Antibacterial efficacy of indigenous Pakistani honey against extensively drug-resistant clinical isolates of Salmonella enterica serovar Typhi: an alternative option to combat antimicrobial resistance

Abstract Background Extensively drug-resistant (XDR) Salmonella enterica serovar Typhi (S. Typhi) poses a grave threat to public health due to increased mortality and morbidity caused by typhoid fever. Honey is a promising antibacterial agent, and we aimed to determine the antibacterial activity of honey against XDR S. Typhi. Methods We isolated 20 clinical isolates of XDR S. Typhi from pediatric septicemic patients and determined the minimum inhibitory concentrations (MICs) of diferent antibiotics against the pathogens using the VITEK 2 Compact system. Antimicrobial-resistant genes carried by the isolates were identifed using PCR. The antibacterial efcacy of fve Pakistani honeys was examined using agar well difusion assay, and their MICs and minimum bactericidal concentrations (MBCs) were determined with the broth microdilution method. Results All 20 isolates were confrmed as S. Typhi. The antibiogram phenotype was confrmed as XDR S. Typhi with resistance to ampicillin (≥32 µg/mL), ciprofoxacin (≥4 µg/mL), and ceftriaxone (≥4 µg/mL) and sensitivity to azithromycin (≤16 µg/mL) and carbapenems (≤1 µg/mL). Molecular conformation revealed the presence of blaTM-1, Sul1, qnrS, gyrA, gyrB, and blaCTX-M-15 genes in all isolates. Among the fve honeys, beri honey had the highest zone of inhibition of 7–15 mm and neem honey had a zone of inhibition of 7–12 mm. The MIC and MBC of beri honey against 3/20 (15%) XDR S. Typhi isolates were 3.125 and 6.25%, respectively, while the MIC and MBC of neem were 3.125 and 6.25%, respectively, against 3/20 (15%) isolates and 6.25 and 12.5%, respectively, against 7/20 (35%) isolates. Conclusion Indigenous honeys have an efective role in combating XDR S. Typhi. They are potential candidates for clinical trials as alternative therapeutic options against XDR S. Typhi isolates. Keywords Antimicrobial resistance, Natural antibiotics, XDR S. Typhi, MIC, Honey, Resistance gene