Enteric fever in Cambodian children is dominated by multidrug-resistant H58 Salmonella enterica serovar Typhi with intermediate susceptibility to ciprofloxacin.
Emary, Kate;
Moore, Catrin E;
Chanpheaktra, Ngoun;
An, Khun Peng;
Chheng, Kheng;
Sona, Soeng;
Duy, Pham Thanh;
Nga, Tran Vu Thieu;
Wuthiekanun, Vanaporn;
Amornchai, Premjit;
+7 more...Kumar, Varun;
Wijedoru, Lalith;
Stoesser, Nicole E;
Carter, Michael J;
Baker, Stephen;
Day, Nicholas PJ;
Parry, Christopher M;
(2012)
Enteric fever in Cambodian children is dominated by multidrug-resistant H58 Salmonella enterica serovar Typhi with intermediate susceptibility to ciprofloxacin.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 106 (12).
pp. 718-724.
ISSN 0035-9203
DOI: https://doi.org/10.1016/j.trstmh.2012.08.007
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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.