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Infections with Salmonella enterica serovar Typhi isolates that are multidrug resistant (MDR: resistant to chloramphenicol, ampicillin, trimethoprim-sulphamethoxazole) with intermediate ciprofloxacin susceptibility are widespread in Asia but there is little information from Cambodia. We studied invasive salmonellosis in children at a paediatric hospital in Siem Reap, Cambodia. Between 2007 and 2011 Salmonella was isolated from a blood culture in 162 children. There were 151 children with enteric fever, including 148 serovar Typhi and three serovar Paratyphi A infections, and 11 children with a non-typhoidal Salmonella infection. Of the 148 serovar Typhi isolates 126 (85%) were MDR and 133 (90%) had intermediate ciprofloxacin susceptibility. Inpatient antimicrobial treatment was ceftriaxone alone or initial ceftriaxone followed by a step-down to oral ciprofloxacin or azithromycin. Complications developed in 37/128 (29%) children admitted with enteric fever and two (1.6%) died. There was one confirmed relapse. In a sample of 102 serovar Typhi strains genotyped by investigation of a subset of single nucleotide polymorphisms, 98 (96%) were the H58 haplotype, the majority of which had the common serine to phenylalanine substitution at codon 83 in the DNA gyrase. We conclude that antimicrobial-resistant enteric fever is common in Cambodian children and therapeutic options are limited.

Original publication

DOI

10.1016/j.trstmh.2012.08.007

Type

Journal article

Journal

Transactions of the Royal Society of Tropical Medicine and Hygiene

Publication Date

12/2012

Volume

106

Pages

718 - 724

Addresses

Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.

Keywords

Humans, Salmonella typhi, Typhoid Fever, Ceftriaxone, Azithromycin, Ciprofloxacin, Anti-Infective Agents, Treatment Outcome, Microbial Sensitivity Tests, Child Mortality, Retrospective Studies, Cross-Sectional Studies, Age Distribution, Drug Resistance, Multiple, Bacterial, Haplotypes, Polymorphism, Single Nucleotide, Adult, Child, Child, Preschool, Hospitals, Pediatric, Cambodia, Female, Male