Increasing Frequencies of Antibiotic Resistant Non-typhoidal Salmonella Infections in Michigan and Risk Factors for Disease
Increasing Frequencies of Antibiotic Resistant Non-typhoidal Salmonella Infections in Michigan and Risk Factors for Disease
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DOI：
10.3389/fmed.2019.00250
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发表时间：
2019-11-08
影响因子：
3.9
通讯作者：
Manning, Shannon D.
中科院分区：
文献类型：
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作者：
Mukherjee, Sanjana;Anderson, Chase M.;Manning, Shannon D.
非伤寒沙门氏菌（NTS）是重要的肠道病原体，每年在美国引起超过100万种食源性疾病。抗生素耐药性在NTS分离株中的广泛出现限制了可用于治疗的抗生素的可用性。由于密歇根州不是FoodNet监测系统的一部分，很少有研究量化了抗生素耐药性频率，并确定了该州NTS感染的风险因素。我们从2011年至2014年在密歇根州的四家医院通过主动监测获得了198株临床NTS分离株，用于血清型分类和使用肉汤微量稀释法对24种抗生素的敏感性。这198个分离株属于35种不同的血清型，其中以肠炎（36.9%）为主，其次是鼠伤寒（19.5%）和纽波特（9.7%），尽管每种菌株的比例因年份、居住地和季节而异。肠炎和鼠伤寒病例的数量在夏季更高，而肠炎病例在城市居民中比农村居民更常见。共有30株（15.2%）NTS分离株对≥ 1种抗生素耐药，15株（7.5%）对≥ 3种抗菌剂耐药;与肠杆菌分离株相比，鼠伤寒沙门氏菌分离株的耐药比例显著更高，在4年期间观察到四环素耐药和多重耐药频率呈增加趋势。耐药感染与住院时间延长相关，耐药分离株患者的平均住院时间为5.9天，而感染敏感分离株的患者为4.0天。多项逻辑回归分析表明，肠道菌群以外的血清型感染[比值比（OR）：3.8，95%置信区间（CI）：1.23-11.82]以及秋季感染（OR：3.0; 95% CI：1.22-7.60）与耐药性独立相关。总之，这些发现表明了监测、监测耐药频率和确定风险因素的重要性，这些风险因素有助于制定新的预防策略。
Non-typhoidal Salmonella (NTS) are important enteric pathogens causing over 1 million foodborne illnesses in the U.S. annually. The widespread emergence of antibiotic resistance in NTS isolates has limited the availability of antibiotics that can be used for therapy. Since Michigan is not part of the FoodNet surveillance system, few studies have quantified antibiotic resistance frequencies and identified risk factors for NTS infections in the state. We obtained 198 clinical NTS isolates via active surveillance at four Michigan hospitals from 2011 to 2014 for classification of serovars and susceptibility to 24 antibiotics using broth microdilution. The 198 isolates belonged to 35 different serovars with Enteritidis (36.9%) predominating followed by Typhimurium (19.5%) and Newport (9.7%), though the proportion of each varied by year, residence, and season. The number of Enteritidis and Typhimurium cases was higher in the summer, while Enteritidis cases were significantly more common among urban vs. rural residents. A total of 30 (15.2%) NTS isolates were resistant to >= 1 antibiotic and 15 (7.5%) were resistant to >= 3 antimicrobial classes; a significantly greater proportion of Typhimurium isolates were resistant compared to Enteritidis isolates and an increasing trend in the frequency of tetracycline resistance and multidrug resistance was observed over the 4-year period. Resistant infections were associated with longer hospital stays as the mean stay was 5.9 days for patients with resistant isolates relative to 4.0 days for patients infected with susceptible isolates. Multinomial logistic regression indicated that infection with serovars other than Enteritidis [Odds ratio (OR): 3.8, 95% confidence interval (CI): 1.23-11.82] as well as infection during the fall (OR: 3.0; 95% CI: 1.22-7.60) were independently associated with resistance. Together, these findings demonstrate the importance of surveillance, monitoring resistance frequencies, and identifying risk factors that can aid in the development of new prevention strategies.