Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Pediatr Neonatol. 2020 Aug;61(4):432-438. doi: 10.1016/j.pedneo.2020.03.017. Epub 2020 Apr 4.
The epidemiology of nontyphoidal Salmonella (NTS) resistant to ciprofloxacin or ceftriaxone and its impact on patients' clinical course are rarely reported.
Children with culture-proven salmonellosis treated in a medical center in northern Taiwan in 2017 were enrolled. To trace the source of Salmonella, Salmonella isolated from food samples were collected from markets. Antimicrobial susceptibility and serotypes were determined.
Among the 453 isolates, 122 (26.9%) were highly antimicrobial-resistant, as defined by resistance to ciprofloxacin or ceftriaxone or both. The most prevalent highly resistant serotype was S. Anatum (66, 54.1%). Salmonella was detected in 94.1%, 66.7%, and 8.6% of examined pork, chicken, and vegetables examined, respectively. S. Anatum (6, 21.4%) and S. Derby (6, 21.4%) were the major serotypes isolated. Majority of the S. Anatum (5, 83.3%) were highly antimicrobial-resistant. More patients infected by highly resistant Salmonella required carbapenem treatment (OR = 23.5, 95% confidence interval [CI] 2.8-192.7, P < 0.001). Patients with ceftriaxone-resistant NTS infections had a significantly longer hospital stay than others (P < 0.001). Totally, 34 (7.5%) presented with invasive diseases (31 bacteremia, 1 intestinal perforation, 1 toxic megacolon and 1 septic arthritis). Risk factors for invasive disease included prolonged fever for ≧5 days and infection occurring in warmer season from May to October. The rise of ambient temperature in northern Taiwan was associated with increasing Salmonella infections.
Retail meats were the main source of highly antimicrobial-resistant NTS in northern Taiwan. Highly antimicrobial resistance significantly impacted the clinical course and treatment of children with NTS infection.
非伤寒沙门氏菌（NTS）对环丙沙星或头孢曲松耐药的流行病学及其对患者临床病程的影响鲜有报道。
2017 年，我们对在台湾北部一家医疗中心经培养证实的沙门氏菌感染患儿进行了研究。为了追踪沙门氏菌的来源，我们从市场上采集了食品样本中分离出的沙门氏菌。对分离株进行了药敏试验和血清型鉴定。
在 453 株分离株中，122 株（26.9%）为高度耐药，定义为对环丙沙星或头孢曲松或两者均耐药。最常见的高度耐药血清型为肠炎沙门氏菌（66 株，占 54.1%）。在所检查的猪肉、鸡肉和蔬菜中，沙门氏菌的检出率分别为 94.1%、66.7%和 8.6%。分离出的主要血清型有肠炎沙门氏菌（6 株，占 21.4%）和都柏林沙门氏菌（6 株，占 21.4%）。大多数肠炎沙门氏菌（5 株，占 83.3%）为高度耐药。感染高度耐药沙门氏菌的患者更需要碳青霉烯类药物治疗（OR=23.5，95%置信区间[CI]为 2.8-192.7，P<0.001）。头孢曲松耐药性 NTS 感染患者的住院时间明显长于其他患者（P<0.001）。共有 34 例（7.5%）发生侵袭性疾病（31 例菌血症，1 例肠穿孔，1 例中毒性巨结肠和 1 例化脓性关节炎）。侵袭性疾病的危险因素包括发热≧5 天和 5-10 月的温暖季节发病。台湾北部环境温度升高与沙门氏菌感染增加有关。
零售肉类是台湾北部高度耐药性 NTS 的主要来源。高度耐药性显著影响 NTS 感染患儿的临床病程和治疗。
