Abstract
OBJECTIVES: To describe the demographics, clinical characteristics, antimicrobial resistance profiles, and treatment responses of pediatric XDR Salmonella Typhi in Northern Punjab, Pakistan, and assess their association with disease severity. INTRODUCTION: XDR Salmonella enterica serovar Typhi poses a major pediatric health challenge in Pakistan due to limited treatment options, relapse risk, and contaminated water exposure. METHODS: A prospective cohort study was conducted at POF Hospital, Northern Punjab (January 2024-January 2025), enrolling 65 children (1-12 years) with culture-confirmed XDR S. Typhi. Clinical, laboratory, and treatment data were analyzed using Chi-square tests. RESULTS: Most patients (60%) were aged 5 to 10 years; vomiting (69.2%) and headache (47.7%) were frequent. All isolates were resistant to ceftriaxone, ciprofloxacin, and first-line agents; meropenem and azithromycin remained 100% and 96.9% susceptible. Severe disease was associated with delayed fever clearance (P < .001) and longer hospitalization (P < .05). CONCLUSION: XDR typhoid demands strengthened stewardship, vaccination, and water safety.