2010. Severity of antimicrobial-resistant non-Typhoidal Salmonella infections treated in two large facilities of a health system in Pennsylvania, 2018-2020

Abstract

Abstract Background Nontyphoidal Salmonella (NTS) is a leading cause of foodborne illness. Characterization of clinical outcomes of salmonellosis from antimicrobial-resistant (AMR) NTS is limited. The Pennsylvania Department of Health collaborated with federal and academic partners to enhance surveillance for NTS (AMR and outcomes). Methods We evaluated 82 patients with salmonellosis whose NTS isolates were submitted to the PA Public Health Laboratory during 2018–2020 from two Pennsylvania hospitals. We used broth microdilution to test NTS isolates for susceptibility to antibiotics tracked by the National Antimicrobial Resistance Monitoring System. Isolates resistant to ≥3 antimicrobial classes were considered multidrug-resistant (MDR). Electronic medical records of source patients were reviewed for medical history, diagnoses, treatment, and outcomes. Invasive infection was defined as isolation from normally sterile sites (e.g., blood). Results Seven (9%) of 82 isolates were MDR. Twelve (15%) had decreased susceptibility to ciprofloxacin (MIC ≥0.12 µg/mL), 3 (4%) were ceftriaxone resistant, 3 (4%) were trimethoprim-sulfamethoxazole resistant, and 1 (1%) was azithromycin resistant. The median patient age was 29 years; 31 (38%) patients were ≤18 years and 42 (51%) were female. Nearly a quarter of all patients were immunosuppressed (Figure). Outcomes included hospital admission in 38 (46%), intensive care for 5 (6%) patients, and 1 (1%) death. Ten (12%) patients had invasive infections, including 8 with bacteremia; all were hospitalized. Four (40%) of the invasive disease isolates were resistant to ≥1 antimicrobial, compared with 16 (22%) isolates from patients with the non-invasive disease. Fifty-seven (70%) patients were prescribed empiric antimicrobials for their infection. Antibiotics were changed in 45 (79%) after laboratory diagnosis. Demographic and clinical characteristics of patients with nontyphoidal Salmonella treated in two facilities associated with a health system in Pennsylvania, 2018–2020. The five patients treated in intensive care units are included in the total admissions (n=38). Salmonellosis was considered invasive if the organism was isolated from the blood or other normally sterile site (excluding urine). Conclusion NTS can cause severe invasive illness in some patients; drug-resistant NTS infections may be associated with more severity as compared with susceptible NTS. Resistance to clinically consequential drugs coupled with the severity of infections suggests the need for antimicrobial stewardship and highlights the value of clinical data in enhancing surveillance for salmonellosis. Disclosures All Authors: No reported disclosures.