Clinical spectrum and outcomes of patients with different resistance patterns of Salmonella enterica

2021 ◽  
Vol 38 (ICON-2022) ◽  
Author(s):  
Fivzia Herekar ◽  
Samreen Sarfaraz ◽  
Muhammad Imran ◽  
Nida Ghouri ◽  
Saba Shahid ◽  
...  

Background and Objective: Unceasing rise in cases of enteric fever, in particular extensively drug resistant (XDR) strain of Salmonella enterica, has led to a growing threat, leaving only carbapenems and azithromycin as the precious option. In this regard, we determined the burden and clinical course of XDR salmonella in comparison to multidrug-resistant (MDR) and drug sensitive (DS) strains. Methods: A retrospective chart review of 1515 Salmonella Typhi (S.typhi) culture positive patients was conducted at Indus Hospital and Health Network, Karachi from July 2017 to December 2018. Results: During our study, we observed children at the age of 5-6 years and adults at the age of 20-22 years were the chief targets of S.typhi. Further, we witnessed a rapid shift of drug resistance from MDR to XDR over the one year of study. Almost all patients presented with fever. However other signs and symptoms like malaise, body aches, anorexia, diarrhea, vomiting and abdominal pain were more common in XDR Typhoid patients. Further, the need of hospitalization, total hospital stay and mortality was also greater for XDR typhoid patients. Conclusion: There is a crucial requirement for consolidated steps to curtail the spread of XDR Salmonella tyhi disease as its management is challenging, and it is associated with increased morbidity and mortality. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5789 How to cite this:Herekar F, Sarfaraz S, Imran M, Ghouri N, Shahid S, Mahesar M. Clinical spectrum and outcomes of patients with different resistance patterns of Salmonella enterica . Pak J Med Sci. 2022;38(2):356-361. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5789 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

2009 ◽  
Vol 3 (10) ◽  
pp. 753-761 ◽  
Author(s):  
Khalifa Sifaw Ghenghesh ◽  
Ezzedin Franka ◽  
Khaled Tawil ◽  
Momtaz Wasfy ◽  
Salwa F. Ahmed ◽  
...  

Typhoid fever is endemic in the Mediterranean North African countries (Morocco, Algeria, Tunisia, Libya, and Egypt) with an estimated incidence of 10-100 cases per 100,000 persons. Outbreaks caused by Salmonella enterica serovar Typhi are common and mainly due to the consumption of untreated or sewage-contaminated water. Salmonella enterica Paratyphi B is more commonly involved in nosocomial cases of enteric fever in North Africa than expected and leads to high mortality rates among infants with congenital anomalies. Prevalence among travellers returning from this region is low, with an estimate of less than one per 100,000. Although multidrug resistant strains of Salmonella Typhi and Paratyphi are prevalent in this region, the re-emergence of chloramphenicol- and ampicillin-susceptible strains has been observed. In order to better understand the epidemiology of enteric fever in the Mediterranean North African region, population-based studies are needed. These will assist the health authorities in the region in preventing and controlling this important disease.


Antibiotics ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. 660
Author(s):  
Xuebin Xu ◽  
Silpak Biswas ◽  
Guimin Gu ◽  
Mohammed Elbediwi ◽  
Yan Li ◽  
...  

Salmonella spp. are recognized as important foodborne pathogens globally. Salmonella enterica serovar Rissen is one of the important Salmonella serovars linked with swine products in numerous countries and can transmit to humans by food chain contamination. Worldwide emerging S. Rissen is considered as one of the most common pathogens to cause human salmonellosis. The objective of this study was to determine the antimicrobial resistance properties and patterns of Salmonella Rissen isolates obtained from humans, animals, animal-derived food products, and the environment in China. Between 2016 and 2019, a total of 311 S. Rissen isolates from different provinces or province-level cities in China were included here. Bacterial isolates were characterized by serotyping and antimicrobial susceptibility testing. Minimum inhibitory concentration (MIC) values of 14 clinically relevant antimicrobials were obtained by broth microdilution method. S. Rissen isolates from humans were found dominant (67%; 208/311). S. Rissen isolates obtained from human patients were mostly found with diarrhea. Other S. Rissen isolates were acquired from food (22%; 69/311), animals (8%; 25/311), and the environment (3%; 9/311). Most of the isolates were resistant to tetracycline, trimethoprim-sulfamethoxazole, chloramphenicol, streptomycin, sulfisoxazole, and ampicillin. The S. Rissen isolates showed susceptibility against ceftriaxone, ceftiofur, gentamicin, nalidixic acid, ciprofloxacin, and azithromycin. In total, 92% of the S. Rissen isolates were multidrug-resistant and ASSuT (27%), ACT (25%), ACSSuT (22%), ACSSuTAmc (11%), and ACSSuTFox (7%) patterns were among the most prevalent antibiotic resistance patterns found in this study. The widespread dissemination of antimicrobial resistance could have emerged from misuse of antimicrobial agents in animal husbandry in China. These findings could be useful for rational antimicrobial usage against Salmonella Rissen infections.


2020 ◽  
Author(s):  
Saba Shahid ◽  
Marvi Mahesar ◽  
Nida Ghouri ◽  
Saba Noreen

Abstract Background: Enteric fever is a systemic infection, which can be caused by Salmonella enterica; Typhi and Paratyphi A. Over time, Salmonella Typhi has developed resistance to antibiotics resulting in the emergence of extensively drug-resistant (XDR) enteric fever. WHO estimated 5274 cases of XDR Enteric fever in Karachi from November 2016 to December 2019. This study aims to determine clinical course, complications and outcomes of XDR enteric fever among the pediatric population coming to Indus HospitalMethods: A retrospective chart review of pediatric patients (aged one month to 15 years) seen in Indus Hospital between July 2017 to December 2018 was conducted. A pre-designed data abstraction form was used to record detailed information about seasonality and distribution of cases, demographic details, signs and symptoms, clinical course, treatment, complications and outcomes of the cases treated for XDR Enteric feverResults: Six hundred and eighty children were included in the study. The median (IQR) age of the patients was 5 (2-8) years. More than half (n=391, 57.5%) of the patients were males. Most common clinical manifestations included fever, vomiting and diarrhea, noted in 680 (100%), 242 (35%) and 174 (25%) patients. Outcomes of 270 (39.7%) patients were recorded. Others were lost to follow up [351 (51.6%)], referred out [52 (7.6%)] or left against medical advice [7 (1%)]. 266 (39.1%) patients were cured, and four children (0.6%) expired. Seventy-eight patients (82%) and 15 patients (16.3%) got cured on Azithromycin and Meropenem alone while 157 on a combination of drugs.Conclusion: Our review indicated that children under five years of age were affected more with XDR Enteric fever. Meropenem and Azithromycin, either alone or in combination were the most effective antibiotics for treating XDR Enteric fever in children coming to Indus hospital


2019 ◽  
Vol 70 (9) ◽  
pp. 3299-3304
Author(s):  
Andreea Loredana Golli ◽  
Floarea Mimi Nitu ◽  
Maria Balasoiu ◽  
Roxana Maria Nemes ◽  
Sorin Ioan Tudorache ◽  
...  

The emergence of multidrug-resistant (MDR) pathogens, especially for intensive care unit (ICU) patients is a serious threat to public health. To determine the frequency and antibiotic resistance pattern of bacterial pathogens isolated from tracheal aspirates of the patients admitted in ICU. The retrospective study included endotracheal aspirates from 734 patients admitted to the ICU, from January to December 2017. The analysis of the resistance patterns for the action of the appropriate antibiotics was performed using Vitek 2 Compact system and diffusion method. A total of 985 bacterial isolates were obtained, of which 227 strains of Klebsiella spp. (23.04%), followed by Nonfermenting Gram negative bacilli, other than Pseudomonas and Acinetobacter (NFB) (170- 17.25%), MRSA (134- 13.60%). Isolation rates indicates a higher value for male patients and elderly patients (over 65 years), statistically significant. High rates of MDR were found for Klebsiella spp. (70.04%) and Pseudomonas aeruginosa (66.25%) while almost all of the isolated NFB strains were MDR (98.82%). The study revealed high rates of MDR pathogens in the majority of ICU isolates which may be due to unnecessary use of higher generations of antibiotics, use of mechanical devices, age, comorbidities, and can determine a higher rate of morbidity and mortality among these patients.


2010 ◽  
Vol 76 (21) ◽  
pp. 7188-7193 ◽  
Author(s):  
Bayleyegn Molla ◽  
Allyson Sterman ◽  
Jennifer Mathews ◽  
Valeria Artuso-Ponte ◽  
Melanie Abley ◽  
...  

ABSTRACT The purpose of this study was to determine the occurrence and genotypic relatedness of Salmonella enterica isolates recovered from feed and fecal samples in commercial swine production units. Of 275 feed samples, Salmonella was detected in 10 feed samples that originated from 8 of 36 (22.2%) barns, with a prevalence of 3.6% (10/275 samples). In fecal samples, a prevalence of 17.2% was found at the early finishing stage (1,180/6,880 samples), with a significant reduction in prevalence (7.4%) when pigs reached market age (392/5,321 samples). Of the 280 Salmonella isolates systematically selected for further characterization, 50% of the feed isolates and 55.3% of the isolates of fecal origin showed similar phenotypes based on antimicrobial resistance patterns and serogrouping. About 44% of the isolates were multidrug resistant. Pulsed-field gel electrophoresis (PFGE) genotyping grouped the 46 representative isolates into five genotypic clusters, of which four of the clusters consisted of genotypically related isolates recovered from feed and fecal samples. The occurrence of genotypically related and, in some cases, clonal strains, including multidrug-resistant isolates in commercially processed feed and fecal samples, suggests the high significance of commercial feed as a potential vehicle of Salmonella transmission.


2000 ◽  
Vol 124 (1) ◽  
pp. 17-23 ◽  
Author(s):  
G. SCUDERI ◽  
M. FANTASIA ◽  
T. NIGLIO ◽  
ITALIAN SALM–NET WORKING GROUP

In this paper we report the distribution of Salmonella Typhi isolates in Italy and their resistance patterns to antibiotics. The data were collected by the Italian SALM–NET surveillance system in a pilot retrospective study of the period 1980–96. Data on drug-resistance were available for 82 isolates out of 176 S. Typhi isolated in Italy. Of these 82 isolates, 32 (39%) were resistant or intermediate to 1 or more antibiotics. Eight isolates were resistant and 7 intermediate to streptomycin; 4 isolates were resistant to ampicillin alone or in association with other antibiotics; only 2 strains (1 isolated in Lombardia in 1993 and the other 1 in Lazio in 1994) were resistant to chloramphenicol, and 2 (isolated in Sardegna and Piemonte in 1995 and 1996, respectively) showed intermediate resistance to chloramphenicol. The strains showing resistance to 3 or more antibiotics were very scarce: 1 (with 5 complete resistances) was isolated in Lazio in 1994, and another 1 (with complete resistance to 10 antibiotics and intermediate resistance to 2 antibiotics) was isolated in Molise in 1988. In conclusion, besides the routine activities to control typhoid fever, an accurate and continuous surveillance is necessary in order to quickly identify multidrug-resistant (MDR) S. Typhi strains and prevent their spread, even though their level, in our country, is still quite low.


2020 ◽  
Author(s):  
Saba Shahid ◽  
Marvi Mahesar ◽  
Nida Ghouri ◽  
Saba Noreen

Abstract Background: Enteric fever is a systemic infection, which can be caused by Salmonella enterica; Typhi and Paratyphi A. Over a period of time Salmonella Typhi has developed resistance to many antibiotics which has resulted in emergence of extensively drug resistant (XDR) enteric fever. WHO estimated 5274 cases of XDR Enteric fever in Karachi from November 2016 to December 2019.This study aims to determine clinical course, complications and outcomes of XDR enteric fever among the pediatric population coming to Indus HospitalMethods: A retrospective chart review of pediatric patients (aged 1 month–15 years) seen in Indus Hospital between July 2017 to December 2018 was conducted. A pre-designed data abstraction form was used to record detailed information about seasonality and distribution of cases, demographic details, signs and symptoms, clinical course, treatment, complications and final outcomes of the cases treated for XDR Enteric feverResults: Six hundred and eighty children were included in the study. The median (IQR) age of the patients was 5 (2-8) years. More than half (n=391, 57.5%) of the patients were males. Most common clinical manifestations included fever vomiting and diarrhea which were noted in 680 (100%), 242 (35%) and 174 patients (25%) Final outcomes of 270 (39.7%) patients have been recorded; 351 (51.6%) were lost to follow up, 52 (7.6%) were referred out and 7 (1%) left without medical advice. 266 (39.1%) patients were cured and 4 children (0.6%) expired. Seventy eight patients (82%) and 15 patients (16.3%) got cured on Azithromycin and Meropenum alone while 157 patients got cured on combination of drugs.Conclusion: Our review indicated that children under 5 years of age were affected more with XDR Enteric fever. Meropenum and Azithromycin, either alone or in combination were the most effective antibiotics for treating XDR Enteric fever in children coming to Indus hospital


Author(s):  
Dr. Manish Kulshrestha ◽  
Dr. Anjali Kulshrestha

INTRODUCTION: Enteric fever includes typhoid and paratyphoid fever. Peak incidence is seen in children 5–15 years of age; but in regions where the disease is highly endemic, as in India, children younger than 5 years of age may have the highest infection rates. There are about 22 million new typhoid cases occur each year. Young children in poor, resource limited areas, who make up the majority of the new cases and there is a mortality figures of 215,000 deaths annually. A sharp decline in the rates of complications and mortality due to typhoid fever is observed as a result of introduction of effective antibiotic therapy since 1950s. MDR-ST became endemic in many areas of Asia, including India soon after multidrug-resistant strains of Salmonella enterica serotype typhi (MDR-ST) that were resistant to all the three first-line drugs then in use, namely chloramphenicol, amoxycillin and co-trimoxazole emerged in early 1990s. MATERIAL AND METHODS: Only blood culture or bone marrow culture positive cases were included. The patients with culture isolated enteric fever were included in the study. Antimicrobial susceptibility testing was carried out by disk diffusion method using antibiotic discs. The analysis of the antimicrobial susceptibility was carried out as per CLSI interpretative guidelines. RESULTS: A total of 82 culture positive cases were included in the present study. 80 culture isolates were from blood culture and 2 from the bone marrow culture. Salmonella entericasubspecies enterica serovartyphi (S typhi) was isolated from 67 (81.70%) patients while Salmonella enterica subspecies entericaserovarparatyphi (S paratyphi A) was isolated from 13 (15.85%) cases and 2 (2.44%) were Salmonella enterica subspecies entericaserovarschottmuelleri (S paratyphi B). Of the 82 cases 65(79.3%) isolates were resistant to ciprofloxacin, 17 (20.7%) were resistant to nalidixic acid, one (1.2%) case each was resistant to Cefotaxime and ceftriaxone, 2 (2.4%) were resistant to chloramphenicol, 10 (12.2%) were resistant and to cotrimoxazole 3 (3.7%) were resistant. CONCLUSION: In a culture positive cases 65(79.3%) isolates were resistant to ciprofloxacin and 17 (20.7%) were resistant to nalidixic acid. Multidrug resistant isolates were 65(79.3%).


2020 ◽  
Vol 20 (2) ◽  
pp. 160-166
Author(s):  
Seyedeh Hanieh Eshaghi Zadeh ◽  
Hossein Fahimi ◽  
Fatemeh Fardsanei ◽  
Mohammad Mehdi Soltan Dallal

Background: Salmonellosis is a major food-borne disease worldwide. The increasing prevalence of antimicrobial resistance among food-borne pathogens such as Salmonella spp. is concerning. Objective: The main objective of this study is to identify class 1 integron genes and to determine antibiotic resistance patterns among Salmonella isolates from children with diarrhea. Methods: A total of 30 Salmonella isolates were recovered from children with diarrhea. The isolates were characterized for antimicrobial susceptibility and screened for the presence of class 1 integron genes (i.e. intI1, sulI1, and qacEΔ1). Results: The most prevalent serotype was Enteritidis 36.7%, followed by Paratyphi C (30%), and Typhimurium (16.7%). The highest rates of antibiotic resistance were obtained for nalidixic acid (53.3%), followed by streptomycin (40%), and tetracycline (36.7%). Regarding class 1 integrons, 36.7%, 26.7%, and 33.3% of the isolates carried intI1, SulI, and qacEΔ1, respectively, most of which (81.8%) were multidrug-resistant (MDR). Statistical analysis revealed that the presence of class 1 integron was significantly associated with resistance to streptomycin and tetracycline (p = 0.042). However, there was no association between class 1 integron and other antibiotics used in this study (p > 0.05). Conclusion: The high frequency of integron class 1 gene in MDR Salmonella strains indicates that these mobile genetic elements are versatile among different Salmonella serotypes, and associated with reduced susceptibility to many antimicrobials.


2016 ◽  
Vol 5 (12) ◽  
pp. 5138
Author(s):  
Shyamji Shukla* ◽  
Priyanka Soni ◽  
Harish K. Kewat

There is an alarming increase in the problem of resistance towards antibiotics amongst most of the pathogenic bacterial strains in recent years. This has drawn the attention of researchers around the world to search for novel and eco-friendly antibacterial compounds. Several biological sources have been explored in this respect but medicinal plants have taken a centre stage out of all. Plants have been known as a reservoir of number of bioactive compounds specially the antibacterial ones since time immemorial. Therefore, the present investigation was undertaken to analyze the antibacterial potential of the medicinal plant Achyranthes aspera. This study revealed that highest antibacterial activity was observed in the methanolic extract of stem against almost all test Bacteria. It showed maximum activity against E.coli (30 mm), followed by S. aureus (28 mm), Enterococcus sp.(25mm), Salmonella typhi ( 20 mm) and least activity was recorded in same extract against K.pneumoniae (6 mm). Four phytochemicals were screened in various solvent extracts. They are alkaloid, flavonoids, saponins and tannins.


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