Increasing ceftriaxone resistance in Salmonella isolates from a university hospital in Taiwan

Objectives: Salmonella infection is a distressing health problem worldwide. This study reports the changing epidemiology of Salmonella infections in Taiwan during 1999-2003, with emphasis on increasing ceftriaxone resistance. Methods: Records of Salmonella clinical isolates in Chang Gung Memorial Hospital during 1999-2003 were reviewed. All isolates were identified and antimicrobial susceptibility determined by standard methods. A total of 22 ceftriaxone-resistant isolates were investigated by PCR sequencing of the bla(TEM), bla(SHV), bla(CTX-M) and ampC genes. Southern-blot hybridization was used to localize the ampC gene. Infrequent-restriction-site PCR was used to genotype these isolates. Results: A total of 3635 Salmonella isolates, including 3592 (98.8%) non-typhoid Salmonella, were identified. Serogroup B (55.6%) remained the most predominant, but the prevalence has been decreasing. In contrast, serogroup D infections have increased significantly from 13.6 to 22.8%. Overall resistance to ampicillin and chloramphenicol remained high, with the highest rate (91% to both drugs) observed in Salmonella enterica serotype Choleraesuis in 2003. A sudden upsurge of ciprofloxacin resistance from zero to 69% was found in S. Choleraesuis. Ceftriaxone resistance increased in several serogroups (0.8-2.1%; average, 1.5%). The resistance was associated with plasmid-mediated bla(CMY-2) in 14 cases and extended-spectrum beta-lactamases (ESBLs), including CTX-M-3 (n = 6), SHV-2a (n = 1) and SHV-12 (n = 1), in others. Diverse serotypes and genotypes were found among the ceftriaxone-resistant isolates. Conclusions: Increasing ceftriaxone resistance in non-typhoid Salmonella appears to link to the spread of plasmid-mediated ampC or ESBL genes. Effective measures should be taken to prevent the problem worsening.