Salmonella typhimurium outbreak in a neonatal unit in Turkey

Anıl, Murat; Helvacı, Mehmet Rami; Ozkalay, Nisel; Toprak, Esra; Anıl, Ayşe Berna; Dilek, Mustafa; Ağuş, Neval

doi:10.1007/s12098-009-0083-4

Cited by 10 publications

(6 citation statements)

References 23 publications

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“…Although mortality was independent of HIV status in our series, a greater proportion of infants who acquired NTS meningitis were HIV exposed at birth. Absence of maternal immunity in HIV-infected mothers may increase the risk in infants to acquiring NTS meningitis, which should be included in the differential diagnosis of causes of neonatal and infant meningitis in settings of high HIV seroprevalence [13, 33–36]. Previously, we described the role of childhood Shigella infections predisposing HIV-infected women to invasive shigellosis [30].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Microbiological Features ofSalmonellaMeningitis in a South African Population, 2003–2013

Keddy

Sooka²,

Musekiwa³

et al. 2015

Clin Infect Dis.

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Background The clinical and microbiological characteristics of nontyphoidal Salmonella (NTS) meningitis in South Africa, where human immunodeficiency virus (HIV) prevalence is high (approximately 15% in persons ≥15 years of age), were reviewed. Methods From 2003 through 2013, 278 cases were identified through national laboratory-based surveillance. Clinical information (age, sex, outcome, Glasgow Coma Scale [GCS], and HIV status) was ascertained at selected sites. Isolates were serotyped; susceptibility testing and multilocus sequence typing on Salmonella enterica serovar Typhimurium isolates was performed. Multivariable logistic regression was used to determine factors associated with mortality outcome, using Stata software, version 13. Results Where age was ascertained, 139 of 256 (54.3%) patients were <15 years. Males represented 151 of 267 (56.6%). Mortality outcome was recorded for 112 of 146 (76.7%) enhanced surveillance patients; 53 of 112 (47.3%) died. Death was associated with GCS ≤13 (adjusted odds ratio [OR], 18.7; 95% confidence interval [CI], 3.0–118.5; P = .002) on multivariable analysis. Where data were available, all 45 patients aged >15 years were HIV infected, compared with 24 of 46 (52.2%) patients aged <5 years. Neonates were less likely to be HIV infected than infants aged 2–12 months (OR, 4.8; 95% CI, 1.1–21.1; P = .039). Salmonella Typhimurium represented 106 of 238 (44.5%) serotyped isolates: 65 of 95 (68.4%) were ST313 vs ST19, respectively, and significantly associated with HIV-infected patients (P = .03) and multidrug resistance (OR, 6.6; 95% CI, 2.5–17.2; P < .001). Conclusions NTS meningitis in South Africa is highly associated with HIV in adults, with neonates (irrespective of HIV status), and with Salmonella Typhimurium ST313. GCS is the best predictor of mortality: early diagnosis and treatment are critical. Focused prevention requires further studies to understand the sources and transmission routes.

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Section: Discussionmentioning

confidence: 99%

Clinical and Microbiological Features ofSalmonellaMeningitis in a South African Population, 2003–2013

Keddy

Sooka²,

Musekiwa³

et al. 2015

Clin Infect Dis.

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“…Typhimurium infections have been more commonly reported from sub-Saharan African countries, where it is an important cause of morbidity and mortality in children under 5 years of age, second only to pneumococcal pneumonia [3, 4]. It has also been implicated in causing several foodborne outbreaks in adults [5, 6] as well as diarrhoeal and/or septicaemic outbreaks in neonates and pediatrics [7, 8].…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial resistance, plasmid, virulence, multilocus sequence typing and pulsed-field gel electrophoresis profiles of Salmonella enterica serovar Typhimurium clinical and environmental isolates from India

et al. 2018

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Salmonella enterica serovar Typhimurium (S. Typhimurium) is a common serovar associated with non-typhoidal salmonellosis globally. However, there is insufficient data on molecular characterization of S. Typhimurium isolates from India. This study was undertaken to determine the antimicrobial resistance (AMR), plasmid, virulence profiles and molecular subtypes of S. Typhimurium Indian isolates (n = 70) of clinical and environmental origin isolated during 2010–2017. Antimicrobial susceptibility and minimum inhibitory concentrations were determined by disc diffusion and E-test methods respectively. Plasmid extraction was done following standard protocol. AMR genes, virulence genes and plasmid incompatibility types were detected by PCR; Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were used for molecular subtyping. Majority (57%) of the study isolates was pan susceptible; five AMR profiles were observed among the resistant (43%) isolates. AMR was significantly (p = 0.004) associated with extra-intestinal isolates than intestinal isolates.The class 1 integron and plasmid-mediated quinolone resistance genes (qnrB1, qnrS1) in the resistant isolates were transferable by conjugation. Plasmids (≥1) ranging from 1.9 to 254kb size and of IncFIIS and/or FIB type were found in most isolates. A total of 39 pulsotypes by PFGE and four sequence types by MLST like ST36 (55.7%), ST19 (32.9%), ST313 (10%) and ST213 (1.4%) were observed. ST36 and ST19 were found circulating in both clinical and environmental host, while ST313 isolates had an exclusive clinical origin. All ST19 isolates (100%) were drug-resistant, while isolates belonging to ST313 (100%), ST213 (100%) and ST36 (82%) were pan susceptible. The virulence plasmid (VP) genes (spvB- spvC) were present in all genotypes except ST36. The VP was significantly (p<0.001) associated with extra-intestinal than intestinal isolates. Some environmental and clinical isolates were clonal indicating their zoonotic transmission. Knowledge on the molecular subtypes and AMR profiles of locally prevalent Salmonella serotypes is important for effective control of spread of resistant organisms. The MLST of S. Typhimurium isolates and its association with AMR, virulence profiles was not reported earlier from India.

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“…The eligible studies were undertaken in 30 NICUs in 15 locations. Nineteen (63%) came from high income countries, 3 – 21 four (13%) from upper-middle income countries, 22 – 25 six (20%) from lower-middle income countries 26 – 31 and one (3%) from a low income country. 32 Six studies reported Methicillin-resistant Staphylococcus aureus (MRSA).…”

Section: Resultsmentioning

confidence: 99%

Lack of evidence for the efficacy of enhanced surveillance compared to other specific interventions to control neonatal healthcare-associated infection outbreaks

Birt¹,

Doare²,

Kortsalioudaki³

et al. 2016

Trans R Soc Trop Med Hyg

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BackgroundDespite current prevention efforts, outbreaks of healthcare-associated infections in neonatal units remain high globally, with a considerable burden of mortality and morbidity.MethodsWe searched Medline, Cochrane Library and Outbreak database to identify studies of neonatal healthcare-associated outbreaks between 2005 and 2015 that described interventions to control outbreaks. All studies were evaluated using the ORION guidance.ResultsThirty studies were identified including 17 102 infants of whom 664 (3.9%) became infected. No single intervention was identified that reduced duration or mortality. Studies that introduced multiple interventions had significantly reduced case fatality ratio and outbreak duration compared to those that used basic surveillance only. Low and low-middle income countries reported the fewest interventions to control outbreaks and these studies were also associated with higher mortality than that found in middle and high income countries.ConclusionsSystematic reporting and formal evaluation of interventions used to reduce healthcare-associated neonatal infection outbreaks is key to identifying containment strategies worldwide.

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Salmonella typhimurium outbreak in a neonatal unit in Turkey

Abstract: This study increases the understanding of the burden of multidrug-resistant S. typhimurium infection. Nosocomial outbreaks have a major effect on healthcare delivery, costs and outcomes.

Cited by 10 publications

References 23 publications

Clinical and Microbiological Features ofSalmonellaMeningitis in a South African Population, 2003–2013

Clinical and Microbiological Features ofSalmonellaMeningitis in a South African Population, 2003–2013

Antimicrobial resistance, plasmid, virulence, multilocus sequence typing and pulsed-field gel electrophoresis profiles of Salmonella enterica serovar Typhimurium clinical and environmental isolates from India

Lack of evidence for the efficacy of enhanced surveillance compared to other specific interventions to control neonatal healthcare-associated infection outbreaks

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