Bacteraemia due to ciprofloxacin-resistant Salmonella enterica serotype Choleraesuis in adult patients at a university hospital in Taiwan, 1996–2004

Abstract

Eighty-one adult patients with Salmonella enterica serotype Choleraesuis (S. Choleraesuis) bacteraemia treated at a university hospital from 1996 to 2004 were evaluated. Multivariate analysis with a logistic regression model was used to characterize risk factors for primary bacteraemia and mycotic aneurysm and to determine the association of clinical characteristics of patients based on ciprofloxacin susceptibility of the causative organism. The incidence per 100,000 discharges was 0.76 in 1996 and 3.9 in 2004. The overall rate of ciprofloxacin resistance among these isolates was 59% (87 isolates) and the annual rate increased with time from 0% prior to 2000 to 80% in 2004. Among these patients, 48 (59%) had primary bacteraemia and 13 (16%) had secondary bacteraemia with mycotic aneurysm. Seventy (86%) patients had fever at presentation, 22 (27%) developed shock during hospitalization, and eight (10%) died of S. Choleraesuis bacteraemia. Patients with immunocompromised conditions had a higher risk of developing primary bacteraemia (OR 18.442, P< 0.001). Hypertension (OR 15.434, P = 0.002) and male gender (OR 7.422, P = 0.039) were associated with mycotic aneurysm. Patients with mycotic aneurysm were more frequently infected with ciprofloxacin-susceptible isolates (P = 0.028) and ciprofloxacin-susceptible isolates were also more frequently associated with recurrent infection than ciprofloxacin-resistant isolates (P = 0.038). The incidence of S. Choleraesuis bacteraemia has increased in the past 8 years, and this increase is associated with the upsurge of ciprofloxacin-resistant isolates.

Molecular Characterization and Antimicrobial Susceptibility of Salmonella Isolates from Infections in Humans in Henan Province, China

“…We found a very high prevalence of antimicrobial resistance among the nontyphoid Salmonella isolates from outpatients in Henan Province compared to what has been reported in North America and Europe (2,5,10,12,19,22,23,27,29). In particular, we found that 54% of all isolates were resistant to ciprofloxacin and 23% were highly resistant.…”

“…This was especially evident among S. enterica serovars Indiana, Enteritidis, and Typhimurium, among which 100%, 97%, and 89%, respectively, were ciprofloxacin resistant. Reports from other countries have found an increasing frequency of ciprofloxacin-resistant isolates (2,10,19,22,23,27,29) but not a frequency approaching that observed in Henan Province. Infections with ciprofloxacin-resistant isolates are associated with increased morbidity and mortality (16,17,28), and the alarmingly high frequency makes it difficult to use fluoroquinolones for treatment of Salmonella infections in humans.…”

“…In recent years, an increase in the occurrence of antimicrobial resistance, including resistance to quinolones, among salmonellae has been observed in many countries, particularly in Asia (2,10,19,22,23,27,29). The emergence of antimicrobial resistance is a matter of concern.…”

High burden of antimicrobial resistance in Asia

“…In the USA and Europe, community-acquired meticillin-resistant Staphylococcus aureus (MRSA) [1], vancomycin-resistant enterococci (VRE) [2], Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae [3] and fluoroquinolone-and carbapenemresistant Pseudomonas aeruginosa [4] have spread throughout community and hospital settings. In striking contrast, high prevalence rates of penicillin-resistant Streptococcus pneumoniae [5,6], ␤-lactamase-negative ampicillin-resistant (BLNAR) Haemophilus influenzae [7,8], carbapenem-non-susceptible Acinetobacter baumannii [9][10][11], extended-spectrum ␤-lactamase (ESBL)-producing K. pneumoniae [12,13], New Delhi metallo-␤-lactamase 1 (NDM-1)-producing Enterobacteriaceae [14], multidrug-resistant (MDR) Salmonella enterica serotypes Choleraesuis and Typhi [15][16][17], azole-resistant Candida spp. (particularly Candida glabrata) [18] and extensively drug-resistant Mycobacterium tuberculosis (XDR-TB) [19,20] are commonly reported in Asia.…”

Antibiotic resistance pattern of Salmonella spp. isolated from stool samples of hospitalized diarrheal patients in Bangladesh

“…In 10 European countries a survey conducted in 2000 identified a cefotaxime resistance rate of 0.6% in Salmonella isolates recovered from human sources (Threlfall et al, 2000). In recent years, such a trend of increase in drugresistant salmonellae including resistance to quinolones has been observed in many countries, particularly in Asia (Lauderdale et al, 2006;Wang et al, 2006). The use of antimicrobials in any purpose, including disease treatment and growth promotion in domestic livestock, can potentially lead to develop drug resistant bacteria.…”