The Clinical Implication of Serogroup Distribution and Drug Resistance of Non-Typhoidal Salmonella in Children: A Single Center Study in Southern Taiwan during 2004-2019.

Background: A regional antibiotic susceptibility database of certain pathogens is crucial for first-line physicians in terms of providing clinical judgement and appropriate selection of antimicrobial agents. The aim of this study is to update the epidemiological data of Salmonella serogroups and drug resistance in pediatric patients. Methods: This is a single-center retrospective study enrolling patients aged from 0 to 18 years who were hospitalized with cultured proven non-typhoidal Salmonella (NTS) infection from 2004 to 2019. The isolates were collected and the demographic data, serogroups of Salmonella and antimicrobial susceptibilities were further analyzed. Results: A total of 1583 isolates of NTS were collected. Serogroup C2 was prone to cause invasive non-typhoidal salmonellosis (iNTS), especially bacteremia. Patients aged < 2 years were associated with serogroups B and C2 infection, while those aged ≥ 2 years were associated with serogroups D and E infection. The prevalence of serogroup B declined with simultaneous increase in prevalence of serogroups D and E. Serogroups B and E were associated with ceftriaxone resistance, while Serogroup D was less drug-resistant than the others. The prevalence of ceftriaxone-resistant Salmonella had not increased, although more ciprofloxacin-resistant isolates were found in iNTS infection. Conclusions: Age < 2 years is a risk factor of iNTS for children, and the distribution of serogroup changes should be closely monitored. Ceftriaxone is still the drug of choice for treating pediatric iNTS infection, and although no increase was observed in the prevalence of ceftriaxone-resistant strains in this study, continuing surveillance of such cases is warranted.

The antimicrobial susceptibility in adult invasive pneumococcal disease in the era of pneumococcus vaccination: A hospital-based observational study in Taiwan.

BACKGROUND: A regional antibiotic susceptibility data of common pathogens is crucial to first-line physician for clinical judgment and appropriate selection of antimicrobial agents. The aim of this study is to update the epidemiology data of drug resistance of pneumococcus causing invasive pneumococcal disease (IPD) in adults. METHODS: From the logbooks of microbiology laboratories, we retrospectively retrieved Streptococcus pneumoniae isolates, collected from normally sterile sites in adult patients in three hospitals in Taiwan from July 2011 to June 2015. Antibiotic resistance and serotypes of the isolates and clinical manifestations were further analyzed. RESULTS: A total of 150 non-duplicated isolates were collected. According to CLSI meningitis breakpoint, the proportion of ceftriaxone non-susceptible pneumococcus (CNSP) showed an increasing trend from 4.5% in 2011 to > 40% in 2013-2015 (p = 0.007). Serotypes 19A and 23F were significantly associated with CNSP. Imipenem and meropenem had a relative low susceptible rate of 36.7% and 50.7%, respectively. Serotypes 6A, 14, 19A and 19F were significantly associated with the non-susceptibility to these carbepanems. CONCLUSION: The increase in the prevalence of CNSP using meningitis breakpoint was observed. For treating pneumococcal meningitis, empirical monotherapy with ceftriaxone might not be adequate. Imipenem and meropenem might not be a good choice for empirical treatment of adult IPDs. Antibiotic resistance of pneumococcus to ceftriaxone, cefepime, imipenem and meropenem were associated with 13-velent pneumococcal conjugate vaccine serotypes.

The clinical implication of serotype distribution and drug resistance of invasive pneumococcal disease in children: A single center study in southern Taiwan during 2010-2016.

BACKGROUND: The regional study of pediatric invasive pneumococcal disease (IPD) is still limited in Taiwan. The aim of this study is to update the epidemiologic data of pediatric IPD in Taiwan, focusing on the trend of non-13-valent pneumococcal conjugate vaccines (PCV13)-specific serotypes and antimicrobial susceptibility. METHODS: This was a single-center retrospective study by chart reviewing and recruited patients aged <18 years who were reported having IPD between January 2010 and December 2016. Clinical manifestations, serotypes of pneumococcus and antimicrobial susceptibility were compared and analyzed. RESULTS: A total of 46 patients were enrolled in this study. Serotype 19 A was the most common serotype (32.6%) in pediatric IPD and significantly correlated with empyema. Non-PCV13-specific serotypes such as serotype 15, 15B, 15C and 22 were reported during this period. There was no mortality or significant morbidity associated with these emerging strains. Using the meningitis breakpoint of minimum inhibitory concentration (MIC), although it showed no significant linear trend of the prevalence of ceftriaxone non-susceptible pneumococcus (CNSP) (p = 0.392), the prevalence of CNSP increased from 50% (11 over 22) before 2013 to 83% (20 over 24) after 2013 with statistical significance (p = 0.027). CONCLUSION: The increase in the prevalence of CNSP using meningitis breakpoint was observed since 2013. For treating pneumococcal meningitis, empirical therapy with vancomycin and ceftriaxone is warranted. Although the non-PCV13-specific serotypes reported in our study caused no morbidity and mortality, further monitoring and surveillance are still recommended.