Publication:

Antibiotic resistance trends and diagnostic accuracy of Typhi Dot and Widal in enteric fever: a 2023-24 single-centre study from North India

Background Antimicrobial resistance (AMR) in enteric fever is an emerging public health challenge in India. Early and accurate diagnosis, along with appropriate antibiotic therapy, is essential for reducing disease-related morbidity.

Methods This retrospective, single-center observational study included all culture-confirmed enteric fever cases diagnosed at Moolchand K.R. Hospital, New Delhi, between August 2023 and September 2024. A total sample size of 45 patients with positive blood cultures for Salmonella Typhi or Salmonella Paratyphi was analyzed. Antimicrobial susceptibility testing was performed using the VITEK 2 compact system with GN and AST-N cards. Diagnostic performance of WIDAL and Typhi Dot tests was evaluated descriptively using blood culture as the reference standard.

Results Forty-five culture-confirmed cases were analyzed (mean age 22.6±14.5 years; 51.1% female). S. Typhi accounted for 75.6% (34/45) isolates, while S. Paratyphi represented 24.4% (11/45). WIDAL was positive in 20.0% (9/45) cases and demonstrated a sensitivity of 20.6% (7/34), missing 79.4% of confirmed S. Typhi infections. Typhi Dot testing was performed in 25 patients, and all results were negative. Third-generation cephalosporins showed high susceptibility (97.8%), whereas resistance to fluoroquinolones was common. Multidrug resistance was identified in 2.2% (1/45) of isolates.

Conclusions S. Typhi remained the predominant pathogen. Third-generation cephalosporins continue to be effective, although emerging multidrug resistance warrants ongoing surveillance and antimicrobial stewardship. Blood culture remains the diagnostic gold standard, while WIDAL and Typhi Dot demonstrated limited clinical utility.