Epidemiology and antimicrobial resistance of invasive non-typhoidal Salmonellosis in rural Thailand from 2006-2014

Abstract

IntroductionInvasive salmonellosis is a common cause of bloodstream infection in Southeast Asia. Limited epidemiologic and antimicrobial resistance data are available from the region.MethodsBlood cultures performed in all 20 hospitals in the northeastern province of Nakhon Phanom (NP) and eastern province of Sa Kaeo (SK), Thailand were captured in a bloodstream infection surveillance system. Cultures were performed as clinically indicated in hospitalized patients; patients with multiple positive cultures had only the first included. Bottles were incubated using the BacT/Alert system (bioMérieux, Thailand) and isolates were identified using standard microbiological techniques; all Salmonella isolates were classified to at least the serogroup level. Antimicrobial resistance was assessed using disk diffusion.ResultsSalmonella was the fifth most common pathogen identified in 147,535 cultures with 525 cases (211 in Nakhon Phanom (NP) and 314 in Sa Kaeo (SK)). The overall adjusted iNTS incidence rate in NP was 4.0 cases/100,000 person-years (95% CI 3.5–4.5) and in SK 6.4 cases/100,000 person-years (95% CI 5.7–7.1; p = 0.001). The most common serogroups were C (39.4%), D (35.0%) and B (9.9%). Serogroup D predominated in NP (103/211) with 59.2% of this serogroup being Salmonella serovar Enteritidis. Serogroup C predominated in SK (166/314) with 84.3% of this serogroup being Salmonella serovar Choleraesuis. Antibiotic resistance was 68.2% (343/503) for ampicillin, 1.2% (6/482) for ciprofloxacin (or 58.1% (280/482) if both intermediate and resistant phenotypes are considered), 17.0% (87/512) for trimethoprim-sulfamethoxazole, and 12.2% (59/484) for third-generation cephalosporins (cefotaxime or ceftazidime). Multidrug resistance was seen in 99/516 isolates (19.2%).ConclusionsThe NTS isolates causing bloodstream infections in rural Thailand are commonly resistant to ampicillin, cefotaxime, and TMP-SMX. Observed differences between NP and SK indicate that serogroup distribution and antibiotic resistance may substantially differ throughout Thailand and the region.

Antimicrobial Susceptibility Profiles of Non-Typhoidal Salmonella Isolates Obtained from Food Animals in Selected Sites in Kenya

“…Folate pathway inhibitors (TMP/STX) and third generation cephalosporins (cefotaxime or ceftazidime) also a great percentage of intermediate susceptibility. These are similar to rates found in a study carried out in Thailand (Toni Whistler, et al, 2018).…”

Population-based bloodstream infection surveillance in rural Thailand, 2007–2014

“…Our clinical partners reiterated this message consistently and observed improvements in patient outcomes for B. psuedomallei cases after implementation of the automated blood culturing systems support their impressions [28, 31]. BSI surveillance has facilitated timely responses to public health threats [32, 33], enabled evaluation of new diagnostic tests [34, 35] and incidence and trends in antimicrobial resistance [36–38], and raised awareness of regional emerging infectious diseases, such as community-associated Acinetobacter bacteremia, S. suis bacteremia, and bacteremic melioidosis in a part of Thailand not traditionally considered highly endemic for that disease [28, 30, 39]. BSI surveillance has contributed to international reports and national health policy evaluations [40, 41].…”

High Burden of Extended-Spectrum β-Lactamase–Producing Escherichia coli and Klebsiella pneumoniae Bacteremia in Older Adults: A Seven-Year Study in Two Rural Thai Provinces

“…This study used the same well-established surveillance database that was previously used to estimate the incidence and susceptibility profiles of several other pathogens in rural Thailand. 16–19…”