Non-typhoidal Salmonella serotypes, antimicrobial resistance and co-infection with parasites among patients with diarrhea and other gastrointestinal complaints in Addis Ababa, Ethiopia.
Non-typhoidal Salmonella serotypes, antimicrobial resistance and co-infection with parasites among patients with diarrhea and other gastrointestinal complaints in Addis Ababa, Ethiopia.
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DOI：
10.1186/s12879-015-1235-y
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发表时间：
2015-11-04
影响因子：
3.7
通讯作者：
Engidawork E
中科院分区：
文献类型：
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作者：
Eguale T;Gebreyes WA;Asrat D;Alemayehu H;Gunn JS;Engidawork E
非伤寒沙门氏菌（NTS）是全球重要的公共卫生问题。食用动物源性食品以及直接和/或间接接触动物是感染 NTS 的主要途径。在埃塞俄比亚，已发表的信息，特别是关于胃肠炎人类患者中 NTS 血清型分布和相关危险因素的信息很少。本研究调查了亚的斯亚贝巴卫生中心的腹泻门诊患者和提库尔安贝萨专科医院 (TASH) 患有各种胃肠道疾病的患者中沙门氏菌的患病率、危险因素、血清型分布和抗菌药物敏感性。根据世界卫生组织全球食源性感染网络实验室方案，对粪便样本进行沙门氏菌培养。使用载玻片凝集和微孔板凝集技术进行沙门氏菌血清分型。根据临床和实验室标准协会指南，使用纸片扩散法进行抗生素敏感性测试。 957 份粪便样本中，共有 59 份 (6.2%) 沙门氏菌培养呈阳性。来自卫生中心的 765 名腹泻患者中有 55 名 (7.2%) 和 TASH 的 192 名患者中有 4 名 (2.1%) 沙门氏菌培养呈阳性。调整所有其他变量后的多变量逻辑回归分析显示，沙门氏菌感染与食用生蔬菜（OR = 1.91，95% CI = 1.29–2.83，χ2 = 4.74，p = 0.025）和水样腹泻症状（OR = 3.3，95%）存在统计学显着相关性。 CI = 1.23–8.88，χ2 = 10.54，p = 0.005）。检测到 11 种血清型，最突出的是鼠伤寒沙门氏菌 (37.3%)、魏尔啸沙门氏菌 (34%) 和科特布斯沙门氏菌 (10.2%)。其他血清型有 S.迈阿密、S.肯塔基、S.纽波特、S.肠炎、S.Braenderup、S.Saintpaul、S.Concord 和 S.V:ROUGH-O。在 27 株 (40.3%) 分离株中检测到对三种或更多抗菌药物具有耐药性。 17 名患者 (25.4%) 检测到对五种或更多抗菌药物产生耐药性。对各种抗菌药物的耐药性比例不同：链霉素（50；74.6%）、呋喃妥因（27；40.3%）、磺胺异恶唑（26；38.8%）、卡那霉素（23；34.3%）、头孢噻吩（12；17.9%）和氨苄青霉素（11；17.9%）和氨苄西林（11；38.8%）。 16.4%）分别。两株肯塔基沙门氏菌、一株鼠伤寒沙门氏菌和一株康科德沙门氏菌分离株对 10 多种抗菌药物具有多重耐药性。该研究表明沙门氏菌感染与生吃蔬菜有显着关联。沙门氏菌感染与同时存在的寄生虫没有显着关联。该研究还显示了鼠伤寒沙门氏菌和魏尔啸沙门氏菌在初级卫生保健单位中的主导地位。总体而言，与之前的研究相比，耐多药的患病率较低。尽管比例较低，但南肯塔基州和南康科德州表现出更广泛的耐多药范围。持续监测循环血清型、抗菌素耐药性概况和分子耐药性决定因素的特征对于正确治疗患者和识别抗菌素耐药性的潜在环境根源至关重要。本文的在线版本 (doi:10.1186/s12879-015-1235-y) 包含补充材料，可供授权用户使用。
Non-typhoidal Salmonella (NTS) is an important public health problem worldwide. Consumption of animal-derived food products and direct and/or indirect contact with animals are the major routes of acquiring infection with NTS. Published information, particularly on the serotype distribution of NTS among human patients with gastroenteritis and associated risk factors, is scarce in Ethiopia. This study investigated the prevalence, risk factors, serotype distribution and antimicrobial susceptibility of Salmonella species among diarrheic out-patients attending health centers in Addis Ababa and patients with various gastrointestinal complaints at Tikur Anbessa Specialized Hospital (TASH). Stool samples were cultured for Salmonella species according to the WHO Global Foodborne Infections Network laboratory protocol. Salmonella serotyping was conducted using slide agglutination and microplate agglutination techniques. Antibiotic susceptibility testing was performed using the disk diffusion method according to Clinical and Laboratory Standards Institute guidelines. A total of 59 (6.2 %) stool samples, out of 957 were culture positive for Salmonella species. Fifty-five (7.2 %) of 765 diarrheic patients from health centers and 4 (2.1 %) of 192 patients from TASH were culture positive for Salmonella species. Multivariable logistic regression analysis after adjusting for all other variables revealed statistically significant association of Salmonella infection with consumption of raw vegetables (OR = 1.91, 95 % CI = 1.29–2.83, χ2 = 4.74, p = 0.025) and symptom of watery diarrhea (OR = 3.3, 95 % CI = 1.23–8.88, χ2 = 10.54, p = 0.005). Eleven serotypes were detected, and the most prominent were S. Typhimurium (37.3 %), S. Virchow (34 %), and S. Kottbus (10.2 %). Other serotypes were S. Miami, S. Kentucky, S. Newport, S. Enteritidis, S. Braenderup, S. Saintpaul, S. Concord and S. V:ROUGH-O. Resistance to three or more antimicrobials was detected in 27 (40.3 %) of the isolates. Resistance to five or more antimicrobials was detected in 17 (25.4 %). Resistance to individual antimicrobials was found at varying proportions: streptomycin (50; 74.6 %), nitrofurantoin (27; 40.3 %), sulfisoxazole (26; 38.8 %), kanamycin (23; 34.3 %), cephalothin (12; 17.9 %), and ampicillin (11; 16.4 %) respectively. Two S. Kentucky, one S. Typhimurium and one S. Concord isolates were multi-drug resistant to more than 10 antimicrobials. The study demonstrated significant association of Salmonella infection with consumption of raw vegetables. There was no significant association of Salmonella infection with co-occurring parasites. The study also showed the dominance of S. Typhimurium and S. Virchow in primary health care units. Overall, prevalence of MDR was low compared to previous studies. Although their proportion was low, S. Kentucky and S. Concord demonstrated wider spectrum of MDR. Continuous monitoring of circulating serotypes, antimicrobial resistance profile and characterization on molecular resistance determinants is essential for proper treatment of patients and for identifying potential environmental origins of antimicrobial resistance. The online version of this article (doi:10.1186/s12879-015-1235-y) contains supplementary material, which is available to authorized users.