|Year : 1989 | Volume
| Issue : 2 | Page : 79-82
Chloramphenicol resistant Salmonella species isolated between 1978 and 1987.
NN Talawadekar, PJ Vadher, DU Antani, VV Kale, SA Kamat
N N Talawadekar
During the ten year study i.e. 1978 to 1987, out of 53,251 cases of suspected enteric fever, S.typhi was isolated from 4005 cases (7%) and S.para typhi «SQ»A«SQ» from 1108 cases (2.5%). A total of 52 strains of S. typhi and 4 strains of S.para typhi «SQ»A«SQ» were found to be resistant to chloramphenicol. Minimal inhibitory concentration was greater than 256 micrograms/ml of all the strains of S.typhi and S.para typhi «SQ»A«SQ».
|How to cite this article:|
Talawadekar N N, Vadher P J, Antani D U, Kale V V, Kamat S A. Chloramphenicol resistant Salmonella species isolated between 1978 and 1987. J Postgrad Med 1989;35:79-82
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Talawadekar N N, Vadher P J, Antani D U, Kale V V, Kamat S A. Chloramphenicol resistant Salmonella species isolated between 1978 and 1987. J Postgrad Med [serial online] 1989 [cited 2022 Sep 27 ];35:79-82
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Woodward et al first described the dramatic effect of chloramphenicol in treatment of acute typhoid fever. Since then chloramphenicol is generally accepted as the preferred drug of choice for treatment of typhoid fever.,, Chloramphenicol resistance in Salmonella typhi was first reported in England. Subsequently this was observed in India, West Africa and Greece.,, Since the first report of chloramphenicol resistant Salmonella paratyphi 'A', a few sporadic cases of such resistant organisms have been recorded in India.,,,
Kasturba Hospital is the only infectious diseases hospital in Bombay and a large number of enteric fever cases are seen every year at this hospital. In view of the reported emergence of chloramphenicol resistant Salmonella elsewhere in our country; it was decided to verify this impression in our laboratory.
MATERIAL AND METHODS
Blood was drawn before therapy from patients suspected to be suffering from enteric fever admitted during the period from January 1978 to December 1987 for blood culture and clot culture. Blood was collected in tryptic soya broth and the specimen was later inoculated on MacKonkey's agar. Blood cultures were followed up for fourteen days. For clot culture 5 ml blood was collected in a sterile test tube. Serum was separated aseptically. To the clot was added 45 ml of sterile ox-bile and after enrichment and incubation for 24 hours, it was inoculated on MacKonkey's agar. The Salmonella typhi (S.typhi) and Salmonella paratyphi 'A' (S. paratyphi 'A') were identified by standard biochemical and agglutination tests. Slide agglutination test was done using high titre antisera.
Antibiotic susceptibility test of all the isolated strains of S.typhi and para typhi 'A' was done by single disk diffusion method. A resistant strain was identified by absence of clear zone around the disk. Chloramphenicol 30 µg/ml disk, supplied commercially by span diagnostics India, was used to determine sensitivity. Confirmatory tube dilution susceptibility studies were performed on a serially doubling dilution antibiotic concentration in Mueller Hinton Broth against Chloramphenicol. The strains were sent to National Salmonella phage typing centre, Lady Hardinge Medical College, New Delhi for phage typing.
During the study out of 53,251 cases of suspected enteric fever, S.typhi was isolated from 4005 cases (7%) and S.para typhi 'A' from 1108 cases (2.5%). A total of 52 strains of S.typhi and 4 strains of S.para. typhi 'A' were found to be resistant to chloramphenicol. Minimal inhibitory concentrations were greater than 256 µg/ml of all the strains of S.typhi and S. para typhi. 'A'.
[Table 1]shows the year-wise distribution of resistant strain of S.typhi and S. para typhi 'A'. It is seen from the table that maximum number of resistant strain of S. typhi (11%) were isolated in 1984 followed by 8% isolated in 1985. Two strains each of S. para typhi 'A' were isolated in 1980 and 1981. [Table 2]describes the different phage types of S.typhi and S. para typhi 'A'. It is seen from the table that phage typing of S.typhi showed that type 'O' was the most common followed by phage type 'A'.
It can be assumed that chloramphenicol resistance will appear in S.typhi from time to time as a result of either mutation or the acquisition of R. factors. Even while chloramphenicol was used successfully in treatment of typhoid fever there were scattered reports of chloramphenicol resistant S. typhi from India beginning in 1959.,
Our study revealed that there was not a single strain of Salmonella resistant to chloramphenicol in the year 1978. We encountered in vitro resistance for the first time in 1979 and since then resistant strains are being encountered at varying frequency.
From 1981 onwards Bombay City has been getting filtered water since then there has been marked reduction in incidence of enteric fever in Bombay resulting in corresponding reduction in isolation of Salmonella organisms. However, there seems to be a sudden relative increase in chloramphenicol resistant strains since 1980.
During the years 1984 and 1985 the percentage of chloramphenicol resistant strains of S.typhi was quite high i.e. 11.2 and 8.05% respectively. Majority of the S. typhi strains occurred in the 'O' phage type.
Sridhar et al in their five year study (1976-1980) encountered the first resistant strain of S.typhi in 1978. They have reported an incidence of resistant strains as 1.7%, 22.2%, 43.7% in 1978, 1979 and 1980 respectively and all resistant strains of S.typhi belonged to type 'O' biotype II. Lorian et al in their study reported 5% resistant S.typhi.
The appearance of chloramphenicol resistant strains of S.typhi are most likely in our city as two conditions are satisfied. First is that typhoid fever being common in Bombay, organism is frequently present in human intestine and secondly is that chloramphenicol being used indiscriminately and this promotes the emergence of resistant strains. The sudden emergence of chloramphenicol resistant Salmonella in scattered parts of the world are a reminder that if antibiotic like chloramphenicol is to retain efficacy for important diseases, their use should be largely if not entirely restricted to these diseases for which it is meant throughout the world.
The authors wish to thank the Medical Superintendent, Kasturba Hospital for Infectious Diseases for allowing us to publish the work and Dr. K. Prakash I/C National Salmonella phage typing centre, Lady Hardinge Medical College, New Delhi, for phage typing these strains.
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