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 under-researched. 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 2005–2018 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 3.5–5.7%). An increase in iNTS infections was observed since 2012 (odds ratio (OR) 1.09, 95% confidence interval (95% CI) 1.04–1.14). Increased iNTS infection risk was associated with wintertime (OR 1.37, 95% CI 1.12–1.66), male sex (OR 1.73, 95% CI 1.51–1.99), older age (ORs: 3.27 to 16.33, depending on age groups), and living in rural areas (OR 1.54, 95% CI 1.23–1.93). While 52% of iNTS infections (n = 950) were caused by serotypes Enteritidis and Typhimurium, those displaying the highest invasiveness relative to their occurrence were Dublin (32.9%, n = 163), Panama (21.6%, n = 106), and Poona (14.1%, n = 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.

中文翻译：

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侵袭性非伤寒沙门氏菌感染的流行病学变化：一项基于全国人口的登记研究。

目标

非伤寒沙门氏菌（NTS）可能会侵入肠道之外，导致菌血症，败血症和正常无菌部位的感染。侵袭性NTS（iNTS）感染的流行病学研究不足。我们确定了高收入人群中iNTS感染的趋势，危险因素，血清型分布，抗菌素耐药性（AMR）以及可归因的来源。

方法

从国家监视登记处检索到2005-2018年间在荷兰的五个推定动物库（猪，牛，肉鸡，蛋鸡，爬行动物）中经文化确认的沙门氏菌病例和22,008例血清型沙门氏菌分离株的记录，共有22,837记录。使用Logistic回归分析确定iNTS感染的危险因素。来源归因建模基于血清分型，患病率和暴露数据。

结果

iNTS感染的年平均百分比为4.6％（范围为3.5-5.7％）。自2012年以来，iNTS感染有所增加（赔率（OR）为1.09，95％置信区间（95％CI）为1.04-1.14）。iNTS感染风险增加与冬季（OR 1.37，95％CI 1.12-1.66），男性（OR 1.73，95％CI 1.51-1.99），年龄较大（OR：3.27至16.33，取决于年龄组）相关，并且生活在农村地区（OR 1.54，95％CI 1.23–1.93）。尽管52％的iNTS感染（n = 950）是由肠炎和伤寒血清型引起的，但相对于其发生率而言，侵袭性最高的是都柏林（32.9％，n = 163），巴拿马（21.6％，n = 106）和潘纳（14.1％，n = 71）。与非iNTS感染相比，牛是iNTS的更大来源（vs为12.2％。7.6％）。与非iNTS分离株（48.6％）相比，iNTS（37.9％）的AMR和多药耐药率更低。

讨论

在其他国家也有报道，iNTS感染的增加是公共卫生和临床关注的问题。根本原因似乎本质上是多因素的。iNTS感染的风险更多地取决于感染的血清型和患者的人口统计信息，而更少地取决于可归因的储库和AMR档案。