Clinical Spectrum, Outcomes, and Quality of Life Implications of Extensively Drug-Resistant Salmonella Typhi Infection at a Tertiary Care Hospital in Pakistan

Abstract

  Background: Extensively drug-resistant (XDR) Salmonella Typhi has become a dominant cause of enteric fever in Pakistan, leaving few effective antibiotic options. In addition to acute complications and healthcare utilization, prolonged illness and hospitalization may affect recovery and health-related quality of life (HRQoL). We described clinical characteristics, antimicrobial treatment patterns, clinical outcomes, and long-term recovery in these patients.   Methods: We conducted a cross-sectional study at a tertiary care hospital in Islamabad, Pakistan, from March 2025 to February 2026. Patients with blood culture–confirmed XDR Salmonella Typhi infection were included. Demographic, laboratory, treatment, and clinical outcome data were reviewed from electronic medical records and summarized descriptively. Patients were interviewed after completion of treatment, to assess health related quality of life by completing DePaul Symptom-Brief-(DSQ-Brief) Questionnaire.   Results: Seventy-five patients were included; median age was 25 years (25-30). Fever was present in 97.3% of patients. 60% required hospitalization and 9.3% required intensive care stay. Median days of hospitalization were 5 days. Complications included bicytopenia (18%), pancytopenia (4%), gastrointestinal bleeding (6.7%), anemia (10%), septic encephalopathy (6.7%) and septic shock (2.7%). No in-hospital deaths were recorded. Most admitted patients received carbapenem-based therapy with or without azithromycin. 52 % of patients had no symptoms of chronic fatigue syndrome on follow-up.   Conclusions: XDR Salmonella infection was associated with substantial morbidity and healthcare utilization despite zero in-hospital mortality. Pakistan’s shifting resistance spectrum and increasing dependence on reserve antibiotics, necessitates the need for culture-guided care, antimicrobial stewardship, and prevention. Future studies should directly quantify post-discharge HRQoL after treatment. 

Keywords:
Typhoid fever; XDR Salmonella Typhi; Antimicrobial resistance; Carbapenems; Azithromycin; Hospitalization; Quality of life; Pakistan.