Clinical Characteristics and Resistance Patterns of Extensively Drug-Resistant Salmonella Typhi in the Pediatric Population of Pakistan: A Prospective Study

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.