chinh NT, Diep TS, Parry CM, Wain J, White NJ. Use of paired serum samples for serodiagnosis of typhoid fever. J Clin Microbiol. 2005;43(9):4889-90.
Cheesbrough M. District Laboratory Practice in Tropical Countries. 2nd ed. Cambridge: Cambridge University Press; 2006.
Qamar MU, Rizwan M, Uppal R, Khan AA, Saeed U, Ahmad K, et al. Antimicrobial susceptibility and clinical characteristics of multidrug-resistant polymicrobial infections in Pakistan, a retrospective study 2019-2021. Future Microbiol. 2023;18(17):1265-77.
Kaur J, Dhama AS, Buttolia H, Kaur J, Walia K, Ohri V, et al. ICMR’s Antimicrobial Resistance Surveillance system (i-AMRSS): a promising tool for global antimicrobial resistance surveillance. JAC Antimicrob Resist. 2021;3(1):dlab023.
Surveillance for Enteric Fever in India (SEFI) Collaborators. Surveillance for enteric fever in India (SEFI). J Infect Dis. 2021;224(5):S625-7.
Rasheed F, Saeed M, Alikhan NF, Baker D, Khurshid M, Ainsworth EV, et al. Emergence of resistance to fluoroquinolones and third-generation cephalosporins in Salmonella Typhi in Lahore, Pakistan. Microorganisms. 2020;8(9):1336.
Wijedoru L, Mallett S, Parry CM. Rapid diagnostic tests for typhoid and paratyphoid (enteric) fever. Cochrane Database Syst Rev. 2017;5:CD008892.
Tegene BA, Eshetie MT. Evaluating alternatives to the Widal test for typhoid fever diagnosis in developing countries: A targeted literature review. J Public Health Afr. 2025;16(1):a700.
Sapkota J, Roberts T, Basnyat B, Baker S, Hampton LM, Dittrich S. Diagnostics for typhoid fever: Current perspectives and future outlooks for product development and access. Open Forum Infect Dis. 2023;10(1):S17-20.
Pustake M, Giri P, Tambolkar S, Nayak S. Extensively drug-resistant typhoid fever: A call to action. Indian J Community Med. 2022;47(1):153-4.
Birkhold M, Mwisongo A, Pollard AJ, Neuzil KM. Typhoid conjugate vaccines: Advancing the research and public health agendas. J Infect Dis. 2021;224(7):S781-7.
Kishore J, Paruti K, Lall DP. Evolving strategies in typhoid prevention and control: Recent advancements and future directions. J Commun Dis. 2024;56(3):169-71.
Andrews JR, Yu AT, Saha S, Shakya J, Aiemjoy K, Horng L, et al. Environmental surveillance as a tool for identifying high-risk settings for typhoid transmission. Clin Infect Dis. 2020;71(2):S71-8.
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