Risk factors of multi drug resistance enteric fever among pediatric patients in Lahore

Background: Enteric fever, caused primarily by Salmonella enterica serovars Typhi and Paratyphi, remains a major public health concern in developing countries, particularly in South Asia. The objective of this study is to determine the risk factors associated with multidrug-resistant (MDR) enteric fever among pediatric patients presenting to a tertiary-care hospital. Material and Methods: This descriptive cross-sectional study was conducted at Department of Pediatrics, Pakistan Sheikh Zayed Hospital, Lahore, from 8-11-25 to 7-02-26. A total of 177 children aged 1–12 years with clinically suspected enteric fever were enrolled using non-probability consecutive sampling. Results: Among 177 children (mean age 6.4 ± 3.2 years), 115 (65%) had culture-positive enteric fever, and 35 of these (30%) were MDR. Fever lasted an average of 7.9 ± 3.1 days, with headache in 51%, constipation in 43%, and diarrhea in 47%. Prior antibiotic use was reported in 28% of all patients, and only 21% were fully vaccinated. Most children belonged to low socioeconomic households (55%), with poor food hygiene in 50% and poor water sanitation in 45%. MDR cases were significantly associated with prior antibiotic exposure (39% vs 22%; p = 0.01), antibiotic misuse (29% vs 16%; p = 0.04), low socioeconomic status (64% vs 49%; p = 0.03), poor water sanitation (57% vs 38%; p = 0.02), and unvaccinated status (46% vs 30%; p = 0.04). Conclusion: Multidrug-resistant enteric fever in children is strongly linked to modifiable behavioral and environmental factors. Keywords: Antibiotic misuse, Enteric fever, Multidrug resistance, Pediatrics, Risk factors