Enteric fever in Cambodian children is dominated by multidrug resistant H58 Salmonella enterica serovar Typhi with decreased susceptibility to ciprofloxacin

Peng An Khun, Chanpheaktra Nguon, Emary Kate, Moore Catrin, Soeng Sona, Duy P.T., Day N., Stoesser N., Parry C., Carter M., Kumar V.

Research output: Contribution to conferencePoster

Abstract

Background: Enteric fever (EF) infections with isolates of Salmonella enterica serovar Typhi and Paratyphi A that are multidrug resistant (MDR: resistant to chloramphenicol; ampicillin; trimethoprim-sulphamethoxazole) and have decreased ciprofloxacin susceptibility (DCS) are common in Asia. There is limited data about any EF from Cambodia. Methods: We conducted a retrospective analysis of invasive salmonellosis in Cambodian children at Angkor Hospital for Children in Siem Reap, northwest Cambodia, between January 2007 and December 2011. Results: S.enterica was isolated from blood in 161 children. There were 150 children with EF including 147 with serovar Typhi and 3 with serovar Paratyphi A. A further 11 children had bacteraemia with a non-typhoidal Salmonella (NTS) serovar. 125/147 (85%) of serovar Typhi isolates were MDR and 132/147 (90%) had DCS.Noneof the ParatyphiAisolates wereMDR,all had DCS.Among the 127 children admitted to hospital with EF antimicrobial treatment was ceftriaxone alone in 58 (46%), ceftriaxone followed by oral ciprofloxacin in 25 (20%), by oral azithromycin in 41 (32%), by cefixime in 1 (0.8%) and azithromycin alone in 2 (1.6%). A complication developed in 36/127 (28%) children admitted with EF including gastrointestinal bleeding in 13, jaundice in 9, a lung infection in 9, cholecystitis in 6, haemodynamic shock in 3, encephalopathy in 2, one child required surgery and one child had a blood culture confirmed relapse. NTS blood stream infections were mostly a complication of severe diarrhoea in children <1 year old (5) or HIV infection (4). The case fatality rate among hospital admitted children was 2/10 (20.0%) of those with a NTS bloodstream infection compared with 2/127 (1.6%) of those with EF (OR 15.8; 95%CI 1.3- 190; p = 0.03). In a subset of 102 serovar Typhi strains genotyped by investigation of a subset of single nucleotide polymorphism (SNPs), 94 (92%) belonged to theH58haplotype and had thecommonserine to phenylalanine substitution at codon 83 in the DNA gyrase. Conclusion: EF caused by the H58 haplotype of S.enterica Typhi that is MDR and has DCS is an important problem in Cambodian children. Strategies for its treatment and control are needed.
Original languageEnglish
Pagese427
Number of pages1
DOIs
Publication statusPublished - 16 Jun 2012
Event15th ICID Abstracts / International Journal of Infectious Diseases 16S (2012) - Thailand, Bangkok, Thailand
Duration: 16 Jun 201216 Jun 2012
Conference number: 56.046
http://dx.doi.org/10.1016/j.ijid.2012.05.596

Conference

Conference15th ICID Abstracts / International Journal of Infectious Diseases 16S (2012)
CountryThailand
CityBangkok
Period16/06/1216/06/12
Internet address

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