Burden of antimicrobial resistance in culture-confirmed Salmonella Typhi isolates in India from 1977 to 2024: A systematic review and meta-analysis

BACKGROUND: Antimicrobial-resistant (AMR) Salmonella Typhi (S. Typhi) is a persistent public health threat in India. We conducted a systematic review and meta-analysis to estimate the prevalence and temporal trends of AMR S. Typhi across Indian states to inform prevention and treatment strategies. METHODS: We systematically reviewed antimicrobial resistance in S. Typhi isolates from India, including studies published up to March 31, 2025, with no start-date restriction. We screened eligible articles from PubMed-MEDLINE, EMBASE, Scopus, Web of Science, and AMR surveillance networks and excluded studies on chronic carriers and travellers. We assessed risk of bias using the Risk Of Bias In Non-randomised Studies - of Exposures (ROBINS-E) tool. We conducted meta-analysis using a random-effects model to estimate the prevalence of multidrug resistance (MDR; resistance to chloramphenicol, ampicillin, and co-trimoxazole) and resistance to fluoroquinolones, third-generation cephalosporins, and azithromycin across five-year periods, Indian states, and age groups (