Importation of Extensively Drug-Resistant Salmonella enterica Serovar Typhi Cases in Ontario, Canada

Eshaghi, Alireza; Zittermann, Sandra; Bharat, Amrita; Mulvey, Michael R.; Allen, Vanessa; Patel, Samir N.

doi:10.1128/aac.02581-19

Cited by 19 publications

(15 citation statements)

References 10 publications

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“…This study reflects the similar pattern [33]. For last few years, scattered cases of ceftriaxone or azithromycin resistant strains have also been reported [32] which resemble with the present study.…”

Section: Discussionsupporting

confidence: 93%

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Blood Culture and Widal Test as Diagnostic Tools for Enteric Fever with Antibiogram in a Tertiary Care Centre at Dhaka in Bangladesh

Roy¹,

Ahmed²,

Saha

et al. 2021

AJMAH

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Background: Enteric fever still exists as one of the major public health issue occurring in our country. Antimicrobials are the mainstays of treatment of typhoid fever. Due to rapidly growing antibiotic resistance, Salmonella spp. is required to be periodically tested for susceptibility patterns. This will also enable planning of rational use of antibiotics. Objective: To observe the diagnostic accuracy of enteric fever by blood culture and Widal test in a tertiary care center, at Savar, Dhaka; Bangladesh. Antimicrobial sensitivity pattern of this study will guide to modify recent changes in the trends of antimicrobial use at the local level. Methodology: Blood samples were collected from 2194 febrile patients with clinically suspected enteric fever cases at a Tertiary Care Outdoor Centre from January 2017 to March 2020. Blood culture was performed to isolate S. typhi and S. paratyphi. Widal tests were done for the determination of antibody titer. An antibody titer of ≥1:80 for anti TO and anti TH were taken as a cut off value to indicate recent infection of typhoid fever. Antibiotic susceptibility testing was carried out using modified disk diffusion (Kirby–Bauer) technique. Results: Out of 111 Salmonella isolates, 74 (5%) were S. typhi and 37 (25%) were S. paratyphi A. Total 697 samples were positive for Widal test. A large number of isolates showed resistance to commonly used antibiotics such as nalidixic acid (94.6%), chloramphenicol (87.3%), amoxicillin (76.6%), cephradine (53.1%), azithromycin (46.8) etc. Resistance to cefixime and cefipime, ceftriaxone tended to increase than past. Imipenem, moxifloxacin and cefuroxime are escalating resistance which is alarming. Conclusion: Blood culture is the most reliable among the diagnostic methods but it needs 5 to 7 days for delivery of final report. This delay leads to late diagnosis as well as provision of irrational usage of antibiotics. It is concluded that widal test would remain relevant as a diagnostic tool for enteric fever, which is more convenient, cheaper and faster than the other molecular tests. Our study revealed the antibiotic susceptibility of Salmonella isolates will be recommended for addressing the drug resistance.

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Section: Discussionsupporting

confidence: 93%

“…Fluoroquinolone resistance has increased, which has established the use of the third generation cephalosporin (ceftriaxone). After fluoroquinolone resistance has increased, requiring the use of the third generation cephalosporin (ceftriaxone) [32]. This study reflects the similar pattern [33].…”

Section: Discussionsupporting

confidence: 65%

Blood Culture and Widal Test as Diagnostic Tools for Enteric Fever with Antibiogram in a Tertiary Care Centre at Dhaka in Bangladesh

Roy¹,

Ahmed²,

Saha

et al. 2021

AJMAH

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“…CIPARS does not collect information on human travel or imported foods, but these factors might contribute to ESBLs in humans in Canada. Although ESBLs were not detected in typhoidal Salmonella during the study period, several cases of extensively drug resistant Salmnella Typhi containing bla CTX-M-15 were imported into Canada during 2018 and 2019 by patients who had traveled to Pakistan, where a large outbreak is ongoing ( 43 ). Pets might be another reservoir of ESBL-producing bacteria.…”

Section: Discussionmentioning

confidence: 99%

One Health Genomic Analysis of Extended-Spectrum β-Lactamase‒Producing Salmonella enterica, Canada, 2012‒2016

Bharat¹,

Mataseje²,

Parmley³

et al. 2022

Emerg. Infect. Dis.

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N ontyphoidal Salmonella is a leading cause of foodborne diarrheal illness. There were an estimated 535,000 human cases of invasive infection with nontyphoidal Salmonella and 59,100 deaths in 2017 globally (1,2). Gastroenteritis is usually self-limiting, but antimicrobial treatment, including ceftriaxone, ciprofloxacin, trimethoprim/sulfamethoxazole, or amoxicillin, might be recommended for severe disease and invasive infections (3).Extended-spectrum cephalosporins are a major class of broad-spectrum antimicrobial drugs and can be hydrolyzed by β-lactamases belonging to molecular class C (AmpC type, such as bla CMY-2 ) and molecular class A (ESBLs, such as bla CTX-M , bla SHV , and some alleles of bla TEM ) (4). ESBLs are a special concern because they sometimes cause reduced susceptibility to fourth-generation cephalosporins, such as cefepime, and they tend to be carried on mobile genetic elements (5). ESBLs are susceptible to β-lactamase inhibitors (e.g., clavulanic acid) and cephamycin-type cephalosporins (e.g., cefoxitin). Potential reservoirs of antimicrobial drug resistance are the food chain, the community, hospitals, and the environment (6). Ceftiofur was used systematically in the poultry industry in Canada. However, as of 2014, the industry voluntarily eliminated

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“…Nevertheless, the results from these two cities underline the fallibility of reliance on these drugs to treat typhoid in Pakistan. There is now serious concern that S. Typhi XDR strains originating from Pakistan that have been detected recently in North America and Europe may become more widespread through intercontinental travel, which poses a significant global public health threat [35][36][37]. It is advised for international visitors to Pakistan to be vaccinated against typhoid prior to arrival and to follow safe hygiene practices when travelling to identified endemic hot spots [38].…”

Section: Discussionmentioning

confidence: 99%

Burden of antibiotic resistance among children with typhoid in Gadap Town, Karachi, Pakistan

Mohsin

Aziz²,

Muurlink

et al. 2021

Microbes and Infectious Diseases

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Background: Increasing antibiotic resistance by pathogenic bacteria is observed in poor sanitary conditions. The peak incidence of typhoid occurs between 5-15 years of age. This is the most common bacteraemic illness of children in Pakistan. The aim of this study was to investigate the frequency of drug-resistant Salmonella Typhi and S. Paratyphi A in children hospitalized or treated as outpatients at a tertiary care centre that serves Gadap Town, an extensive slum district of Karachi. Methods: A total of 275 peripheral blood samples were collected from children up to 14 years old who presented with clinical features of typhoid to Fatima Hospital, Baqai Medical University, over a two-year period. Samples were cultured for growth of aerobic and facultative anaerobic bacteria, identified by biochemical reactions. Antimicrobial susceptibility was tested by Kirby-Bauer disc diffusion using eight different antibiotics. Results: Among all samples, 30 (10.9%) were positive for S. Typhi by blood culture. The rate of positivity was 23 (76.7%) cases for ages 5-14 years, three (10.0%) in each of age groups 2.0-2.9 and 4.0-4.9 years, and one patient (3.3%) aged 3.0-3.9 years. The majority of S. Typhi isolates were resistant to co-trimoxazole (66.7%), ampicillin (63.3%), nalidixic acid (60.0%), chloramphenicol (50.0%) and aztreonam (50.0%). However, most isolates were susceptible to ceftriaxone (76.7%) and ciprofloxacin (66.7%). There were 15 multidrug-resistant isolates but no typhoid-related deaths. Conclusion: Our findings show evidence of antimicrobial resistance by S. Typhi isolated from Karachiite children living in a poverty-stricken setting where water quality and sanitation are both unsatisfactory. Currently, Pakistan's most populated city is recognized as a focus of typhoid cases. Therefore, this first report of the emergence of confirmed cases of multidrug-resistant S. Typhi from the only public hospital in its largest neighbourhood identifies a grave public health concern.

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Importation of Extensively Drug-Resistant Salmonella enterica Serovar Typhi Cases in Ontario, Canada

Cited by 19 publications

References 10 publications

Blood Culture and Widal Test as Diagnostic Tools for Enteric Fever with Antibiogram in a Tertiary Care Centre at Dhaka in Bangladesh

Blood Culture and Widal Test as Diagnostic Tools for Enteric Fever with Antibiogram in a Tertiary Care Centre at Dhaka in Bangladesh

One Health Genomic Analysis of Extended-Spectrum β-Lactamase‒Producing Salmonella enterica, Canada, 2012‒2016

Burden of antibiotic resistance among children with typhoid in Gadap Town, Karachi, Pakistan

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