title: Enteric fever in Cambodian children is dominated by multidrug-resistant H58 Salmonella enterica serovar Typhi with intermediate susceptibility to ciprofloxacin.
abstract: Infections with Salmonella enterica serovar Typhi isolates that are multidrug resistant (MDR: resistant to chloramphenicol, ampicillin, trimethoprim-sulphamethoxazole) with intermediate ciprofloxacin susceptibility are widespread in Asia but there is little information from Cambodia. We studied invasive salmonellosis in children at a paediatric hospital in Siem Reap, Cambodia. Between 2007 and 2011 Salmonella was isolated from a blood culture in 162 children. There were 151 children with enteric fever, including 148 serovar Typhi and three serovar Paratyphi A infections, and 11 children with a non-typhoidal Salmonella infection. Of the 148 serovar Typhi isolates 126 (85%) were MDR and 133 (90%) had intermediate ciprofloxacin susceptibility. Inpatient antimicrobial treatment was ceftriaxone alone or initial ceftriaxone followed by a step-down to oral ciprofloxacin or azithromycin. Complications developed in 37/128 (29%) children admitted with enteric fever and two (1.6%) died. There was one confirmed relapse. In a sample of 102 serovar Typhi strains genotyped by investigation of a subset of single nucleotide polymorphisms, 98 (96%) were the H58 haplotype, the majority of which had the common serine to phenylalanine substitution at codon 83 in the DNA gyrase. We conclude that antimicrobial-resistant enteric fever is common in Cambodian children and therapeutic options are limited.
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
authors.forename: Kate
authors.initials: K
authors.lastname: Emary
authors.forename: Catrin E
authors.initials: CE
authors.lastname: Moore
authors.forename: Ngoun
authors.initials: N
authors.lastname: Chanpheaktra
authors.forename: Khun Peng
authors.initials: KP
authors.lastname: An
authors.forename: Kheng
authors.initials: K
authors.lastname: Chheng
authors.forename: Soeng
authors.initials: S
authors.lastname: Sona
authors.forename: Pham Thanh
authors.initials: PT
authors.lastname: Duy
authors.forename: Tran Vu Thieu
authors.initials: TV
authors.lastname: Nga
authors.forename: Vanaporn
authors.initials: V
authors.lastname: Wuthiekanun
authors.forename: Premjit
authors.initials: P
authors.lastname: Amornchai
authors.forename: Varun
authors.initials: V
authors.lastname: Kumar
authors.forename: Lalith
authors.initials: L
authors.lastname: Wijedoru
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Stoesser
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Carter
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Parry
mesh_terms: D000328:Adult; D017677:Age Distribution; D000890:Anti-Infective Agents / Q000494:pharmacology* / Q000627:therapeutic use; D017963:Azithromycin / Q000494:pharmacology / Q000627:therapeutic use; D002160:Cambodia / Q000453:epidemiology; D002443:Ceftriaxone / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000494:pharmacology* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006239:Haplotypes; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D020641:Polymorphism, Single Nucleotide; D012189:Retrospective Studies; D012485:Salmonella typhi / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D016896:Treatment Outcome; D014435:Typhoid Fever / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D002443:Ceftriaxone; D017963:Azithromycin