Epidemiology, Serotype and Resistance of Salmonella Isolates from a Children’s Hospital in Hangzhou, Zhejiang, China, 2006–2021

Abstract

This research investigated the dynamics of antibiotic resistance in Salmonella and the epidemiology of Salmonella infection in children. These data can aid in the prevention and control of the Salmonella epidemic and the diagnosis and treatment of salmonellosis. Methods: In this study, we retrospectively reviewed and analysed data regarding epidemiology, clinical symptoms, Salmonella serotypes, and antibiotic resistance from the medical records of patients with Salmonella infections in Hangzhou Children's Hospital from April 2006 to December 2021. Results: A total of 2099 Salmonella isolates were identified during the 16-year study period, and 98.6% (2069) of the isolates were isolated from stool. About 84.5% (1773/2099) of the total Salmonella isolates were detected from May to October. The median age of the 2099 children with Salmonella infection was 1.4 years (17 months) (IQR: 0.9-2.8 years). In 1572 (74.9%) patients, the course of the disease was limited to uncomplicated gastroenteritis. S. Typhimurium (805/2099, 38.4%) was predominant, followed by S. Enteritidis (290/2099, 13.8%). The total number of serotypes and the number of less common serotypes are increasing. Nontyphoid Salmonella that cause invasive infections, including S. Typhimurium, S. Stanley, and S. Choleraesuis, accounted for 60.0% (18/30). The Salmonella strains were resistant to ampicillin, ampicillin-sulbactam, trimethoprim-sulfamethoxazole, ceftriaxone, and ciprofloxacin at percentages of 71.5%, 51.5%, 36.5%, 22.4%, and 14.7%, respectively. No imipenem-resistant strains were identified. 24.8% of the isolates exhibited multidrug resistance (MDR). Conclusion: S. typhimurium and S. enteritidis were the dominant serotypes in children (<2 years) with salmonella-infected arrhoea in Hangzhou, China. Ongoing serotype monitoring should be necessitated and dynamic changes in serotypes should be carefully examined to prevent the sudden outbreak of foodborne illness. Salmonella exhibits a higher rate of resistance to common antibiotics, and the risk of multidrug resistance should not be ignored. Therefore, clinicians should administer antibiotics judiciously according to the results of drug sensitivity tests.

Characterization of Salmonella spp. in a tertiary hospital during 2019-2021 in Nanjing, China: Focusing on the clonal dissemination of Salmonella Enteritidis ST11

“…Interestingly, we found that the infection of Salmonella mostly occurred in autumn, which was consistent with other studies [26,31], indicating that autumn may be a season of high incidence for Salmonella infection. Further, the Salmonella isolates originated mainly from blood in our hospital, which may be the bloodstream infection caused by the strains transferred from gastrointestinal tract.…”

“…The high frequency of resistance to ampicillin and ampicillin/sulbactam in our study was similar to the previous reports from China [27,29], Italy [28], and Argentina [30], suggesting that ampicillin and ampicillin/sulbactam should be carefully prescribed for clinical treatment of infections caused by such strains. In addition, resistance to sulfamethoxazole/trimethoprim in our study was lower than those in previous domestic and foreign studies [29][30][31][32], however, relatively higher than those of other studies [33,34]. The reason may lie on the regional or strain difference.…”

“…Meanwhile, our study showed that the resistance rates to cipro oxacin and levo oxacin were relatively lower than those in China [27,35], but it was higher when compared to data from Korea [34], USA [33], and Australia [36], suggesting the potential for treatment failure in patients treated with uoroquinolones in our country. Fortunately, the observed frequencies of resistance to monocyclic β-lactam antibiotics (aztreonam) and third and fourth generation cephalosporins were lower when compared to data from other studies [27,29,31]. Luckily, the distribution of MDR strains in our study was lower than reports in Argentina [30], Iran [37], Philippine [38], USA [33,39], and parts of China [31,35], indicating that the third-and fourth-carbapenems could be still effective for the clinical therapy of Salmonella infections.…”

“…Fortunately, the observed frequencies of resistance to monocyclic β-lactam antibiotics (aztreonam) and third and fourth generation cephalosporins were lower when compared to data from other studies [27,29,31]. Luckily, the distribution of MDR strains in our study was lower than reports in Argentina [30], Iran [37], Philippine [38], USA [33,39], and parts of China [31,35], indicating that the third-and fourth-carbapenems could be still effective for the clinical therapy of Salmonella infections.…”

Non-Typhoidal Salmonella Infections Among Children in Fuzhou, Fujian, China: A 10-Year Retrospective Review from 2012 to 2021

“…Typhimurium infections with children annually is not clear. This trend was also happened in other areas in China like Hangzhou, 39 Chongqing, 14 Ningbo 22 and so on. Data from the European Food Safety Authority (EFSA) showed that outbreaks caused by S .…”