Prevalence and Trends in Antimicrobial Susceptibility Patterns of Multi-Drug-Resistance Non-Typhoidal Salmonella in Central Thailand, 2012–2019

Abstract

Purpose

Multi-drug resistance of non-typhoidal Salmonella (MDR-NTS) is an increasing threat worldwide. In Thailand, data for the past decade is limited. This research is to determine the prevalence and trends of nonsusceptibility patterns of the bacteria, especially to ciprofloxacin and ceftriaxone.

Methods

This retrospective study was extracted data of patients who had non-typhoidal Salmonella (NTS) infection, from 10 hospitals between June 2011 and June 2020. Demographic data, culture reports, and antimicrobial susceptibility were included in the analysis.

Results

A total of 433 patients were identified. The most common age group was less than 15 years old (53.6%), with a median age of 12 years (IQR 57–4). Of these people, 61.1% had gastroenteritis and 36.7% had bacteremia. The most prevalent serogroups was C (28.6%). MDR-NTS rate was 52.8% (95% CI 39–44). The resistant rates were 43%, 32.8%, 22.8%, 6.7%, 4%, 0.45%, 0.45% for sulfamethoxazole/trimethoprim, amoxicillin-clavulanic acid, cefotaxime, ampicillin/sulbactam, piperacillin/tazobactam, imipenem and meropenem retrospectively. Resistant rates have been increasing, especially for ciprofloxacin (30%), which rose from 16.6% in 2011–2015 to 39.5% in 2016–2020 (prevalence rate ratio (PRR) 2.4,95% CI 1.51–3.72) and for ceftriaxone 25.4% which rose from 16.1% to 32% (PRR 2 95% CI 1.24–3.16). Ampicillin, norfloxacin, tetracycline, amikacin, gentamicin, and ceftazidime remained static at 62.3%, 49.5%, 33.2%, 15.2%, 8.8%, 2.8%, respectively.

Conclusion

The prevalence of MDR-NTS has been increasing over the past decade, particularly those strains which demonstrate resistance to ciprofloxacin and ceftriaxone. Finding successful treatment requires a comprehensive selection of proper antimicrobials as well as close monitoring, especially in cases with severe infection.

Keywords:

• multi-drug resistance
• non-typhoidal Salmonella
• drug-resistance pattern
• ceftriaxone resistance
• ciprofloxacin resistance
• prevalence

Ethical Approval

The research protocol was approved by the research ethics committee of Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University. All information was anonymized to maintain patients’ privacy, Declaration of Helsinki. Considering the retrospective and anonymous nature of the study, the Ethics Committee didn’t require written informed consent provided by patients.

Acknowledgments

The authors thank all patients, health practitioners and directors of all hospitals authorized to collect research data. Writing advice, the article from Professor Emeritus Colonel Sriluck Simasathien, special lecturer and advisor department of pediatrics Phramongkutklao Hospital, Bangkok, Thailand, and Professor Thanyawee Puthanakit, pediatric infectious disease specialist at the department of pediatrics, faculty of medicine, Chulalongkorn University, Bangkok, Thailand.

Disclosure

The authors declare that they have no known competing interests in this work.

Additional information

Funding

This work was supported by Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University.