Prevalence of the Antibiotic Resistance of Salmonella typhi and Salmonella paratyphi in Pakistan: A Systematic Review and Meta-analysis.

Abstract

Background: Antibiotic resistance to Salmonella is a significant threat to public health globally, particularly in low- and middle-income countries such as Pakistan. This study reviews the existing literature to determine the pooled prevalence of antibiotic resistance among Salmonella typhi and Salmonella paratyphi strains across Pakistan in the past decade, including the emergence of extended-spectrum β-lactamase.

Methods: Six databases were searched for studies published from January 2014 to December 2024. Studies were screened for relevance, and data were extracted on antibiotic susceptibility among human S typhi and S paratyphi isolates. Their quality was assessed per the Joanna Briggs Institute checklist. A random effects model was employed by R statistical software (version 4.4) to calculate the pooled resistance rates.

Results: Thirty-one studies met the inclusion criteria after full-text screening. The analysis revealed significant resistance rates to commonly used antibiotics for S typhi, including nalidixic acid (92%; 95% CI, 88%-95%), ampicillin (80%; 95% CI, 66%-89%), ciprofloxacin (64%; 95% CI, 48%-77%), azithromycin (7%; 95% CI, 3%-16%), and meropenem (2%; 95% CI, 1%-3%), with notable variations across cities, and for S paratyphi, such as nalidixic acid (91%; 95% CI, 82%-96%), ampicillin (34%; 95% CI, 21%-50%), ciprofloxacin (51%; 95% CI, 25%-77%), azithromycin (4%; 95% CI, 1%-12%), and meropenem (2%; 95% CI, 1%-5%). In S typhi, 29% and 25% of patients had multidrug resistance (95% CI, 21%-41%) and extensive drug resistance (95% CI, 12%-44%), respectively; corresponding rates for S paratyphi were 9% (95% CI, 2%-28%) and 2% (95% CI, 1%-7%).

Conclusions: The findings revealed the alarming prevalence of antibiotic-resistant Salmonella in Pakistan and the need for updated treatment guidelines. Public health strategies must focus on improving antibiotic use and developing alternative treatment options to mitigate the rising threat of resistant Salmonella strains. Continued research, policy intervention, and national and international cooperation are essential to safeguard public health and ensure effective management of enteric fever.