Antimicrobial resistance and management of invasive Salmonella disease

Abstract

Invasive Salmonella infections (typhoidal and non-typhoidal) cause a huge burden of illness estimated at nearly 3.4 million cases and over 600,000 deaths annually especially in resource-limited settings. Invasive non-typhoidal Salmonella (iNTS) infections are particularly important in immunosuppressed populations especially in sub-Saharan Africa, causing a mortality of 20–30% in vulnerable children below 5 years of age. In these settings, where routine surveillance for antimicrobial resistance is rare or non-existent, reports of 50–75% multidrug resistance (MDR) in NTS are common, including strains of NTS also resistant to flouroquinolones and 3rd generation cephalosporins. Typhoid (enteric) fever caused by Salmonella Typhi and Salmonella Paratyphi A remains a major public health problem in many parts of Asia and Africa. Currently over a third of isolates in many endemic areas are MDR, and diminished susceptibility or resistance to fluoroquinolones, the drugs of choice for MDR cases over the last decade is an increasing problem. The situation is particularly worrying in resource-limited settings where the few remaining effective antimicrobials are either unavailable or altogether too expensive to be afforded by either the general public or by public health services. Although the prudent use of effective antimicrobials, improved hygiene and sanitation and the discovery of new antimicrobial agents may offer hope for the management of invasive salmonella infections, it is essential to consider other interventions including the wider use of WHO recommended typhoid vaccines and the acceleration of trials for novel iNTS vaccines. The main objective of this review is to describe existing data on the prevalence and epidemiology of antimicrobial resistant invasive Salmonella infections and how this affects the management of these infections, especially in endemic developing countries.

Distribution and Antimicrobial Resistance of Salmonella Serovars Isolated in Kayseri Region

“…Son yıllarda bu Salmonella izolatları arasında antimikrobiyal direnç oranlarının artığı bildirilmiştir (7,8). Ülkemizde yapılan farklı çalışmalarda Salmonella serovarlarının direnç durumları değerlendirmiş-tir.…”

“…Fakat bakteriyemi, septik artrit, kolesistit, akut enterit, endokardit, menenjit gibi infeksiyonlara da yol açabilmektedir (2,6). Son yıllarda tüm dünyada Salmonella izolatlarındaki antimikrobiyal direnç oranlarının artığı bildirilmektedir (7,8). Ampisilin, kloramfenikol, trimetoprimsülfametoksazol gibi geleneksel birinci basamak ilaçların yanı sıra, seftriakson ve florokinolonlara da direnç bildirilmiştir (9)(10)(11)(12).…”

Analysis of Trends in Resistance to Fluoroquinolones and Extended Spectrum Beta-Lactams among <i>Salmonella</i> Typhi Isolates Obtained from Patients at Four Outpatient Clinics in Nairobi County, Kenya

“…Typhoid fever is mainly a disease of adults and older children [3] over ten years of age and is commonly spread through the fecal-oral route via food, drinks, and contaminated water. Human carriers can also contaminate water or food and spread to other people through ingestion of the contaminated materials [4], [5].…”

Plasma Immunoglobulin A Responses Against 2SalmonellaTyphi Antigens Identify Patients With Typhoid Fever

“…Lack of optimal diagnostics for typhoid fever limits our ability to diagnose acute cases of typhoid fever, which is often diagnosed clinically and treated empirically. This has led to substantial overdiagnosis and the overprescribing of antityphoid antimicrobials [2,3], which has driven emergence of antimicrobial resistance, especially fluoroquinolone resistance in Asia [4]. Misdiagnosis also often leads to delay of care for the true causative pathogen of the febrile illness, such as typhus or leptospirosis [5].…”