Epidemiological Investigation of Salmonella enterica Isolates in Children with Diarrhea in Chengdu, China

Abstract

Background: Children with the immature intestinal immune system are prone to Salmonella infection through the fecal-oral route causing diarrhea. Non-typhoid Salmonella (NTS) is difficult to treat and eliminate due to its zoonosis. Salmonella typhi, including typhoid and paratyphoid A, B, and C, only infect humans and cause invasive infectious diseases. Salmonella typhi infection is serious and requires antibiotic treatment. The bacterial resistance caused by conventional antibacterial drugs brings great difficulties to treatment. Objectives: This study aimed to investigate the epidemiology of S. enterica in children with diarrhea in Chengdu, China. Methods: Fresh stool specimens or rectal swabs from 6656 children aged 1 day to 13 years with diarrhea were collected, cultured, identified, and tested for antimicrobial susceptibility. Analytical Profile index 20E was used for biochemical identification, and the Kirby-Bauer method was used for the bacterial sensitivity test. The whole process was conducted in accordance with the fourth edition of the National Clinical Examination procedures, and the drug sensitivity test was conducted in accordance with the Clinical and Laboratory Standards Institute 2020 guidelines. Results: A total of 649 Salmonella strains were isolated from 6656 children with suspected Salmonella infection, among which the isolation rates of NTS and S. typhi were 8.92% and 0.83%, respectively. The infection rate of S. typhimurium was the highest every year (74.88%). Salmonella infections are on the rise, especially typhimurium, Dublin, Typhi, and London. Paratyphi is unstable, presenting a phenomenon of transition and replacement (the male to female ratio:1.12:1). The infection rate was the lowest within 1 day and 6 months (P < 0.05). Salmonella mainly infected children under 3 years of age, and the positive rate was reported as 88.29%. Within June-September, the infection rate of Salmonella was the highest, with a positive rate of 72.73%. The isolated 649 Salmonella strains had good susceptibility to cefotaxime and ciprofloxacin (87.67% and 79.20%, respectively), almost no susceptibility to ampicillin, and a drug resistance rate of 92.91%. Conclusions: The typhoid and paratyphoid vaccines should be considered together, and vaccines should focus on children under 3 years of age. Antibiotics should be rationally selected according to the drug sensitivity test and disease condition.