scholarly journals Laboratory and Molecular Surveillance of Paediatric Typhoidal Salmonella in Nepal: Antimicrobial Resistance and Implications for Vaccine Policy

2018 ◽  
Author(s):  
Carl D Britto ◽  
Zoe A Dyson ◽  
Sebastian Duchene ◽  
Michael J Carter ◽  
Meeru Gurung ◽  
...  
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Enteric Fever ◽  
Bacterial Population ◽  
Febrile Illness ◽  
Fluoroquinolone Resistance ◽  
Multi Drug Resistance ◽  
Public Health Issue ◽  
Molecular Surveillance ◽  
High Burden

AbstractBackgroundChildren are substantially affected by enteric fever in most settings with a high burden of the disease, which could be due to immune naivety, or enhanced risk of exposure to the pathogen. Although Nepal is a high burden setting for enteric fever, the bacterial population structure and transmission dynamics are poorly delineated in young children, the proposed target group for immunization programs.MethodsBlood culture surveillance amongst children aged 2 months to 15 years of age was conducted at Patan Hospital between 2008 and 2016. A total of 198 S. Typhi and 66 S. Paratyphi A isolated from children treated in both inpatient and outpatient settings were subjected to whole genome sequencing and antimicrobial susceptibility testing. Demographic and clinical data were also collected from the inpatients. The resulting data were used to place these paediatric Nepali isolates into a worldwide context, based on their phylogeny and carriage of molecular determinants of antimicrobial resistance (AMR).ResultsChildren aged ≤4 years made up >40% of the inpatient population. The majority of isolates (78 %) were S. Typhi, comprising several distinct genotypes but dominated by 4.3.1 (H58). Several distinct S. Typhi genotypes were identified, but the globally disseminated S. Typhi clade 4.3.1 (H58) dominated. The majority of isolates (86%) were insusceptible to fluoroquinolones. This was mainly associated with S. Typhi H58 Lineage II and S. Paratyphi A; non-susceptible strains from these two genotypes accounted for 50% and 25% of all enteric fever cases. Multi-drug resistance (MDR) was rare (3.5% of S. Typhi, 0 S. Paratyphi A) and restricted to chromosomal insertions of AMR genes in H58 lineage I strains. Comparison to global data sets showed the local S. Typhi and S. Paratyphi A strains had close genetic relatives in other South Asian countries, indicating regional strain circulation.ConclusionsThese data indicate that enteric fever in Nepal continues to be a major public health issue with ongoing inter- and intra-country transmission, and highlights the need for regional coordination of intervention strategies. The absence of a S. Paratyphi A vaccine is cause for concern, given its prevalence as an enteric fever agent in this setting, and the large proportion of isolates displaying fluoroquinolone resistance. This study also highlights an urgent need for routine laboratory and molecular surveillance to monitor the epidemiology of enteric fever and evolution of antimicrobial resistance within the bacterial population as a means to facilitate public health interventions in prevention and control of this febrile illness.

scholarly journals Antimicrobial sensitivity of Salmonella species isolated from University of Mkar Students

2020 ◽  
Author(s):  
Terzulum Gwaza
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Broad Spectrum ◽  
Antimicrobial Agents ◽  
Research Work ◽  
Diffusion Method ◽  
Multi Drug Resistance ◽  
Public Health Issue ◽  
Systemic Complications ◽  
Antimicrobial Sensitivity

The emergence of antimicrobial resistance amongst pathogenic microorganisms is a worrying public health issue which needs urgent fix. Several attempts have been made to overcome this problem, most recently, the advent of broad spectrum antimicrobial agents have been one of them. In as much, antimicrobial resistance seems to persist amongst different pathogenic genera due to inappropriate use of antibiotics. Salmonella, a causative agent of typhoid and other human systemic complications have displayed multi-drug resistance to antimicrobial agents. This research work therefore aims at investigating the antimicrobial sensitivity of Salmonella species isolated from University of Mkar students. A total of 50 stool samples were collected in sterile sample containers and isolation of Salmonella was carried out using two classical selective media, Salmonella Shigella Agar and MacConkey Agar. In-vitro antimicrobial sensitivity test was carried out following the disk diffusion method using 10 antimicrobial agents. Salmonella species displayed high rate of resistance (70%) while showing a worrying low rate susceptibility (30%) to Aminoglycosides, Antifolates and even broad spectrum Fluoroquinolones. Salmonella may have adapted, or acquired resistance inherently as it was evident in very high resistance against common antimicrobial agents like Ampicillin, Co-trimoxazole, Augmentin, and Nalidixic acid. The misuse of antibiotics and therapeutics by the population is obviously the consequential factor for the acquisition of resistance among this genus. Therefore, appropriate drug administration and usage practices must be enforced by government and public health institutions to help curtail the danger of unleashing the post-antibiotic era upon us now, and in time to come.

Prevalence and Antimicrobial Resistance of Campylobacter jejuni and Campylobacter coli Isolated from Cattle between 2002 and 2006 in France

2010 ◽  
Vol 73 (5) ◽  
pp. 825-831 ◽  
Author(s):  
PIERRE CHÂTRE ◽  
MARISA HAENNI ◽  
DANIÈLE MEUNIER ◽  
MARIE-ANNE BOTREL ◽  
DIDIER CALAVAS ◽  
...  
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Campylobacter Jejuni ◽  
Fluoroquinolone Resistance ◽  
Campylobacter Coli ◽  
Multiple Resistance ◽  
Upward Trend ◽  
Environmental Reservoir ◽  
Notable Increase ◽  
Clinical Breakpoints

Feces from 2,255 cattle (calves, young beef cattle, and culled cows) were collected at slaughter from nine departments across France. Campylobacter was recovered from 16.5% of the 2,255 samples (C. jejuni from 12.8% and C. coli from 3.7%), predominantly from calves. Antimicrobial resistance to six antibiotics of medical and/or veterinary interest was tested with the E-test. Resistance to tetracycline was found in most isolates (52.8% of C. jejuni isolates and 88.1% of C. coli isolates) in contrast to low but consistent resistance to ampicillin and erythromycin. Only two C. coli isolates were resistant to gentamicin. Multiple resistance was frequently detected in C. jejuni and C. coli isolates, and 0.8% (3 of 372) of the isolates were resistant to five of the six antimicrobials. An upward trend in the resistance to quinolones and fluoroquinolones in C. jejuni from calves was found; resistance to nalidixic acid reached 70.4% in 2006 and fluoroquinolone resistance increased from 29.7 to 70.4% during 2002 through 2006. All data were analyzed in parallel using clinical breakpoints or epidemiological cutoff values, and the results overlapped largely, except those for gentamicin. This 5-year survey (2002 through 2006) gives the first overview of the prevalence and antimicrobial resistance of C. jejuni and C. coli in cattle in France and documents to what extent cattle may contribute to the environmental reservoir of Campylobacter in France in the context of recurrent reports on links between human campylobacterioses and livestock. The results underline a notable increase in the resistance to fluoroquinolones in C. jejuni from cattle that may be of significant importance for public health.

scholarly journals Combating Antimicrobial Resistance Through Student-Driven Research and Environmental Surveillance

2021 ◽  
Vol 12 ◽  
Author(s):  
Erica R. Fuhrmeister ◽  
Jennifer R. Larson ◽  
Adam J. Kleinschmit ◽  
James E. Kirby ◽  
Amy J. Pickering ◽  
...  
Keyword(s):  
Public Health ◽  
Antibiotic Resistance ◽  
Antimicrobial Resistance ◽  
Modern Medicine ◽  
Classroom Research ◽  
Public Health Issue ◽  
Environmental Surveillance ◽  
Immune Systems ◽  
Institutional Participation ◽  
Common Barriers

Emerging resistance to all classes of antimicrobials is one of the defining crises of the 21st century. Many advances in modern medicine, such as routine surgeries, are predicated on sustaining patients with antimicrobials during a period when their immune systems alone cannot clear infection. The development of new antimicrobials has not kept pace with the antimicrobial resistance (AR) threat. AR bacteria have been documented in various environments, such as drinking and surface water, food, sewage, and soil, yet surveillance and sampling has largely been from infected patients. The prevalence and diversity of AR bacteria in the environment, and the risks they pose to humans are not well understood. There is consensus that environmental surveillance is an important first step in forecasting and targeting efforts to prevent spread and transmission of AR microbes. However, efforts to date have been limited. The Prevalence of Antibiotic Resistance in the Environment (PARE) is a classroom-based project that engages students around the globe in systematic environmental AR surveillance with the goal of identifying areas where prevalence is high. The format of PARE, designed as short classroom research modules, lowers common barriers for institutional participation in course-based research. PARE brings real-world microbiology into the classroom by educating students about the pressing public health issue of AR, while empowering them to be partners in the solution. In turn, the PARE project provides impactful data to inform our understanding of the spread of AR in the environment through global real-time surveillance.

scholarly journals Salmonella Paratyphi A infection: implications for public health management of extra-intestinal presentations – case study of a neck abscess

2021 ◽  
Vol 45 ◽  
Author(s):  
Moniek Borsovszky ◽  
Sophie Norton ◽  
Shopna K Bag ◽  
Jen Kok
Keyword(s):  
Public Health ◽  
Literature Review ◽  
Enteric Fever ◽  
Health Management ◽  
Febrile Illness ◽  
Health Staff ◽  
Variable Nature ◽  
History Of ◽  
Public Health Management

This study explores the implications of unusual presentations of Salmonella enterica subsp. enterica ser. Paratyphi (S. Paratyphi) infection for public health management, through a literature review and case study. In 2016, a 36-year-old male presented with a five-day history of right sided painful neck swelling, coryza and a two-day history of fevers after arriving in Australia from India nine weeks earlier. S. Paratyphi A was isolated from a fine needle aspirate sample. A descriptive epidemiological review was performed of confirmed cases of S. Paratyphi notified in New South Wales between 2008 and 2017. S. Paratyphi was isolated in blood and/or faecal samples in 247 cases (98.4%). Only four specimens (1.6%) were from a focal site. A literature review of extraintestinal infections of S. Paratyphi A or B was performed. Of the 41 such cases reported, 16 (39%) had a clear history of a prior gastroenteritis and/or febrile illness, or information suggested this was highly likely. No preceding gastroenteritis or febrile illness occurred in 15 (37%) of the cases. Information was reviewed and presented with a public health lens, valuable for ‘evidence-informed’ public health risk assessment of contacts and exposures related to these types of S. Paratyphi infection. S. Paratyphi infection usually presents as an enteric fever illness. Our case illustrates the variable nature of infectious diseases and the importance of laboratory testing in obtaining a diagnosis. S. Paratyphi can have unusual presentations, which may require adjustment in the public health management of the case. Public health staff should keep an open mind when investigating possible sources and assessing risk. In Western Sydney, this disease is largely associated with residents travelling to high-incidence countries to visit family and friends, and receiving family visits from these countries. The increasing number of cases of S. Paratyphi (prior to COVID-19) in Western Sydney and the importance of awareness of the risk of enteric fever to travellers to endemic regions is highlighted.

Molecular mechanisms of antimicrobial resistance and phylogenetic relationships of Salmonella enterica isolates from febrile patients in Yangon, Myanmar

2019 ◽  
Vol 113 (10) ◽  
pp. 641-648 ◽  
Author(s):  
Khine Mar Oo ◽  
Tin Ohn Myat ◽  
Wah Win Htike ◽  
Ambarish Biswas ◽  
Rachel F Hannaway ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Phylogenetic Relationships ◽  
Salmonella Enterica ◽  
Enteric Fever ◽  
Genetic Basis ◽  
Molecular Mechanisms ◽  
Epidemiologic Study ◽  
Fluoroquinolone Resistance ◽  
Chromosomal Genes

Abstract Background Enteric fever is common in southeast Asia. However, there is little information on the circulating Salmonella enterica strains causing enteric fever in Myanmar. Methods We performed antimicrobial susceptibility testing and whole genome sequencing on S. enterica bloodstream isolates from febrile patients aged ≥12 y attending two hospitals in Yangon, Myanmar, from 5 October 2015 through 4 October 2016. We identified the serovar of S. enterica, determined antimicrobial susceptibility and the molecular mechanisms of resistance. We analysed phylogenetic relationships among Myanmar S. enterica isolates and those with isolates from neighbouring countries. Results Of 73 S. enterica isolated, 39 (53%) were serovar Typhi and 34 (47%) were Paratyphi A. All isolates were susceptible to ampicillin, chloramphenicol and trimethoprim-sulfamethoxazole but resistant to ciprofloxacin. We identified mutations in chromosomal genes gyrA, gyrB and parC as responsible for fluoroquinolone resistance. All S. enterica Typhi isolates were of 4.3.1 subclade (formerly known as H58) and formed two closely related genotypic clusters; both clusters were most closely related to isolates from India from 2012. All S. enterica Paratyphi A were lineage C, clade C4 and were closely related. Conclusion Our study describes currently circulating S. enterica serovars in Myanmar, the genetic basis of their antimicrobial resistance and provides a genotypic framework for epidemiologic study.

scholarly journals Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Annie J. Browne ◽  
Bahar H. Kashef Hamadani ◽  
Emmanuelle A. P. Kumaran ◽  
Puja Rao ◽  
Joshua Longbottom ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
South Asia ◽  
Enteric Fever ◽  
Meta Analysis ◽  
Public Health Intervention ◽  
Antimicrobial Treatment ◽  
Sub Saharan Africa ◽  
Fluoroquinolone Resistance ◽  
Drug Resistant

Abstract Background Antimicrobial resistance (AMR) is an increasing threat to global health. There are > 14 million cases of enteric fever every year and > 135,000 deaths. The disease is primarily controlled by antimicrobial treatment, but this is becoming increasingly difficult due to AMR. Our objectives were to assess the prevalence and geographic distribution of AMR in Salmonella enterica serovars Typhi and Paratyphi A infections globally, to evaluate the extent of the problem, and to facilitate the creation of geospatial maps of AMR prevalence to help targeted public health intervention. Methods We performed a systematic review of the literature by searching seven databases for studies published between 1990 and 2018. We recategorised isolates to allow the analysis of fluoroquinolone resistance trends over the study period. The prevalence of multidrug resistance (MDR) and fluoroquinolone non-susceptibility (FQNS) in individual studies was illustrated by forest plots, and a random effects meta-analysis was performed, stratified by Global Burden of Disease (GBD) region and 5-year time period. Heterogeneity was assessed using the I2 statistics. We present a descriptive analysis of ceftriaxone and azithromycin resistance. Findings We identified 4557 articles, of which 384, comprising 124,347 isolates (94,616 S. Typhi and 29,731 S. Paratyphi A) met the pre-specified inclusion criteria. The majority (276/384; 72%) of studies were from South Asia; 40 (10%) articles were identified from Sub-Saharan Africa. With the exception of MDR S. Typhi in South Asia, which declined between 1990 and 2018, and MDR S. Paratyphi A, which remained at low levels, resistance trends worsened for all antimicrobials in all regions. We identified several data gaps in Africa and the Middle East. Incomplete reporting of antimicrobial susceptibility testing (AST) and lack of quality assurance were identified. Interpretation Drug-resistant enteric fever is widespread in low- and middle-income countries, and the situation is worsening. It is essential that public health and clinical measures, which include improvements in water quality and sanitation, the deployment of S. Typhi vaccination, and an informed choice of treatment are implemented. However, there is no licenced vaccine for S. Paratyphi A. The standardised reporting of AST data and rollout of external quality control assessment are urgently needed to facilitate evidence-based policy and practice. Trial registration PROSPERO CRD42018029432.

scholarly journals Increasingly limited options for the treatment of enteric fever in travellers returning to England, 2014–2019: a cross-sectional analytical study

2021 ◽  
Vol 70 (8) ◽  
Author(s):  
M. Trent Herdman ◽  
Basel Karo ◽  
Jayshree Dave ◽  
Parisha Katwa ◽  
Joanne Freedman ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antimicrobial Resistance ◽  
Enteric Fever ◽  
Significant Risk ◽  
Empirical Treatment ◽  
Multi Drug Resistance ◽  
Third Generation ◽  
Returning Travellers ◽  
Empirical Antibiotics ◽  
Third Generation Cephalosporins

Introduction. Enteric fever (caused by Salmonella enterica serovars Typhi and Paratyphi) frequently presents as an acute, undifferentiated febrile illness in returning travellers, requiring timely empirical antibiotics. Gap Statement. Determining which empirical antibiotics to prescribe for enteric fever requires up-to-date knowledge of susceptibility patterns. Aim. By characterising factors associated with antimicrobial resistance in cases of S. Typhi and S. Paratyphi imported to England, we aim to guide effective empirical treatment. Methodology. All English isolates of S. Typhi and S. Paratyphi 2014–2019 underwent antimicrobial susceptibility testing; results were compared to a previous survey in London 2005–2012. Risk factors for antimicrobial resistance were analysed with logistic regression models to predict adjusted odds ratios (aOR) for resistance to individual antibiotics and multi-drug resistance. Results. We identified 1088 cases of S. Typhi, 729 S. Paratyphi A, 93 S. Paratyphi B, and one S. Paratyphi C. In total, 93 % were imported. Overall, 90 % of S. Typhi and 97 % of S. Paratyphi A isolates were resistant to ciprofloxacin; 26 % of S. Typhi were multidrug resistant to ciprofloxacin, amoxicillin, co-trimoxazole, and chloramphenicol (MDR+FQ). Of the isolates, 4 % of S. Typhi showed an extended drug resistance (XDR) phenotype of MDR+FQ plus resistance to third-generation cephalosporins, with cases of XDR rising sharply in recent years (none before 2017, one in 2017, six in 2018, 32 in 2019). For S. Typhi isolates, resistance to ciprofloxacin was associated with travel to Pakistan (aOR=32.0, 95 % CI: 15.4–66.4), India (aOR=21.8, 95 % CI: 11.6–41.2), and Bangladesh (aOR=6.2, 95 % CI: 2.8–13.6) compared to travel elsewhere, after adjusting for rising prevalence of resistance over time. MDR+FQ resistance in S. Typhi isolates was associated with travel to Pakistan (aOR=3.5, 95 % CI: 2.4–5.2) and less likely with travel to India (aOR=0.07, 95 % CI 0.04–0.15) compared to travel elsewhere. All XDR cases were imported from Pakistan. No isolate was resistant to azithromycin. Comparison with the 2005–2012 London survey indicates substantial increases in the prevalence of resistance of S. Typhi isolates to ciprofloxacin associated with travel to Pakistan (from 79–98 %) and Africa (from 12–60 %). Conclusion. Third-generation cephalosporins and azithromycin remain appropriate choices for empirical treatment of enteric fever in most returning travellers to the UK from endemic countries, except from Pakistan, where XDR represents a significant risk.

scholarly journals Serotypes and antimicrobial resistance profiles of Salmonella enterica recovered from clinical swine samples

2020 ◽  
Vol 13 (11) ◽  
pp. 2312-2318
Author(s):  
Siriporn Kongsoi ◽  
Suksun Chumsing ◽  
Darunee Satorn ◽  
Panisa Noourai
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
High Resistance ◽  
Salmonella Enterica ◽  
Foodborne Pathogen ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Public Health Issue ◽  
Diagnostic Laboratory ◽  
Disk Diffusion Method

Background and Aim: Salmonella enterica is an important foodborne pathogen and is recognized as a major public health issue. The emergence of multidrug-resistant (MDR) S. enterica represents a major challenge for national public health authorities. We investigated the distribution of serovars and antimicrobial resistance of S. enterica isolates from clinical swine samples stored at the Veterinary Diagnostic Laboratory, Faculty of Veterinary Medicine, Kasetsart University from 2016 to 2017. Materials and Methods: Clinical samples were collected and subjected to standard microbiological techniques outlined in the Manual of Clinical Microbiology to identify Salmonella serovars. Susceptibility to antimicrobials was tested by the Kirby–Bauer disk diffusion method using a panel of 14 antimicrobials. Results: A total of 144 Salmonella isolates were identified and the dominant serovar was Salmonella Choleraesuis (66.67%), followed by monophasic Salmonella Typhimurium (18.75%), S. Typhimurium (9.03%), and Rissen (5.56%). The isolates displayed high resistance rates to ampicillin (AMP [100%]), amoxicillin (AX [100%]), tetracycline (TE [100%]), cefotaxime (CTX [89.58%]), ceftriaxone (CRO [87.50%]), chloramphenicol (C [82.64%]), gentamicin (CN [79.17%]), nalidixic acid (NA [72.92%]), and ceftazidime (CAZ [71.53%]). All isolates were MDR, with 29 distinct resistance patterns. The dominant MDR pattern among serovars Choleraesuis and Rissen exhibited resistance to 9 antimicrobials: ( R7-14 AMP-AX-CAZ-CRO-CTX-NA-C-CN-TE). However, all tested isolates were susceptible to AX/ clavulanic acid and fosfomycin. Conclusion: High resistance levels to the third generation of cephalosporins such as CAZ, CRO, and CTX highlight the need for careful and reasonable usage of antimicrobials in animals and humans, especially for S. Choleraesuis infections.

scholarly journals Antimicrobial resistance ? a public health issue?

2007 ◽  
Vol 28 (4) ◽  
pp. 165 ◽  
Author(s):  
Keryn Christiansen
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Social Stigma ◽  
Management Plan ◽  
Health Issue ◽  
Public Health Issue ◽  
Sexually Transmitted ◽  
Adults And Children ◽  
Definition Of ◽  
Food Borne Infections

With any decision to label a disease a public health issue comes an implicit understanding that action must be taken and that there should be a government intervention or management plan ? but there is no standard definition of what constitutes a public health issue. Most often the factors considered are the number of cases, the vulnerability of the affected group and rapidity of spread, and the levels of morbidity and mortality caused. The cost to the community ? either directly in managing the disease or in loss of work or productivity ? is also an important factor. We can all think of infectious diseases that fit these criteria; meningococcal meningitis, because it kills young healthy adults and children rapidly; pandemic influenza because it has the potential to kill many rapidly; sexually transmitted diseases carrying with them social stigma and the potential to cause sterility; tuberculosis with its transmissability and protracted and potentially lethal course; and food borne infections causing large outbreaks. Where does antimicrobial resistance (AMR) fit in this and is it a public health issue? To answer this question we must look at the evidence.

Sign in / Sign up

Export Citation Format

Share Document