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

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 doi: http://dx.doi.org/
 

 

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.

 

References

1. Kazemi M, Gumpest G, Masks MI. Clinical spectrum and carrier state of non-typhoidal Salmonella infections in infants and children. Can Med Assoc J 1974; 110: 1253-1257.P>

2. Yamanoto LG, Ashton MG. Salmonella infection in infants in Hawaii. Pediatr Infect Dis J 1988; 7: 48-52.P>

3. MacDonald KL, Cohen ML, Hapgrett-Bean NT, Wells JG, Puhr ND, Collin SF et al. Changes in antimicrobial resistance of salmonella isolated from human in the United States. JAMA 1987; 258: 1496-1499.P>

4. Lee LA, Puhr ND, Maloney EKC, Bean NH, Tause RV. Increase in antimicrobial resistance in salmonella infections in the United States, 1989-1990. J Infect Dis 1994; 170: 128-134.P>

5. Anand AC, Katarin VK, Singh W, Chatterjee SU. Epidemic multiresistant enteric fever in Eastern India. Lancet 1990; 315: 352.P>

6. Akhtar MA, Karamat KA, Malik AZ, Hashim A, Khan QM, Rashid P. Efficacy of ofloxacin in typhoid fever, particularly in drug resistant cases. Rev Infect Dis 1989; 2 Suppl 5: S1193.P>

7. Gaafar MM, Hameed AA, Walid A, Mohamed M, Ahmed EB. Salmonella infection in Asir region, Southern Saudi Arabia: Expatriate implications. Annals of Saudi Medicine 1993; 13: 242-245.P>

8. Peter J, Gosling AIMLS, Mohammed AK. Salmonella Gastroenteritis in Jeddah: A study of 1017 patients over a fourteen-month period. Saudi Med J 1983; 4: 61-66.P>

9. Kambal AM, Chowdhury MNH, Al-Eissa YA, Al-Zamil FA, Al-Kharashi MA. Salmonella gastroenteritis in children; experience at teaching hospital in Riyadh Saudi Arabia. Medical Science Research 1992; 20: 149-151.P>

10. National Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobiologically. 2nd ed. Approved Standard. USA: NCCLS document M7-A2 Villnova, PA: NCCLS; 1990.P>

11. Cohen ML, Tauxe RV. Drug-resistant Salmonella in the United States, an epidemiologic perspective. Science 1986; 234: 964-969.P>

12. Maiorini E, Lopez EL, Morrow AL, Ramirez F, Procopio A, Furkenski S et al. Multiple resistant non-typhoidal salmonella gastroenteritis in children. Pediatr Infect Dis J 1993; 12: 139-144.P>

13. Chin HY, Tsen HH, Hehen KJ, Lui JD. Salmonella infections. Retrospective 10-year Analysis of 134 cases in a Regional Hospital in Taiwan. Scand J Infect Dis 1996; 28: 171-175.P>

14. Chiu CH, Lin TY, Ou JT. A clinical trial comparing oral azithromycin, cefixime and no antibiotics in the treatment of acute uncomplicated Salmonella enteritis in children. J Paediatr Child Health 1999; 35: 372-374.P>

15. Al-Rajab WJ, Abdullah BA, Shareef AY. Salmonella responsible for infantile gastroenteritis in Mosur, Iraq. J Trop Med Hyg 1988; 91: 315-318.P>

16. Osisanya JOS, Daniel SO, Sehgal SC, Afigbo A, Iyanda A, Okoro FI et al. Acute diarrhoeal disease in Nigeria: detection of enteropathogens in a rural Sub-Saharan population. Trans R Soc Trop Med Hyg 1988; 82: 773-777.P>

17. Khuffash FA, Majeed HA, Sethi SK, Al-Nakilo W. Gastroenteritis in a regional hospital in Kuwait: Some aspects of the disease. Ann Trop Paediatr 1982; 2: 123-128.P>

18. Hussain Qadri SM, Khaled AQ, Haysam TT, Buske AC. Etiology of a bacterial diarrhoea in a major referral center in Saudi Arabia. Annals of Saudi Medicine 1991; 11: 633-636.P>

19. Lee WS, Puthucheasy SD, Boey CCM. Non-typhoid Salmonella gastroenteritis. J Paediatr Child Health 1998; 34: 387-390.P>

20. Al-Eissa Y, Al-Zamil F, Al-Kharashi M, Kambal A, Chowdhury M, Al-Ayed I. The Relative Importance of Shigella in the Aetiology of Childhood Gastroenteritis in Saudi Arabia 1992. Scand J Infect Dis 1992; 24: 347-351.P>

21. Chowdhury MNH, El-Idrissy ATH, Al-Sowaygh IA. Bacterial gastroenteritis in children in Riyadh. Proceedings of the 5th Saudi Medical Meeting; 1980 29 April - 1 May; Riyadh, Saudi Arabia. Riyadh (KSA): College of Medicine, Uni



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