Infection and Drug Resistance (Nov 2022)
Factors Associated with Multi-Drug-Resistant Non-Typhoidal Salmonella in the Invasive Disease, Thailand
Abstract
Kitchawan Hengkrawit,1 Chidchanok Tangjade2 1Pediatric Infectious Disease Unit, Department of Pediatrics, Panyananthaphikkhu Chonprathan Medical Center, Srinakarinwirot University, Nonthaburi, Thailand; 2Pediatrics Gastroenterology and Hepatology Unit, Department of Pediatrics, Panyananthaphikkhu Chonprathan Medical Center, Srinakarinwirot University, Nonthaburi, ThailandCorrespondence: Chidchanok Tangjade, Pediatrics Gastroenterology and Hepatology Unit, Department of Pediatrics, Panyananthaphikkhu Chonprathan Medical Center, Srinakarinwirot University, P.O. Box 222 Moo 1, Tiwanon Road, Pak Kret, Nonthaburi, 11120, Thailand, Tel +66 2 502 2345, Fax +66 2 502-2305, Email [email protected]: Invasive non-typhoidal Salmonella disease, iNTS is a major global health concern, especially multi-drug resistant non-typhoidal Salmonella, MDR-NTS. Information about risk factors of MDR-NTS in the invasive disease patient group was limited. This study aimed to identify those risk factors.Methods: This retrospective study examined data from patients who had non-typhoidal Salmonella, NTS infection, from 10 hospitals between June 2011 and June 2020. The multivariate regression analysis included demographic data, clinical data, culture reports, and antimicrobial susceptibility.Results: A total of 166 patients were invasive salmonellosis. where the median age was 8.3 years (IQR 1.8– 79). 52% were the under-15-years-old group. Most of the patient data, 64.5% (107/166), was from a tertiary hospital. The majority of cases were bacteremia 95.7% (159/166). Serogroup C was the most common serogroup (39%). MDR-NTS was present in 68.8% (95% CI 7.17– 11.06) of patients. Univariate analysis showed that onset of illness > 3 days PTA (p=0.11), age over 60 years old (0.014), diabetic (p=0.002), or serogroup C infection (p=0.43) were significant factors for MDR-NTS infection. Multivariate analysis showed that the onset of symptoms more than 3 days before admission (p=0.001), and age over 60 years were significant factors. The patient who had white blood cells > 15,000 cells/uL (p< 0.001), a peak of fever ≥ 39 C° (p=001), and illness for more than 3 days before admission (p=0.035) were significantly related to invasive infection by multivariate analyses.Conclusion: The iNTS patients who were over 60 years old or had onset of illness more than 3 days before admission were associated with MDR-NTS infection. Therefore, the choice of antimicrobials selected must be appropriate for the local prevalence and epidemiology of MDR-NTS including clinical correlation.Keywords: risk factor, multi-drug resistance, non-typhoidal Salmonella, invasive infection, invasive non-typhoidal Salmonella disease
