SMJ Current Issue

Serogroups and antimicrobial susceptibility of non-typhoidal salmonellas in children
  Fahad A Al-Zamil,  Awado R Al-Anazi

Objectives: To update knowledge regarding the pattern of Serogroups and antimicrobial susceptibility of Salmonellas causing gastroenteritis in children at the King Khalid University Hospital in Riyadh, Saudi Arabia during the period of 1st April 1996 to 30th September 1999.
Methods: The case records of 416 children, from whom Salmonella species were isolated from stool cultures between April 1996 and September 1999 were reviewed. The isolates and susceptibility of these Salmonella were carried out accordingly to standard microbiological methods.
Results: During a period of 3 and 1/2 years a total of 412 non-typhoidal Salmonellas were isolated from stool cultures of 416 children who presented to King Khalid University Hospital complaining of gastroenteritis. The majority of these children (70%) belonged to the age group 0-4 years. Eighty seven percent of the Salmonella isolates were Serogroup D1, B and C1. The Serogroups and antimicrobial susceptibility of these Salmonellas differed from those previously reported from this country and other parts of the world.
Conclusions: Salmonella gastroenteritis is an important clinical condition in infants and children in the Kingdom of Saudi Arabia. Salmonella Serogroups D1, B and C predominate as causative agents of this condition. Most of the salmonella serogroups isolated in this study were highly susceptible to commonly used antimicrobial agents but ampicillin showed a rising resistance pattern. This may make it unsuitable therapy for Salmonella gastroenteritis.

Saudi Medical Journal 2001; Vol.  (2): 129-132


Salmonellas are important pathogens in infants and children.1 Gastrointestinal infections caused by non-typhoidal salmonellas continue to be a problem of great magnitude in different parts of the world.1,2 Salmonella gastroenteritis is generally, a self-limiting disease1 but a high risk of bacteremia and extra intestinal infections in infants and children has prompted recommendation for antimicrobial treatment in these age groups.2 The increase of antimicrobial resistance in Salmonella species has been reported by several authors.3-4 The emergence of Salmonella species resistant to chloramphenicol, ampicillin and trimethoprim sulfamethoxazole has made the treatment of salmonellosis difficult.5-6 The incidence of antimicrobial resistance among Salmonella species in different regions of the Kingdom has been documented in previous reports which showed changing patterns of resistance among these species.7-8P> FONT> FONT>

Methods.FONT> King Khalid University Hospital is a tertiary health care center with an 850-bed capacity, situated in the central region of Saudi Arabia. The case records of 416 children, from whom Salmonella species were isolated from stool between April 1996 and September 1999 were reviewed. Salmonella gastroenteritis in a child was defined as diarrhea, vomiting, or both, and positive salmonella culture - other than Salmonella, paratyphi A, B and C - from stool. For isolation of Salmonella species, the specimens were cultured directly onto xylose lysine deoxycholate (XLD) agar (Difco Laboratories, Deboit, USA) and Selenite F broth (Oxoid, Basingstroke, UK). After overnight incubation, the latter was subcultured onto deoxycholate citrate agar (DCA) (Difco, Laboratories). Non-lactose fermenting, urease and oxidase negative colonies resembling Salmonella species were further identified by means of API 20 (Analytical Profile Index, Biomeriuex, France). Organisms giving a Salmonella profile were serogrouped using specific antisera (Wellcome Diagnostics, Dartford, UK). Antimicrobial susceptibility testing was performed by Stoke’s disc comparative diffusion method using E.coli (NCTC 10418) as a control organism. In this study the antimicrobial agents used had the same potencies recommended in a previous study.9 The minimum inhibitory concentration (MIC) was performed by the E test method (E test, AB, Biodisk Solona Sweden). The breakpoint MIC was defined according to the recommendations of the National Committee for Clinical Laboratory Standards (NCCLS).10P> FONT>

Results.FONT> The majority of our patients (70%) were from the age group 0-4 years; (26%) belong to the age group 0-2 years. The age distribution of our patients is shown in Table 1. Table 2 shows the incidence of salmonella serogroups isolated with 87% of the isolates belonging to Serogroups D1, B and C1. Table 3 shows the resistance pattern of the salmonella serogroups, with all Serogroups showing high susceptibility to chloramphenicol except serogroup C1 and E2. Serogroup E2 isolates were susceptible to all antimicrobial agents tested except chloramphenicol and ampicillin.P> FONT>

Discussion.FONT> Salmonella infections are common in Saudi Arabia.7,8 An increasing incidence of non-typhoidal salmonellosis has been noted throughout the world11 and the same trend can be expected in Saudi Arabia. Another important problem is the increase of antimicrobial resistance in Salmonella, as recently reported by several authors.12-14 There are only a few published studies of salmonella infections in Saudi Arabia, most focusing on Pediatric patients.7-9 One such study was an attempt to evaluate the susceptibility pattern in different Serogroups of salmonellas.9 The majority


From the Department of Pediatrics (Al-Zamil) and the Department of Medicine (Al-Anazi), Infectious Diseases Unit, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.

Received 26th August 2000. Accepted for publication in final form 24th October 2000.

Address correspondence and reprint request to: Dr. Fahad A. Al-Zamil, Assistant Professor of Pediatrics, Pediatrics Consultant of Infectious Diseases, Department of Pediatrics, Box 39, College of Medicine and King Khalid University Hospital, King Saud University, PO Box 2925, Riyadh 11461, Kingdom of Saudi Arabia. Tel. +966 (1) 4670875/4670807. Fax. +966 (1) 4679463.



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