Salmonella Infections among Pediatric Population in Qatar: Phenotypic Resistance and Associated Genotypic Determinants

Abstract

Salmonella is a significant public health burden worldwide and being the most common bacterial diarrheal illness among infants and young children. In the last few years, Qatar reports a high incidence of salmonellosis outbreaks coupled with a significant increase of Multidrug-Resistant (MDR) among pediatric populations every year. This study aims to elucidate the molecular mechanisms underlying resistance to ceftriaxone, cefepime, amoxicillinclavulanate tetracycline, trimethoprim-sulfamethoxazole, chloramphenicol, and azithromycin among Salmonella isolated from the pediatric population. A total of 246 Salmonella isolates were collected from children under 18 years old admitted to the Pediatric Emergency Center (PEC), Hamad Medical Corporation (HMC) from Jan. 2018 to Dec 2019 with gastroenteritis. Isolates were tested for antibiotic susceptibility against nineteen relevant antibiotics using E-test. Resistance was confirmed using PCR-specific primers for 38 genes. Resistance was detected against 14 antibiotics, and 38.2% of isolates were resistant to at least one antibiotic. Overall, we reported 23.9%, resistance to tetracycline 21.1%, ampicillin 18.7%, AMC, and 13% sulfamethoxazole-trimethoprim. Further, 16.2% of the isolates were Multidrug-Resistant (MDR), with 4.1% being Extended-Spectrum Β Lactamase (ESBL) producers. 90% of ESBL producers harbored one of bla CTX-M-Group. Class 1 AMC resistant samples showed the highest resistance to different antibiotics. Our results indicate a high antimicrobial resistance pattern of Salmonella and the presence of Class (1) cassette that involves the transmission and expression of the resistance among AMC resistance isolates, which might lead to increased multi-drug resistance. This study provides evidence guidance to activate and implement the pillars of an antimicrobial stewardship program in human health to reduce MDR salmonellosis.