Changing epidemiology of invasive non-typhoid Salmonella infection: a nationwide population-based registry study

Abstract

Objectives: Non-typhoid Salmonella (NTS) may invade beyond the intestine, causing bacteraemia, sepsis, and infection of normally sterile sites. The epidemiology of invasive NTS (iNTS) infection is underresearched. We determined trends, risk factors, serotype distribution, antimicrobial resistance (AMR), and attributable sources of iNTS infection in a high-income setting. Methods: 22,837 records of culture-confirmed human salmonellosis cases and 10,008 serotyped Salmonella isolates from five putative animal reservoirs (pigs, cattle, broilers, layers, reptiles) in the Netherlands during 2005e2018 were retrieved from national surveillance registries. Risk factors for iNTS infection were identified using logistic regression analysis. Source attribution modelling was based on serotyping, prevalence, and exposure data. Results: The average annual percentage of iNTS infections was 4.6% (range 3.5e5.7%). An increase in iNTS infections was observed since 2012 (odds ratio (OR) 1.09, 95% confidence interval (95% CI) 1.04e1.14). Increased iNTS infection risk was associated with wintertime (OR 1.37, 95% CI 1.12e1.66), male sex (OR 1.73, 95% CI 1.51e1.99), older age (ORs: 3.27 to 16.33, depending on age groups), and living in rural areas (OR 1.54, 95% CI 1.23e1.93). While 52% of iNTS infections (n ¼ 950) were caused by serotypes Enteritidis and Typhimurium, those displaying the highest invasiveness relative to their occurrence were Dublin (32.9%, n ¼ 163), Panama (21.6%, n ¼ 106), and Poona (14.1%, n ¼ 71). Cattle were a larger source of iNTS than non-iNTS infections (12.2% vs. 7.6%). Lower AMR and multi-resistance rates were observed among iNTS (37.9%) than non-iNTS isolates (48.6%). Discussion: The increase in iNTS infections, which is reported also in other countries, is of public health and clinical concern. The underlying reasons seem to be multi-factorial in nature. iNTS infection risk depends more on the infecting serotypes and patient demographics, and less on the attributable reservoirs and AMR profiles.

Changing Antimicrobial Resistance and Epidemiology of Non-Typhoidal Salmonella Infection in Taiwanese Children

“…On the basis of the current findings, we recommend against routinely using antimicrobials to treat uncomplicated NTS gastroenteritis in cases of high CRP level. This finding is consistent with that of Mughini-Gras et al (2020) who reported that iNTS isolates were generally less resistant than non-iNTS isolates (Mughini-Gras et al, 2020;Ke et al, 2020). NTS bacteremia in this study tended to develop in young children with prolonged fever.…”

Non-typhoidal Salmonella infections among children in a tertiary hospital in Ningbo, Zhejiang, China, 2012–2019

“…We found that Salmonella Typhimurium was the most common serotype of NTS infection cases among children in Ningbo (62.7%), which was in accordance with the findings of studies performed in Guangzhou, southern China [4,33,34]. However, some studies from other regions of China [5,35], the United States [11], the Netherlands [14], and Greece [36] reported that Salmonella Enteritidis was the most common serotype, followed by Salmonella Typhimurium. The modes of NTS transmission may be a key factor in the geographical variation in serotype distribution.…”

“…A few studies have explored the health consequences of antimicrobial-resistant NTS, with conflicting results reported. The results that patients with antimicrobial-resistant NTS infection more likely to have invasive disease and severe outcomes were reported in the United States [11], while a study in the Netherlands found that iNTS isolates were generally less (multi-) resistant than non-iNTS isolates were [14]. Our results were similar to the latter.…”

“…Moreover, antibiotic resistance and antimicrobial therapy are related to the invasiveness of NTS infections [ 10 ]. Some prior studies have found that NTS with higher rates of antibiotic resistance was more likely to cause invasive infections [ 11 – 13 ]; however, a recent study in the Netherlands reported that iNTS isolates were generally less (multi-) resistant [ 14 ]. The optimal choice and length of therapy for NTS infections in children are not clear [ 15 , 16 ].…”

Simple differentiation of Salmonella Typhi, Paratyphi and Choleraesuis from Salmonella species using the eazyplex TyphiTyper LAMP assay

“…Its mortality has been significantly reduced by implementation of appropriate antibiotic treatment but the increase in beta-lactam and fluoroquinolone resistance of Salmonella strains is a growing public health problem [3][4][5][6]. Depending on the immune status of the patient, NTS can also cause extraintestinal and bloodstream infections with various manifestations such as meningitis, septic arthritis, abscesses and osteomyelitis [7,8]. Some serovars which are highly adapted to animal hosts can cause complicated disease in humans.…”