Changing epidemiology of invasive non-typhoid Salmonella infection: a nationwide population-based registry study

Lapo Mughini-Gras; Roan Pijnacker; Janneke Duijster; Max Heck; Ben Wit; Kees Veldman; Eelco Franz

doi:10.1016/j.cmi.2019.11.015

Changing epidemiology of invasive non-typhoid Salmonella infection: a nationwide population-based registry study

Lapo Mughini-Gras
, Roan Pijnacker
, Janneke Duijster
, Max Heck
, Ben Wit
, Kees Veldman
, Eelco Franz

From the *National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control (CIb), Bilthoven, the Netherlands; †Department of Infectious Diseases and Immunology, Utrecht University, Utrecht, the Netherlands; and ‡Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands.
Netherlands Food and Consumer Product Safety Authority, Wageningen, the Netherlands.
Wageningen BioVeterinary Research (WBVR), Lelystad, the Netherlands.

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: Non-typhoid Salmonella (NTS) may invade beyond the intestine, causing bacteraemia, sepsis, and infection of normally sterile sites. The epidemiology of invasive NTS (iNTS) infection is under-researched. We determined trends, risk factors, serotype distribution, antimicrobial resistance (AMR), and attributable sources of iNTS infection in a high-income setting.

METHODS: 22,837 records of culture-confirmed human salmonellosis cases and 10,008 serotyped Salmonella isolates from five putative animal reservoirs (pigs, cattle, broilers, layers, reptiles) in the Netherlands during 2005-2018 were retrieved from national surveillance registries. Risk factors for iNTS infection were identified using logistic regression analysis. Source attribution modelling was based on serotyping, prevalence, and exposure data.

RESULTS: The average annual percentage of iNTS infections was 4.6% (range: 3.5-5.7%). An increase in iNTS infections was observed since 2012 (Odds Ratio [OR]: 1.09, 95% Confidence Interval [95%CI]: 1.04-1.14). Increased iNTS infection risk was associated with wintertime (OR: 1.37, 95%CI: 1.12-1.66), male sex (OR: 1.73, 95%CI: 1.51-1.99), older age (ORs: 3.27 to 16.33, depending on age groups), and living in rural areas (OR: 1.54, 95%CI: 1.23-1.93). While 52% of iNTS infections (n=950) were caused by serotypes Enteritidis and Typhimurium, those displaying the highest invasiveness relative to their occurrence were Dublin (32.9%, n=163), Panama (21.6%, n=106), and Poona (14.1%, n=71). Cattle were a larger source of iNTS than non-iNTS infections (12.2% vs. 7.6%). Lower AMR and multi-resistance rates were observed among iNTS (37.9%) than non-iNTS isolates (48.6%).

CONCLUSIONS: The increase in iNTS infections, which is reported also in other countries, is of public health and clinical concern. The underlying reasons seem to be multi-factorial in nature. iNTS infection risk depends more on the infecting serotypes and patient demographics, and less on the attributable reservoirs and AMR profiles.

Original language	English
Journal	Clinical Microbiology and Infection
Volume	26
Issue number	7
Early online date	21 Nov 2019
DOIs	https://doi.org/10.1016/j.cmi.2019.11.015
Publication status	Published - 21 Nov 2019

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10.1016/j.cmi.2019.11.015

PIIS1198743X19306147Final published version, 268 KBLicence: Taverne

Cite this

@article{d3b01fed37a741029fedfccaba430b85,

title = "Changing epidemiology of invasive non-typhoid Salmonella infection: a nationwide population-based registry study",

abstract = "OBJECTIVES: Non-typhoid Salmonella (NTS) may invade beyond the intestine, causing bacteraemia, sepsis, and infection of normally sterile sites. The epidemiology of invasive NTS (iNTS) infection is under-researched. We determined trends, risk factors, serotype distribution, antimicrobial resistance (AMR), and attributable sources of iNTS infection in a high-income setting.METHODS: 22,837 records of culture-confirmed human salmonellosis cases and 10,008 serotyped Salmonella isolates from five putative animal reservoirs (pigs, cattle, broilers, layers, reptiles) in the Netherlands during 2005-2018 were retrieved from national surveillance registries. Risk factors for iNTS infection were identified using logistic regression analysis. Source attribution modelling was based on serotyping, prevalence, and exposure data.RESULTS: The average annual percentage of iNTS infections was 4.6\% (range: 3.5-5.7\%). An increase in iNTS infections was observed since 2012 (Odds Ratio [OR]: 1.09, 95\% Confidence Interval [95\%CI]: 1.04-1.14). Increased iNTS infection risk was associated with wintertime (OR: 1.37, 95\%CI: 1.12-1.66), male sex (OR: 1.73, 95\%CI: 1.51-1.99), older age (ORs: 3.27 to 16.33, depending on age groups), and living in rural areas (OR: 1.54, 95\%CI: 1.23-1.93). While 52\% of iNTS infections (n=950) were caused by serotypes Enteritidis and Typhimurium, those displaying the highest invasiveness relative to their occurrence were Dublin (32.9\%, n=163), Panama (21.6\%, n=106), and Poona (14.1\%, n=71). Cattle were a larger source of iNTS than non-iNTS infections (12.2\% vs. 7.6\%). Lower AMR and multi-resistance rates were observed among iNTS (37.9\%) than non-iNTS isolates (48.6\%).CONCLUSIONS: The increase in iNTS infections, which is reported also in other countries, is of public health and clinical concern. The underlying reasons seem to be multi-factorial in nature. iNTS infection risk depends more on the infecting serotypes and patient demographics, and less on the attributable reservoirs and AMR profiles.",

author = "Lapo Mughini-Gras and Roan Pijnacker and Janneke Duijster and Max Heck and Ben Wit and Kees Veldman and Eelco Franz",

year = "2019",

month = nov,

day = "21",

doi = "10.1016/j.cmi.2019.11.015",

language = "English",

volume = "26",

journal = "Clinical Microbiology and Infection",

issn = "1198-743X",

publisher = "Elsevier BV",

number = "7",

}

TY - JOUR

T1 - Changing epidemiology of invasive non-typhoid Salmonella infection

T2 - a nationwide population-based registry study

AU - Mughini-Gras, Lapo

AU - Pijnacker, Roan

AU - Duijster, Janneke

AU - Heck, Max

AU - Wit, Ben

AU - Veldman, Kees

AU - Franz, Eelco

PY - 2019/11/21

Y1 - 2019/11/21

N2 - OBJECTIVES: Non-typhoid Salmonella (NTS) may invade beyond the intestine, causing bacteraemia, sepsis, and infection of normally sterile sites. The epidemiology of invasive NTS (iNTS) infection is under-researched. We determined trends, risk factors, serotype distribution, antimicrobial resistance (AMR), and attributable sources of iNTS infection in a high-income setting.METHODS: 22,837 records of culture-confirmed human salmonellosis cases and 10,008 serotyped Salmonella isolates from five putative animal reservoirs (pigs, cattle, broilers, layers, reptiles) in the Netherlands during 2005-2018 were retrieved from national surveillance registries. Risk factors for iNTS infection were identified using logistic regression analysis. Source attribution modelling was based on serotyping, prevalence, and exposure data.RESULTS: The average annual percentage of iNTS infections was 4.6% (range: 3.5-5.7%). An increase in iNTS infections was observed since 2012 (Odds Ratio [OR]: 1.09, 95% Confidence Interval [95%CI]: 1.04-1.14). Increased iNTS infection risk was associated with wintertime (OR: 1.37, 95%CI: 1.12-1.66), male sex (OR: 1.73, 95%CI: 1.51-1.99), older age (ORs: 3.27 to 16.33, depending on age groups), and living in rural areas (OR: 1.54, 95%CI: 1.23-1.93). While 52% of iNTS infections (n=950) were caused by serotypes Enteritidis and Typhimurium, those displaying the highest invasiveness relative to their occurrence were Dublin (32.9%, n=163), Panama (21.6%, n=106), and Poona (14.1%, n=71). Cattle were a larger source of iNTS than non-iNTS infections (12.2% vs. 7.6%). Lower AMR and multi-resistance rates were observed among iNTS (37.9%) than non-iNTS isolates (48.6%).CONCLUSIONS: The increase in iNTS infections, which is reported also in other countries, is of public health and clinical concern. The underlying reasons seem to be multi-factorial in nature. iNTS infection risk depends more on the infecting serotypes and patient demographics, and less on the attributable reservoirs and AMR profiles.

AB - OBJECTIVES: Non-typhoid Salmonella (NTS) may invade beyond the intestine, causing bacteraemia, sepsis, and infection of normally sterile sites. The epidemiology of invasive NTS (iNTS) infection is under-researched. We determined trends, risk factors, serotype distribution, antimicrobial resistance (AMR), and attributable sources of iNTS infection in a high-income setting.METHODS: 22,837 records of culture-confirmed human salmonellosis cases and 10,008 serotyped Salmonella isolates from five putative animal reservoirs (pigs, cattle, broilers, layers, reptiles) in the Netherlands during 2005-2018 were retrieved from national surveillance registries. Risk factors for iNTS infection were identified using logistic regression analysis. Source attribution modelling was based on serotyping, prevalence, and exposure data.RESULTS: The average annual percentage of iNTS infections was 4.6% (range: 3.5-5.7%). An increase in iNTS infections was observed since 2012 (Odds Ratio [OR]: 1.09, 95% Confidence Interval [95%CI]: 1.04-1.14). Increased iNTS infection risk was associated with wintertime (OR: 1.37, 95%CI: 1.12-1.66), male sex (OR: 1.73, 95%CI: 1.51-1.99), older age (ORs: 3.27 to 16.33, depending on age groups), and living in rural areas (OR: 1.54, 95%CI: 1.23-1.93). While 52% of iNTS infections (n=950) were caused by serotypes Enteritidis and Typhimurium, those displaying the highest invasiveness relative to their occurrence were Dublin (32.9%, n=163), Panama (21.6%, n=106), and Poona (14.1%, n=71). Cattle were a larger source of iNTS than non-iNTS infections (12.2% vs. 7.6%). Lower AMR and multi-resistance rates were observed among iNTS (37.9%) than non-iNTS isolates (48.6%).CONCLUSIONS: The increase in iNTS infections, which is reported also in other countries, is of public health and clinical concern. The underlying reasons seem to be multi-factorial in nature. iNTS infection risk depends more on the infecting serotypes and patient demographics, and less on the attributable reservoirs and AMR profiles.

U2 - 10.1016/j.cmi.2019.11.015

DO - 10.1016/j.cmi.2019.11.015

M3 - Article

C2 - 31760114

SN - 1198-743X

VL - 26

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

IS - 7

ER -

Changing epidemiology of invasive non-typhoid Salmonella infection: a nationwide population-based registry study

Abstract

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