Risk factors of Extensive Drug Resistant Typhoid Fever among Children in Karachi: A Case Control Study, 2018

  • Anti-microbial resistance
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Background:
From May-October 2018 cases of lab confirmed extensive drug resistant typhoid fever (XDR-TF) increased among children under 15 years. Resistance included first and second line antibiotics and ceftriaxone. XDR-TF is responsible for a continuing outbreak in Pakistan that began in November 2016. Our study objective was to identify risk factors associated with XDR-TF.

Methods:
Using case-control design, we defined XDR-TF cases as, <15 years old, resident of Karachi with typhoid fever, resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporins on blood culture and sensitivity during September–October 2018. Hospital-based controls (1:1) were matched with age and sex. We obtained relevant information by patient interviews and medical records. Logistic regression was used to identify factors significantly associated with XDR-TF

Results:
We identified 133 laboratory-confirmed cases of XDR-TF during September–October 2018 in laboratory-based surveillance data of Ministry of Health. Of these, we obtained complete information from 75 patients who were included. Case-patients were aged 1–15 years (mean 6.5 years; 53% male). In multivariate logistic regression model, we found positive association of XDR-TF with having family member with previous typhoid illness (exposure rate cases 21% and control 1%: adjusted-OR 16; 95% CI: 1.9–142; P=0.01), using foul-smelling municipal water at home (exposure rate cases 44% and control 7%: adjusted-OR 9; 95% CI: 3-27; P=0.00) and eating French-fries with improperly prepared (adulterated with water) tomato-ketchup from street vendors (exposure rate cases 38% and control 4%: adjusted-OR 8; 95% CI: 2-35; P=0.00) when compared to controls.

Conclusion:
This study suggested that community water supply needed to be improved along-with education of street vendors on the risks of improperly preparing food. It is also recommended that children should be vaccinated and illicit the disease specific health education campaign with the help of media.

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