Current Antimicrobial Susceptibility Trends and Clinical Outcomes of Typhoidal Salmonella in a Large Health Authority in British Columbia, Canada
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Enteric Fever Incidence and Patients’ Baseline Characteristics
3.2. Antimicrobial Susceptibility Trends
3.2.1. Key Findings
3.2.2. S. Typhi Antimicrobial Susceptibility
3.2.3. S. Paratyphi Antimicrobial Susceptibility
3.2.4. Impact of Carbapenemase Colonization on Antimicrobial Susceptibility Results
3.3. Clinical Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
XDR | Extensively drug-resistant |
AMR | Antimicrobial resistance |
MDR | Multi-drug-resistant |
TMP-SMX | Trimethoprim–sulfamethoxazole |
IQR | Interquartile range |
ESBL | Extended spectrum beta-lactamase |
MIC | Minimum inhibitory concentration |
OXA-48 | Oxacillinase-48 |
NDM | New Delhi metallo-beta-lactamase |
CLSI | Clinical and Laboratory Standards Institute |
CIPARS | Canadian Integrated Program for Antimicrobial Resistance Surveillance |
Appendix A
Characteristic | n (%) |
---|---|
Concurrent infections with other pathogens | |
None | 236 (87%) |
Clostridioides difficile, Shigella, Norovirus or Campylobacter | 17 (6.3%) |
Other | 17 (6.3%) |
Colonization with carbapenemase | 19 (7.0%) |
New Delhi metallo-beta-lactamase (NDM) | 11 (4.0%) |
Oxacillinase-48 (OXA-48) | 8 (3.0%) |
Enteric fever cases by year | |
2018 | 38 (14%) |
2019 | 44 (16%) |
2020 | 16 (6%) |
2021 | 8 (3%) |
2022 | 48 (18%) |
2023 | 63 (23%) |
2024 | 54 (20%) |
Antibiotic used 1 | |
Ceftriaxone | 260 (98%) |
Piperacillin and tazobactam | 25 (9%) |
Ciprofloxacin | 25 (9%) |
Trimethoprim-sulfamethoxazole | 20 (8%) |
Ertapenem | 11 (4%) |
Meropenem | 28 (11%) |
Azithromycin | 153 (58%) |
Amoxicillin or ampicillin | 19 (7%) |
Initially presented to Fraser Health acute care site | |
Abbotsford Regional Hospital | 37 (13.7%) |
Burnaby Hospital | 2 (0.7%) |
Chilliwack General Hospital | 5 (1.8%) |
Delta Hospital | 35 (12.9%) |
Eagle Ridge Hospital | 4 (1.5%) |
Fraser Canyon Hospital | 0 (0%) |
Jim Pattison Outpatient Care and Surgical Centre | 0 (0%) |
Langley Memorial Hospital | 16 (5.9%) |
Mission Memorial Hospital | 4 (1.5%) |
Peace Arch Hospital | 27 (10%) |
Ridge Meadows Hospital | 3 (1.1%) |
Royal Columbian Hospital | 13 (4.8%) |
Surrey Memorial Hospital | 125 (46.1%) |
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Characteristics | N (%) of Cases Unless Specified |
---|---|
Median age in years (IQR) | 29 (20 to 42) |
Age group: | |
2 years or less | 11 (4%) |
3–17 years | 48 (18%) |
18–29 years | 83 (31%) |
30–39 years | 53 (19%) |
40–49 years | 32 (12%) |
50–59 years | 25 (9%) |
60 years or above | 19 (7%) |
Sex, male | 137 (51%) |
Median Charlson Comorbidity Index Score (IQR) | 0 (0 to 0) |
Recent travel history within last 3 months | 259 (96%) |
South Asia | 247 |
India | 233 |
Pakistan | 9 |
Other | 5 |
Southeast Asia | 18 |
Latin America, North America, Middle East or East Asia | 16 |
Potentially consumed contaminated food or water during travel | 75 (28%) |
Primary acute care service | |
Medical | 266 (98.1%) |
Surgical | 1 (0.4%) |
Intensive care | 4 (1.5%) |
Infectious Diseases consultation | 202 (75%) |
Presentation 1 | |
Fever | 262 (97.8%) |
Chills | 87 (32.5%) |
Malaise | 65 (24.3%) |
Headache | 96 (35.8%) |
Confusion | 6 (2.2%) |
Tachycardia | 56 (20.9%) |
Hypotension | 31 (11.6%) |
Tachypnea | 8 (3.0%) |
Abdominal pain, constipation, diarrhea, nausea or vomiting | 197 (73.5%) |
Rash | 8 (3.0%) |
Joint pain | 8 (3.0%) |
Leukocytosis or leukopenia | 44 (16.4%) |
Thrombocytopenia | 10 (3.7%) |
Anemia | 10 (3.7%) |
Elevated liver function tests | 63 (23.5%) |
Sepsis or septic shock | 4 (1.5%) |
Meningitis | 1 (0.4%) |
Intestinal perforation | 2 (0.74%) |
Blood culture with | |
Salmonella Typhi | 166 (61%) |
Salmonella Paratyphi A | 98 (36%) |
Salmonella Paratyphi B | 7 (3%) |
Salmonella Paratyphi C | 0 (0%) |
Typhoid drug resistance phenotype 2 | |
Extended spectrum beta-lactamase (ESBL) | 3 (1.1%) |
Multi-drug-resistant (MDR) | 4 (1.5%) |
Extensively drug-resistant (XDR) | 0 (0%) |
Median total duration of effective antibiotics (IQR) 3 | 12 (10 to 14) |
Surgical intervention for intestinal perforation | 2 (0.74%) |
Antimicrobial | Susceptibility Rate (%) Stratified by Year | ||||||
---|---|---|---|---|---|---|---|
2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | |
Ampicillin | 92% | 100% | 90% | 67% | 97% | 100% | 95% |
Ceftriaxone | 96% | 100% | 100% | 83% | 100% | 100% | 98% |
Ciprofloxacin | 12% | 8% | 0% | 16.7% | 3% | 11% | 0% |
TMP-SMX | 96% | 100% | 90% | 83% | 97% | 100% | 98% |
Ertapenem | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
Meropenem | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
Azithromycin | No data | 100% | 100% | 100% | 97% | 100% | 100% |
Antimicrobial | Susceptibility Rate (%) Stratified by Year | ||||||
---|---|---|---|---|---|---|---|
2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | |
Ampicillin | 38% | 60% | 100% | 100% | 100% | 100% | 100% |
Ceftriaxone | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
Ciprofloxacin | 0% | 10% | 17% | 0% | 7% | 3% | 15% |
TMP-SMX | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
Ertapenem | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
Meropenem | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
Azithromycin | No data | 100% | 100% | 100% | 100% | 97% | 100% |
Outcome | n (%) Unless Otherwise Specified |
---|---|
Mortality within 30 days 1 | 0 (0%) |
Clinical cure within 30 days 1 | 186 (97%) |
Relapse of infection within 30 days 1 | 6 (3%) |
Median hospitalization length (days, IQR) | 1 (1 to 4 days) |
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Lo, C.K.-F.; Mok, M.; Schonhofer, C.; Afra, K.; Masud, S. Current Antimicrobial Susceptibility Trends and Clinical Outcomes of Typhoidal Salmonella in a Large Health Authority in British Columbia, Canada. Trop. Med. Infect. Dis. 2025, 10, 108. https://doi.org/10.3390/tropicalmed10040108
Lo CK-F, Mok M, Schonhofer C, Afra K, Masud S. Current Antimicrobial Susceptibility Trends and Clinical Outcomes of Typhoidal Salmonella in a Large Health Authority in British Columbia, Canada. Tropical Medicine and Infectious Disease. 2025; 10(4):108. https://doi.org/10.3390/tropicalmed10040108
Chicago/Turabian StyleLo, Calvin Ka-Fung, Merisa Mok, Cole Schonhofer, Kevin Afra, and Shazia Masud. 2025. "Current Antimicrobial Susceptibility Trends and Clinical Outcomes of Typhoidal Salmonella in a Large Health Authority in British Columbia, Canada" Tropical Medicine and Infectious Disease 10, no. 4: 108. https://doi.org/10.3390/tropicalmed10040108
APA StyleLo, C. K.-F., Mok, M., Schonhofer, C., Afra, K., & Masud, S. (2025). Current Antimicrobial Susceptibility Trends and Clinical Outcomes of Typhoidal Salmonella in a Large Health Authority in British Columbia, Canada. Tropical Medicine and Infectious Disease, 10(4), 108. https://doi.org/10.3390/tropicalmed10040108