Abstract Ref Number = APCP964
Salmonella typhi antimicrobial resistance pattern in Pasar Minggu district hospital A case series
YuliantoSantoso Kurniawan,Siti Rosidah,Putri Salindri,wirdah wirdah
private Pasar Minggu District Hospital
Background : Typhoid fever is oftenly cause enteric fever in Indonesia. Indonesian Pediatric Society guideline propose Ceftriaxon as first line treatment for typhoid fever. Antimicrobial guideline oftenly use data from tertiary level healthcare. There is lack of antimicrobial resistance data from second level healthcare. Using tertiary level data can lead to overestimate of disease severity and inappropriate use of high potention antibiotic such as third generation cephalosporin.
Case Presentation Summary : There were three cases of typhoid fever which was confirmed with blood culture in Pasar Minggu district hospital. First typhoid case was sensitive with amox+clav acid, ampicillin/sulbactam, cefotaxime, ceftriaxone, ceftazidime, cefepime, imipenem, meropenem, amikacin, gentamycin, ciprofloxacin, levofloxacin, trimethoprim/sulfamethoxazole, tetracycline, chloramphenicol, fosfomycin. Second case was sensitive with ampicillin, ampicillin/sulbactam, piperacillin/tazobactam, cefotaxime, cefepime, meropenem, ciprofloxacin, levofloxacin, tetracycline, trimethoprim/sulfamethoxazole. Third case was sensitive with ampicillin, ampicillin/sulbactam,piperacillin/tazobactam, cefotaxime, cefepime, meropenem, ciprofloxacin, levofloxacin, tetracycline, trimethoprim/sulfamethoxazole. All patient were treated with ceftriaxon and have good outcome.
Learning Points/Discussion : Three series of Salmonella typhi blood culture show sensitivity for penicillin and cotrimoxazole. Penicillin and cotrimoxazole can be given in the first and second level health care. This findings should raise awareness to start switching first line treatment of uncomplicated typhoid fever in first or second level healthcare (primary health care and district hospital) with penicillin and cotrimoxazole. Antibiotic selection based on facility base culture sensitivity result can be done to prevent inappropriate antimicrobial use and resistance. Third generation cephalosporin (intravenous and oral) should reserve in serious infection or in third level healthcare.
Keywords: Salmonella typhi resistance penicillin blood culture sensitivity