Background

Enteric fever remains a major public health problem in low resource settings and antibiotic resistance is increasing. In Asia, an increasing proportion of infections is caused by Salmonella enterica serovar Paratyphi A, which for a long time was assumed to cause a milder clinical syndrome compared to Salmonella enterica serovar Typhi.

Methodology

A retrospective chart review study was conducted of 254 unique cases of blood culture confirmed enteric fever who presented at a referral adult hospital in Phnom Penh, Cambodia between 2008 and 2015. Demographic, clinical and laboratory data were collected from clinical charts and antibiotic susceptibility testing was performed. Whole genome sequence analysis was performed on a subset of 121 isolates.

Results

One-hundred-and-ninety unique patients were diagnosed with Salmonella Paratyphi A and 64 with Salmonella Typhi. In the period 2008–2012, Salmonella Paratyphi A comprised 25.5% of 47 enteric fever cases compared to 86.0% of 207 cases during 2013–2015. Presenting symptoms were identical for both serovars but higher median leukocyte counts (6.8 x 10⁹/L vs. 6.3 x 10⁹/L; p = 0.035) and C-reactive protein (CRP) values (47.0 mg/L vs. 36 mg/L; p = 0.034) were observed for Salmonella Typhi infections. All but one of the Salmonella Typhi isolates belonged to haplotype H58 associated with multidrug resistance (MDR) (i.e. resistance to ampicillin, chloramphenicol and co-trimoxazole).;42.9% actually displayed MDR compared to none of the Salmonella Paratyphi A isolates. Decreased ciprofloxacin susceptibility (DCS) was observed in 96.9% (62/64) of Salmonella Typhi isolates versus 11.5% (21/183) of Salmonella Paratyphi A isolates (all but one from 2015). All isolates were susceptible to azithromycin and ceftriaxone.

Conclusions

In Phnom Penh, Cambodia, Salmonella Paratyphi A now causes the majority of enteric fever cases and decreased susceptibility against ciprofloxacin is increasing. Overall, Salmonella Typhi was significantly more associated with MDR and DCS compared to Salmonella Paratyphi A.

中文翻译：

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2008-2015年柬埔寨肠热的临床和微生物学特征

背景

在资源匮乏的情况下，肠热仍然是主要的公共卫生问题，并且抗生素耐药性正在增加。在亚洲，由肠炎沙门氏菌副伤寒沙门氏菌A引起的感染比例不断增加，长期以来，与肠炎沙门氏菌伤寒沙门氏菌相比，该病被认为引起了较轻的临床综合征。

方法

回顾性图表审查研究对254例在2008年至2015年期间在柬埔寨金边的转诊成人医院就诊的经血液培养确诊的肠炎的独特病例进行了回顾。执行。对121个分离株的子集进行了全基因组序列分析。

结果

一百零九名独特的患者被诊断为副伤寒沙门氏菌A型，而伤寒沙门氏菌为64例。在2008-2012年期间，副伤寒沙门氏菌A占47例肠热病例的25.5％，而2013-2015年间占207例肠炎的86.0％。两种血清型的症状相同，但白细胞计数中位数较高（6.8 x 10 ⁹ / L vs. 6.3 x 10 ⁹ / L; p = 0.035）和C反应蛋白（CRP）值（47.0 mg / L vs.36 mg / L; p = 0.034）鼠伤寒沙门氏菌感染。除伤寒沙门氏菌以外，所有分离株均属于与多药耐药性（MDR）相关的单倍型H58（我。e。对氨苄西林，氯霉素和复方新诺明的抗药性）；与无副伤寒沙门氏菌A分离株相比，有42.9％的人实际表现出MDR 。伤寒沙门氏菌分离株的96.9％（62/64）与副伤寒沙门氏菌A分离株的11.5％（21/183）相比，观察到环丙沙星药敏性（DCS）降低（除2015年以外的所有菌株）。所有分离株均对阿奇霉素和头孢曲松敏感。

结论

在柬埔寨金边，副伤寒沙门氏菌A现在引起大多数肠热病例，并且对环丙沙星的敏感性降低正在增加。总体而言，沙门氏菌伤寒是显著更耐多药和DCS相关相比，沙门氏菌副伤寒A.