Salmonella enterica serovar Paratyphi A: an emerging cause of febrile illness in Nepal.

With an aim to evaluate the isolation rate and antibiotic susceptibility pattern in Salmonella enterica serovar Typhi and S. Paratyphi A, 656 blood samples collected from clinically diagnosed enteric fever patients at National Public Health Laboratory, Nepal during January through December 2008 were processed. Isolates were identified by standard microbiological procedures including serotyping. Antibiotic susceptibility testing was performed by disc diffusion method and minimum inhibitory concentration (MIC) to ciprofloxacin, ofloxacin and nalidixic acid was determined by agar dilution method following CLSI guidelines. Altogether 59 isolates of S. Typhi (49.15%) and S. Paratyphi A (50.85%) were recovered. A total of 80% isolates were resistant to nalidixic acid with S. Paratyphi A (93%) showing significantly higher resistance (P < 0.05) compared to S. Typhi (66%). The nalidixic acid resistant S. Paratyphi A strains required significantly higher MICs (P < 0.001) to quinolone (MIC expressed as mean +/- SD for nalidixic acid 477.87 +/- 87.02 microg/mL, ofloxacin 1.8 +/- 0.63 microg/mL, ciprofloxacin 0.62 +/- 0.3 microg/mL) compared with that of S. Typhi (nalidixic acid 173.18 +/- 72.03 microg/mL, ofloxacin 0.43 +/- 0.11 microg/mL, ciprofloxacin 0.25 microg/mL). Increased MIC of fluoroquinolone (FQ) is of particular concern in emerging strains of S. Paratyphi A as exposure to these drugs fuels up further development of full FQ resistant populations. Use of FQs as the first-line drugs for empirical therapy and management of enteric fever in areas where these strains are prevalent is questionable and requires an urgent review.