Abstract
INTRODUCTION: Typhoid fever, caused by Salmonella enterica serovar Typhi, remains a significant public health issue, particularly in low-income countries with inadequate sanitation. The rise of extensively drug-resistant (XDR) strains of Salmonella Typhi has led to a growing reliance on carbapenems as the final line of defense. This study aims to evaluate the effectiveness of carbapenems in treating multidrug-resistant (MDR) and XDR typhoid at Hayatabad Medical Complex, Peshawar. OBJECTIVE: This study aims to assess the efficacy of carbapenems in treating MDR and XDR typhoid fever and identify alternative therapeutic strategies. METHODOLOGY: A retrospective cohort study was conducted at Hayatabad Medical Complex from January to June 2024. A total of 501 patients with confirmed typhoid fever were included. Data on demographics, drug sensitivity, and resistance patterns were extracted from the hospital's Health Management Information System (HMIS) and analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York). Statistical significance was set at p < 0.05. RESULTS: Among 501 patients, 299 (59.7%) were male, with a mean age of 23.84 ± 0.24 years. MDR was observed in 106 (36%) patients, while XDR and carbapenem resistance were present in only three (0.6%) cases. Imipenem demonstrated a high sensitivity of 466 (93%), while meropenem had 380 (75.8%) sensitivity with no resistance. Non-carbapenem antibiotics, such as polymyxin 468 (93.4%) sensitivity and colistin 446 (89%) sensitivity, exhibited higher efficacy than carbapenems. Alarmingly, cephalosporins such as cefepime exhibited 454 (91%) resistance. Resistance to carbapenems was rare, affecting only three (0.6%) patients. CONCLUSION: Carbapenems remain highly effective against MDR and XDR typhoid, but non-carbapenem options such as polymyxin and colistin offer viable alternatives in reducing carbapenem dependence. Enhanced antimicrobial stewardship is critical to preserving these last-resort treatments.