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

Figures & data

Table 1 The Prevalence and Characteristics of Patients Infected with NTS Which Were Classified into Four Groups Based on the Number of Antimicrobials Resistances

Characteristics of Patients Infected	NDR-NTS (n=43)		1-DR-NTS (n=105)		2-DR-NTS (n=56)		MDR-NTS (n=229)
	n (%)	95% Cl	n (%)	95% CIᵅ	n (%)	95% CIᵅ	n (%)	95% CIᵅ
Age (year)
≤ 15 yr (n=232)	19/232(8.2)	4.7–11.6	60(25.8)	19.4–32.2	31(13.3)	8.83–17.8	122(52.5)	43.3–61.8
16–60 yr (n=106)	10/60(9.4)	3.9–14.9	26(24.5)	15.2–33.7	13(24.5)	5.87–18.6	57(53.7)	39.9–67.6
> 60 yr (n=95)	14/95(14.7)	7.3–22.1	19(20)	11.2–28.7	12(12.6)	5.77–19.4	50(52.6)	38.1–67.0
Median age = 12 years (yr) IQR (4–57)
Sex
Male (n=195)	14(7.2)	3.7–10.6	54(27.7)	20.4–34.9	18(9.2)	5.20–13.2	109(55.9)	45.4–66.2
Female (n=238)	29(12.1)	7.9–16.4	81(21.4)	26.7–41.3	38(15.9)	11.0–20.8	120(50.4)	41.4–59.3
Type of hospital
Tertiary hospital (n=207)	13(6.2)	3.1–9.4	45(21.7)	15.5–27.9	20(9.6)	5.65–13.6	129(62.3)	51.6–72.9
District hospital (n=135)	19(14)	8.0–20.1	49(36)	26.2–46.3	19(14)	7.97–20.1	48(35.5)	25.6–45.4
Private hospital (n=91)	11(12)	5.2–18.9	11(12)	5.24–18.9	17(18.6)	10.0–27.3	52(57.1)	41.7–72.5
Type of infection
Non-Invasive (n=267)	27(10)	6.5–13.7	70(26.2)	20.1–32.2	35(13)	8.93–17.2	152(56.9)	47.9–65.8
Invasive (n=166)	16(9.6)	5.2–14.1	35(21)	14.2–27.9	21(12.6)	7.45–17.8	94(56.6)	45.2–67.9
Salmonella serogroup
Salmonella serogroup A (n=38)	1(2.6)	2.0–3.29	9(23.6)	16.3–31.0	5(13.1)	9.13–17.1	23(60)	41.4–79.6
Salmonella serogroup B (n=87)	13(14.9)	7.1–22.7	29(33)	21.3–45.2	11(12.6)	5.47–19.8	34(39)	26.1–52.0
Salmonella serogroup C (n=124)	8(8.1)	2.9–13.4	26(26.5)	16.5–36.5	23(23.4)	14.0–32.8	41(41.8)	29.1–54.4
Salmonella serogroup D (n=95)	6(8)	2.0–14.1	33(44.5)	29.5–59.6	6(8.1)	2.03–14.1	29(39)	25.1–53.2
Salmonella serogroup E (n=41)	13(31.7)	14.7–48.6	8(19.5)	6.34–32.6	11(26.8)	11.2–42.3	9(21.9)	7.94–35.9
Underlying diseases (n=143)
Hematologic (n=69)	11(16)	12.3–19.5	15(21.7)	16.7–26.7	7(10.1)	7.87–12.4	36(52.2)	39.9–64.3
Gastrointestinal (n=24)	3(12.4)	7.70–17.2	2(8.3)	5.20–11.4	4(16.7)	10.2–23.1	15(62.5)	37.6–87.3
Immunological (n=14)	2(14.3)	7.06–21.5	2(14.3)	10.4–32.3	3(21.4)	10.4–32.3	7(50)	24.0–75.9
Neurological (n=25)	3(20)	7.49–16.5	3(20)	22.0–49.9	2(13.3)	5.06–10.9	7(50)	17.2–38.7
Metabolic (n=104)	19(18.2)	14.8–21.6	9(8.7)	7.08–10.2	8(7.7)	6.31–9.07	68(65.4)	52.9–77.8
Other (n=12)	3(25)	11.1–38.8	0(0)	0–0	2(16.7)	7.52–25.8	7(58.3)	25.6–91.0

Note: ᵅ95% Confidence intervals (CIs) -Pearson Chi-square which do not include 1.0 are statistically significant.

Abbreviations: NDR-NTS, nondrug resistance -non-typhoidal Salmonella; 1-DR-NTS, drug resistance non-typhoidal Salmonella at one antimicrobial; 2-DR-NTS, drug resistance -non-typhoidal Salmonella at two antimicrobials; MDR-NTS, drug resistance non-typhoidal Salmonella at least one again in three or more antimicrobials categories.

Figure 1 Percentage of antimicrobial resistance of all NTS patients since 2011 to 2020. By (A) shows the group of antimicrobials resistance rate which has been rising trend, while (B) shows similar or slight changes.

Figure 2 Antimicrobial resistance rate of NTS in invasive patients’ groups since 2011 to 2020. By (A) presents increase trend of non-susceptible rate of antimicrobials, while (B) presents similar or few changes.

Table 2 Comparison the Antimicrobials Resistance Pattern (Ceftriaxone and Ciprofloxacin) by Serogroups of NTS Between 2011–2015 and 2016–2020

Resistance Pattern/Resistance Rate (n/Total)	Serogroup	% Resistance in NTS (n=433)
		2011–2015 n=180 (%)	2016–2020 n=253 (%)	PRR^ᵝ	95% CI^µ
Resistance to ceftriaxone/(110/433) 25%	All (n=110)	29/180(16.1)	81/253(32.0)	2.0	1.24–3.16*
	A	3(1.66)	16(6.32)	3.8	1.08–13.21*
	B	13(7.22)	19(7.50)	1.0	0.50–2.15
	C	7(3.88)	21(8.30)	2.1	0.88–5.12
	D	4(2.22)	13(5.13)	2.3	0.74–7.20
	E	2(1.11)	2(0.79)	0.7	0.09–5.09
Resistance to ciprofloxacin/(130/433) 12.3%	All (n=130)	30/180(16.6)	100/253(39.5)	2.4	1.51–3.72*
	A	4(2.22)	18(7.11)	3.2	1.06–9.61*
	B	7(3.88)	25(9.88)	2.5	1.07–6.00*
	C	7(3.88)	33(13.0)	3.4	1.45–7.75*
	D	10(5.55)	17(6.71)	1.2	0.54–2.70
	E	4(2.22)	5(1.97)	0.9	0.23–3.35

Notes: ^ᵝPrevalence rate ratio (PRR) compare the proportions between 2011–2015 and 2015–2020 using Pearson’s Chi-square test. ^µ95% Confidence intervals (CI) which do not include 1.0 are statistically significant. *Statistically significant (CI do not include 1.0).

Figure 3 The prevalence rate and trend of MDR-NTS, 2011–2020. Black columns represent MDR-NTS. Grey columns represent NDR-NTS.

Table 3 Comparison the Length of Hospital Stays and Virulence Between NTS Serogroup

Serogroup	%Length of Stay		PRR^£	95% CI^µ	%None-Invasive n=267 (%)	%Invasive n=166 (%)	RRP^¥	95% CI^µ
	< 5 Days n=233 (%)	≥ 5 Days n=200 (%)
A (n=52)	16(6.8)	13(6.5)	0.95	0.44–2.05	25(9.3)	5(3.0)	0.32	0.12–0.856
B (n=108)	79(33.9)	35(17.5)	0.52	0.33–0.80	68(25.4)	46(27.7)	1.09	0.71–1.658
C (n=124)	42(18.0)	82(41)	2.27	1.49–3.45*	58(21.7)	66(39.7)	1.83	1.22–2.737*
D (n=95)	40(17.1)	57(28.5)	1.66	0.96–2.59	65(24.3)	32(19.2)	0.79	0.49–1.261
E (n=54)	56(24.0)	13(6.5)	0.27	0.14–0.51	51(19.1)	17(10.2)	0.54	0.29–0.959

Notes: ^£PRR compare the proportions between %length of stay (>5 day) and % length of stay (<5day) using Pearson’s chi-square test. ^¥PRR compare the proportions between %invasive and %none-invasive using Pearson’s chi-square test. ^µ95% Confidence intervals (CI) which do not include 1.0 are statistically significant. *Statistically significant (CI do not include 1.0).

Figure 4 Number of infected patients NTS for each serogroup by age group. Black columns represent patients who are ≤ 15 years. Grey columns represent patients who are 16–60 years. White columns represent patients who are > 60 years.