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

Abstract

Objective: To evaluate the clinical spectrum, management strategies, treatment outcomes, and long-term recovery, including health-related quality of life, in patients with extensively drug-resistant (XDR) Salmonella Typhi infection.

Methodology:  A cross-sectional study was conducted at Shifa International Hospital, Islamabad from March 2025 to February 2026. Both male and female patients aged 14 years and above, with blood culture–confirmed XDR Salmonella Typhi, infection were included. Clinical outcomes included need for admission, length of stay among admitted patients, intensive care unit (ICU) admission, development of complications during hospitalization, discharge status, and in-hospital mortality. Analyses were performed using SPSS. Continuous variables Age, and days of hospitalization were summarized as median and IQR as they were not normally distributed.

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.42.7% received antibiotic monotherapy, while 53.3% received combination therapy; 60.0% of patients required hospitalization, while 7 (9.3%) required intensive care admission. 52 % of patients had no symptoms of chronic fatigue syndrome on follow-up.

Conclusions: XDR Salmonella Typhi infection was associated with substantial healthcare utilization and clinical complications, however no in-hospital deaths occurred. Most patients required treatment with carbapenem-based regimens. On follow-up 52% of patients reported no symptoms suggestive of chronic fatigue syndrome, suggesting generally favorable long-term recovery and health-related quality of life among survivors.