Typhoid and paratyphoid fever known as enteric fever pose important global public health problem, with 21.6 million cases and approximately 250,000 deaths annually. It is a prevalent disease in Indonesia, but data on the antimicrobial resistance pattern is limited. This study aim was to provide data on the antimicrobial resistance pattern of
Enteric fever, both typhoid and paratyphoid fever are important global public health problems, with 21.6 million cases and approximately 250,000 deaths annually [
In many parts of the world, the changing modes of presentation and the development of multidrug resistance have made enteric fever increasingly difficult to diagnose and treat. Multidrug resistant (MDR)
Enteric fever is a prevalent disease in Indonesia, but data on the antimicrobial resistance pattern is limited. The aim of this study was to provide data on the antimicrobial resistance pattern of
This retrospective descriptive study was conducted in Siloam Hospital in Karawaci, Tangerang, Banten, Indonesia. The hospital is a private teaching hospital with 274 beds, affiliated to Faculty of Medicine, Pelita Harapan University. The samples in this study were all bloodstream isolates of
Venous blood samples were collected from patients admitted to hospital from January 2011 to December 2015. Blood was inoculated into enriched soybean-casein digest broth with resins in BACTEC aerobic plus/F (Becton-Dickinson, New Jersey, USA) bottles. For patients with body weight less than 12.8 kg of weight, BACTEC Peds Plus/F bottles were used. When there was bacterial growth indicated by the BACTEC machine, blood culture bottles were subcultured onto a MacConkey agar plate.
Susceptibility of
The data were analyzed statistically using Statistical Package for Social Sciences (SPSS, version 24.0.0.0). Categorical data were presented as frequency (percentage), while numerical data as mean ± SD or median (range).
The study protocol was approved by the Ethical Committee of Siloam Hospital, Karawaci, Tangerang, Banten, Indonesia.
A total of 168
Demographic characteristics of
|
% | |
---|---|---|
Serovars | ||
|
93 | 55.4 |
|
75 | 44.6 |
Sex | ||
Male | 68 | 40.5 |
Female | 100 | 59.5 |
Age group | ||
|
8 | 4.8 |
6–18 years | 68 | 40.5 |
19–59 years | 88 | 52.4 |
|
4 | 2.4 |
Antimicrobial resistance pattern of
Antimicrobial | 2011 |
2012 |
2013 |
2014 |
2015 |
Total |
||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
|
% |
|
% |
|
% |
|
% |
|
% |
|
% | |
AMP | 2 | 14.3 | 2 | 12.5 | 1 | 5.9 | 0 | 0.0 | 0 | 0.0 | 5 | 5.4 |
AMC | 1 | 7.2 | 1 | 6.3 | 1 | 5.9 | 0 | 0.0 | 0 | 0.0 | 3 | 3.2 |
CRO | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 |
CT | 2 | 14.3 | 1 | 6.3 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 3 | 3.2 |
MER | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 1 | 3.7 | 0 | 0.0 | 1 | 1.1 |
IPM | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 1 | 3.7 | 0 | 0.0 | 1 | 1.1 |
TMP-SMX | 5 | 35.7 | 1 | 6.3 | 1 | 5.9 | 1 | 3.7 | 0 | 0.0 | 8 | 8.6 |
AMP + TMP-SMX | 2 | 14.3 | 1 | 6.3 | 1 | 5.9 | 0 | 0.0 | 0 | 0.0 | 4 | 4.3 |
CIP | 0 | 0.0 | 1 | 6.3 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 1 | 1.1 |
LEVX | 0 | 0.0 | 1 | 6.3 | 1 | 5.9 | 1 | 3.7 | 0 | 0.0 | 3 | 3.2 |
AMP, ampicillin; AMC, amoxicillin clavulanate; CRO, ceftriaxone; CT, cefotaxime; MER, meropenem; IPM, imipenem; TMP-SMX, trimethoprim-sulfamethoxazole; AKN, amikacin; GEN, gentamicin; CIP, ciprofloxacin; LEVX, levofloxacin.
Minimum inhibitory concentrations to antimicrobials of
Antimicrobial | MIC ( |
2011 | 2012 | 2013 | 2014 | 2015 | Total | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|
|
|
||||||||
|
% |
|
% |
|
% |
|
% |
|
% |
|
% | ||
AMP | ≤2 | 11 | 78,6 | 10 | 62,5 | 11 | 64,7 | 20 | 74,1 | 16 | 84,2 | 68 | 73,1 |
4 | 1 | 7,1 | 4 | 25,0 | 3 | 17,6 | 4 | 14,8 | 2 | 10,5 | 14 | 15,1 | |
8 | 0 | 0,0 | 0 | 0,0 | 2 | 11,8 | 3 | 11,1 | 1 | 5,3 | 6 | 6,5 | |
≥32 | 2 | 14,3 | 2 | 12,5 | 1 | 5,9 | 0 | 0,0 | 0 | 0,0 | 5 | 5,4 | |
|
|||||||||||||
AMC | ≤2 | 13 | 92,9 | 15 | 93,8 | 16 | 94,1 | 27 | 100,0 | 19 | 100,0 | 90 | 96,8 |
4 | 1 | 7,1 | 1 | 6,3 | 1 | 5,9 | 0 | 0,0 | 0 | 0,0 | 3 | 3,2 | |
|
|||||||||||||
CRO | ≤1 | 14 | 100,0 | 16 | 100,0 | 17 | 100,0 | 27 | 100,0 | 19 | 100,0 | 93 | 100,0 |
>1 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | |
|
|||||||||||||
CT | ≤1 | 12 | 85,7 | 15 | 93,8 | 17 | 100,0 | 27 | 100,0 | 19 | 100,0 | 90 | 96,8 |
>1 | 2 | 14,3 | 1 | 6,3 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 3 | 3,2 | |
|
|||||||||||||
MER | ≤0.25 | 14 | 100,0 | 16 | 100,0 | 17 | 100,0 | 26 | 96,3 | 19 | 100,0 | 92 | 98,9 |
>0.25 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 1 | 3,7 | 0 | 0,0 | 1 | 1,1 | |
|
|||||||||||||
IPM | ≤1 | 14 | 100,0 | 15 | 93,8 | 17 | 100,0 | 26 | 96,3 | 19 | 100,0 | 91 | 97,8 |
2 | 0 | 0,0 | 1 | 6,3 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 1 | 1,1 | |
>2 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 1 | 3,7 | 0 | 0,0 | 1 | 1,1 | |
|
|||||||||||||
TMP-SMX | ≤20 | 9 | 64,3 | 15 | 93,8 | 16 | 94,1 | 26 | 96,3 | 19 | 100,0 | 85 | 91,4 |
≥320 | 5 | 35,7 | 1 | 6,3 | 1 | 5,9 | 1 | 3,7 | 0 | 0,0 | 8 | 8,6 | |
|
|||||||||||||
CIP | ≤0.25 | 12 | 85,7 | 15 | 93,8 | 12 | 70,6 | 21 | 77,8 | 19 | 100,0 | 79 | 84,9 |
0,5 | 0 | 0,0 | 0 | 0,0 | 1 | 5,9 | 0 | 0,0 | 0 | 0,0 | 1 | 1,1 | |
1 | 2 | 14,3 | 0 | 0,0 | 4 | 23,5 | 6 | 22,2 | 0 | 0,0 | 12 | 12,9 | |
4 | 0 | 0,0 | 1 | 6,3 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 1 | 1,1 | |
|
|||||||||||||
LEVX | ≤0.12 | 14 | 100,0 | 14 | 87,5 | 13 | 76,5 | 19 | 70,4 | 19 | 100,0 | 79 | 84,9 |
0,25 | 0 | 0,0 | 0 | 0,0 | 1 | 5,9 | 0 | 0,0 | 0 | 0,0 | 1 | 1,1 | |
0,5 | 0 | 0,0 | 1 | 6,3 | 2 | 11,8 | 1 | 3,7 | 0 | 0,0 | 4 | 4,3 | |
1 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 6 | 22,2 | 0 | 0,0 | 6 | 6,5 | |
2 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | |
≥8 | 0 | 0,0 | 1 | 6,3 | 1 | 5,9 | 1 | 3,7 | 0 | 0,0 | 3 | 3,2 |
MIC, minimum inhibitory concentrations; AMP, ampicillin; AMC, amoxicillin clavulanate; CRO, ceftriaxone; CT, cefotaxime; MER, meropenem; IPM, imipenem; TMP-SMX, trimethoprim-sulfamethoxazole; AKN, amikacin; GEN, gentamicin; CIP, ciprofloxacin; LEVX, levofloxacin.
Antimicrobial resistance pattern of
Antimicrobial | 2011 | 2012 | 2013 | 2014 | 2015 | Total | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|
|
|
|||||||
|
% |
|
% |
|
% |
|
% |
|
% |
|
% | |
AMP | 1 | 7.1 | 2 | 9.1 | 1 | 5.9 | 1 | 5.6 | 0 | 0.0 | 5 | 6.7 |
AMC | 1 | 7.1 | 0 | 0.0 | 1 | 5.9 | 1 | 5.6 | 0 | 0.0 | 3 | 4.0 |
CRO | 0 | 0.0 | 1 | 4.5 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 1 | 1.3 |
CT | 1 | 7.1 | 1 | 4.5 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 2 | 2.7 |
MER | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 |
IPM | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 |
TMP-SMX | 5 | 35.7 | 0 | 0.0 | 0 | 0.0 | 1 | 5.6 | 0 | 0.0 | 6 | 8.0 |
AMO + TMP-SMX | 1 | 7.1 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 1 | 1.3 |
CIP | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 |
LEVX | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 | 1 | 5.6 | 0 | 0.0 | 1 | 1.3 |
AMP, ampicillin; AMC, amoxicillin clavulanate; CRO, ceftriaxone; CT, cefotaxime; MER, meropenem; IPM, imipenem; TMP-SMX, trimethoprim-sulfamethoxazole; AKN, amikacin; GEN, gentamicin; CIP, ciprofloxacin; LEVX, levofloxacin.
Minimum inhibitory concentrations to antimicrobials of
Antimicrobial | MIC ( |
2011 | 2012 | 2013 | 2014 | 2015 | Total | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|
|
|
||||||||
|
% |
|
% |
|
% |
|
% |
|
% |
|
% | ||
AMP | ≤2 | 13 | 92,9 | 18 | 81,8 | 13 | 76,5 | 13 | 72,2 | 2 | 50,0 | 59 | 78,7 |
4 | 0 | 0,0 | 2 | 9,1 | 1 | 5,9 | 1 | 5,6 | 1 | 25,0 | 5 | 6,7 | |
8 | 0 | 0,0 | 0 | 0,0 | 2 | 11,8 | 3 | 16,7 | 1 | 25,0 | 6 | 8,0 | |
≥32 | 1 | 7,1 | 2 | 9,1 | 1 | 5,9 | 1 | 5,6 | 0 | 0,0 | 5 | 6,7 | |
|
|||||||||||||
AMC | ≤2 | 13 | 92,9 | 22 | 100,0 | 16 | 94,1 | 17 | 94,4 | 4 | 100,0 | 72 | 96,0 |
4 | 1 | 7,1 | 0 | 0,0 | 1 | 5,9 | 1 | 5,6 | 0 | 0,0 | 3 | 4,0 | |
|
|||||||||||||
CRO | ≤1 | 14 | 100,0 | 21 | 95,5 | 17 | 100,0 | 18 | 100,0 | 4 | 100,0 | 74 | 98,7 |
>1 | 0 | 0,0 | 1 | 4,5 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 1 | 1,3 | |
|
|||||||||||||
CT | ≤1 | 13 | 92,9 | 21 | 95,5 | 17 | 100,0 | 18 | 100,0 | 4 | 100,0 | 73 | 97,3 |
>1 | 1 | 7,1 | 1 | 4,5 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 2 | 2,7 | |
|
|||||||||||||
MER | ≤0.25 | 14 | 100,0 | 22 | 100,0 | 17 | 100,0 | 18 | 100,0 | 4 | 100,0 | 75 | 100,0 |
>0.25 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | |
|
|||||||||||||
IPM | ≤1 | 14 | 100,0 | 21 | 95,5 | 17 | 100,0 | 18 | 100,0 | 4 | 100,0 | 74 | 98,7 |
2 | 0 | 0,0 | 1 | 4,5 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 1 | 1,3 | |
>2 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | |
|
|||||||||||||
TMP-SMX | ≤20 | 9 | 64,3 | 22 | 100,0 | 17 | 100,0 | 17 | 94,4 | 4 | 100,0 | 69 | 92,0 |
≥320 | 5 | 35,7 | 0 | 0,0 | 0 | 0,0 | 1 | 5,6 | 0 | 0,0 | 6 | 8,0 | |
|
|||||||||||||
CIP | ≤0.25 | 13 | 92,9 | 21 | 95,5 | 14 | 82,4 | 13 | 72,2 | 3 | 75,0 | 64 | 85,3 |
0,5 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | |
1 | 1 | 7,1 | 1 | 4,5 | 3 | 17,6 | 5 | 27,8 | 1 | 25,0 | 11 | 14,7 | |
4 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | |
|
|||||||||||||
LEVX | ≤0.12 | 14 | 100,0 | 21 | 95,5 | 15 | 88,2 | 10 | 55,6 | 2 | 50,0 | 62 | 82,7 |
0,25 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 1 | 5,6 | 0 | 0,0 | 1 | 1,3 | |
0,5 | 0 | 0,0 | 1 | 4,5 | 2 | 11,8 | 2 | 11,1 | 2 | 50,0 | 7 | 9,3 | |
1 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 4 | 22,2 | 0 | 0,0 | 4 | 5,3 | |
2 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | |
≥8 | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | 1 | 5,6 | 0 | 0,0 | 1 | 1,3 |
MIC, minimum inhibitory concentrations; AMP, ampicillin; AMC, amoxicillin clavulanate; CRO, ceftriaxone; CT, cefotaxime; MER, meropenem; IPM, imipenem; TMP-SMX, trimethoprim-sulfamethoxazole; AKN, amikacin; GEN, gentamicin; CIP, ciprofloxacin; LEVX, levofloxacin.
The
The antimicrobial resistance rates of
The two antimicrobial resistance mechanisms in
The explanation of different resistance pattern in the world was that there are different strains of
According to the 2006 Indonesian Typhoid Fever Disease Control Guidelines, chloramphenicol, ampicillin, or trimethoprim-sulfamethoxazole is used as first-line antimicrobials, and if there is resistance to the first-line antimicrobials then the second line antimicrobials; ceftriaxone, cefixime, or quinolones is indicated [
There were limitations of this study that should be mentioned. The samples of this study were blood collected from admitted patients in a hospital; thus the antimicrobial resistance pattern was restricted to the patients of the hospital. The resistance pattern must be interpreted cautiously, as isolates might not represent the entire population of Banten province or Indonesia. Another issue was the unavailability of data on chloramphenicol susceptibility because of the policy of the Indonesian Microbiology Association not to test chloramphenicol for
The study discovered that in the 2011–2015 period, the resistance rates against most antimicrobials and even MDR rate of
The authors declare that there are no conflicts of interest regarding the publication of this paper.
The authors wish to acknowledge the assistance of Dewi Purnamasari M.D., Resident Medical Officer at Siloam Hospital, Karawaci, Tangerang, Banten, Indonesia, who collected the epidemiology, clinical, and microbiological data from medical records and Microbiology laboratory.