Changes of Antibiotic Resistance in Children with Nontyphoidal Salmonella Infections from 2014–2020 in Hangzhou, China

Abstract

Objective: Nontyphoidal Salmonella (NTS) Infection is the most common food-borne disease. Among all groups, young children are the most vulnerable group to NTS. With the increase in the incidence of NTS infection and the development of multi-drug resistance, public health especially children health has had a major impact. In order to characterize the changes of antibiotic resistance of NTS in children in Hangzhou, China, and to provide references for the rational use of drugs for NTS infections in this area. Methods: Three hundred and thirty-one hospitalized children with NTS infections in Hangzhou Children’s Hospital from 2014 to 2020 were included. The clinical data and antibiotic susceptibility test results were retrospectively reviewed and analyzed. Results: Among these 331 children infected by NTS, 190 cases were male and 141 were female. The youngest age of onset was only 18 days, and the median age was 15 months. In Hangzhou, NTS infections mostly occurred in infants and young children from 6 months to 2 years, and often occurred in the summer and Fall. The dominant bacterial types in this region were Salmonella Typhimurium (42.30%) and Salmonella Enteritidis (13.60%). The distribution of the remaining serotypes was relatively scattered. From 2014 to 2020, NTS were completely susceptible to imipenem/ertapenem;its susceptibility and resistance to penicillins and cephalosporins remained relatively stable. The high rates of antibiotic susceptibility were recorded in relation to piperacillin/tazobactam (93.05%), ceftriaxone (70.69%), ceftazidime (78.25%), and cefepime (87.01%). However, the susceptibility to quinolones had decreased significantly, only 37.17% in 2020. The multi-drug resistant (MDR) rate of 331 NTS isolates was 29.61% (98/331). Among them, Salmonella Typhimurium was more prone to MDR. Conclusions: The overall antibiotic resistance rates remained at a high level in Hangzhou, and antibiotic susceptibility rates of NTS to quinolones decreased significantly. The surveillance of antibiotic resistance in NTS and control measures should be further strengthened. For children who need antibacterial drugs due to NTS infection in Hangzhou, the use of piperacillin, tazobactam, ceftazidime or ceftriaxone is recommended until antibiotic susceptibility test results are available.