Current Antimicrobial Susceptibility Trends and Clinical Outcomes of Typhoidal <i>Salmonella</i> in a Large Health Authority in British Columbia, Canada
Background: From 2018 to 2021, travel-related extensively drug-resistant (XDR) <i>Salmonella</i> Typhi was identified in Ontario, Canada. Opportunities remain to characterize typhoidal <i>Salmonella</i> antimicrobial susceptibility trends (including multi-drug resistance phen...
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MDPI AG
2025-04-01
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| Series: | Tropical Medicine and Infectious Disease |
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| author | Calvin Ka-Fung Lo Merisa Mok Cole Schonhofer Kevin Afra Shazia Masud |
| author_facet | Calvin Ka-Fung Lo Merisa Mok Cole Schonhofer Kevin Afra Shazia Masud |
| author_sort | Calvin Ka-Fung Lo |
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| description | Background: From 2018 to 2021, travel-related extensively drug-resistant (XDR) <i>Salmonella</i> Typhi was identified in Ontario, Canada. Opportunities remain to characterize typhoidal <i>Salmonella</i> antimicrobial susceptibility trends (including multi-drug resistance phenotypes; MDR) within a large health authority in British Columbia, Canada. Methods: This retrospective study included patients with <i>Salmonella</i> Typhi or Paratyphi A, B or C bacteremia identified at Fraser Health regional microbiology laboratory from 2018 to 2024. The primary outcome was the proportion of cases with MDR and XDR typhoidal <i>Salmonella</i>. Secondary outcomes included annual antimicrobial susceptibility for ampicillin, ceftriaxone, ciprofloxacin, trimethoprim-sulfamethoxazole, ertapenem, meropenem and azithromycin. Clinical outcomes included hospitalization length, and 30-day mortality, clinical cure and infection relapse. Results: Among 271 patients, most were previously healthy and recently travelled. There were extended spectrum beta-lactamase (1.1%) and MDR (1.5%) typhoidal <i>Salmonella</i>, with no XDR cases observed. In 2024, ciprofloxacin resistance was 96% while susceptibility rates were high for other studied antimicrobials. Within 30 days, no deaths were reported; however, six patients (3%) had infection relapse. Conclusions: Currently, in British Columbia, MDR typhoidal <i>Salmonella</i> remains rare. Empiric ciprofloxacin should be avoided due to persistently high resistance rates. With ongoing travel patterns, it is beneficial for institutions to continue typhoidal <i>Salmonella</i> antimicrobial susceptibility surveillance, and travelers should seek pre-travel health assessments. |
| format | Article |
| id | doaj-art-e1bed3d50706451aa73852d3494eab2f |
| institution | OA Journals |
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| language | English |
| publishDate | 2025-04-01 |
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| series | Tropical Medicine and Infectious Disease |
| spelling | doaj-art-e1bed3d50706451aa73852d3494eab2f2025-08-20T02:25:12ZengMDPI AGTropical Medicine and Infectious Disease2414-63662025-04-0110410810.3390/tropicalmed10040108Current Antimicrobial Susceptibility Trends and Clinical Outcomes of Typhoidal <i>Salmonella</i> in a Large Health Authority in British Columbia, CanadaCalvin Ka-Fung Lo0Merisa Mok1Cole Schonhofer2Kevin Afra3Shazia Masud4Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, CanadaAntimicrobial Stewardship Program, Fraser Health, Burnaby, BC V5G 2X6, CanadaDepartment of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, CanadaDivision of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 3J5, CanadaDepartment of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, CanadaBackground: From 2018 to 2021, travel-related extensively drug-resistant (XDR) <i>Salmonella</i> Typhi was identified in Ontario, Canada. Opportunities remain to characterize typhoidal <i>Salmonella</i> antimicrobial susceptibility trends (including multi-drug resistance phenotypes; MDR) within a large health authority in British Columbia, Canada. Methods: This retrospective study included patients with <i>Salmonella</i> Typhi or Paratyphi A, B or C bacteremia identified at Fraser Health regional microbiology laboratory from 2018 to 2024. The primary outcome was the proportion of cases with MDR and XDR typhoidal <i>Salmonella</i>. Secondary outcomes included annual antimicrobial susceptibility for ampicillin, ceftriaxone, ciprofloxacin, trimethoprim-sulfamethoxazole, ertapenem, meropenem and azithromycin. Clinical outcomes included hospitalization length, and 30-day mortality, clinical cure and infection relapse. Results: Among 271 patients, most were previously healthy and recently travelled. There were extended spectrum beta-lactamase (1.1%) and MDR (1.5%) typhoidal <i>Salmonella</i>, with no XDR cases observed. In 2024, ciprofloxacin resistance was 96% while susceptibility rates were high for other studied antimicrobials. Within 30 days, no deaths were reported; however, six patients (3%) had infection relapse. Conclusions: Currently, in British Columbia, MDR typhoidal <i>Salmonella</i> remains rare. Empiric ciprofloxacin should be avoided due to persistently high resistance rates. With ongoing travel patterns, it is beneficial for institutions to continue typhoidal <i>Salmonella</i> antimicrobial susceptibility surveillance, and travelers should seek pre-travel health assessments.https://www.mdpi.com/2414-6366/10/4/108typhoidparatyphoid<i>Salmonella</i> Typhityphoidal <i>Salmonella</i>antimicrobial resistance |
| spellingShingle | Calvin Ka-Fung Lo Merisa Mok Cole Schonhofer Kevin Afra Shazia Masud Current Antimicrobial Susceptibility Trends and Clinical Outcomes of Typhoidal <i>Salmonella</i> in a Large Health Authority in British Columbia, Canada Tropical Medicine and Infectious Disease typhoid paratyphoid <i>Salmonella</i> Typhi typhoidal <i>Salmonella</i> antimicrobial resistance |
| title | Current Antimicrobial Susceptibility Trends and Clinical Outcomes of Typhoidal <i>Salmonella</i> in a Large Health Authority in British Columbia, Canada |
| title_full | Current Antimicrobial Susceptibility Trends and Clinical Outcomes of Typhoidal <i>Salmonella</i> in a Large Health Authority in British Columbia, Canada |
| title_fullStr | Current Antimicrobial Susceptibility Trends and Clinical Outcomes of Typhoidal <i>Salmonella</i> in a Large Health Authority in British Columbia, Canada |
| title_full_unstemmed | Current Antimicrobial Susceptibility Trends and Clinical Outcomes of Typhoidal <i>Salmonella</i> in a Large Health Authority in British Columbia, Canada |
| title_short | Current Antimicrobial Susceptibility Trends and Clinical Outcomes of Typhoidal <i>Salmonella</i> in a Large Health Authority in British Columbia, Canada |
| title_sort | current antimicrobial susceptibility trends and clinical outcomes of typhoidal i salmonella i in a large health authority in british columbia canada |
| topic | typhoid paratyphoid <i>Salmonella</i> Typhi typhoidal <i>Salmonella</i> antimicrobial resistance |
| url | https://www.mdpi.com/2414-6366/10/4/108 |
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