Community-acquired septicaemia in southern Viet Nam: the importance of multidrug-resistant Salmonella typhi

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene 1998-09, Vol.92 (5), p.503-508
• Main Authors: Tuyet Hoa, Nguyen Thi, Diep, To Song, Wain, John, Parry, Christopher M., Hien, Tran Tinh, Smith, Michael D., Walsh, Amanda L., White, Nicholas J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aeromonas hydrophila; ampicillin; Bacterial diseases; Bacterial sepsis; Bacteriological Techniques; Biological and medical sciences; ceftazidime; ceftriaxone; Child; Child, Preschool; co-trimoxazole; Cryptococcus neoformans; drug resistance; Drug Resistance, Multiple; erythromycin; Escherichia coli; Female; gentamicin; Haemophilus influenzas; Human bacterial diseases; Humans; Infant; Infectious diseases; Klebsiella spp; Male; Medical sciences; methicillin; Middle Aged; nalidixic acid; Neisseria meningitidis; ofloxacin; oxacillin; penicillin; prevalence; Proteus mirabilis; Pseudomonas aeruginosa; Salmonella cholerasuis; Salmonella paratyphi A; Salmonella spp; Salmonella typhi; Sepsis - epidemiology; Sepsis - microbiology; septicaemia; Staphylococcus aureus; Streptococcus bovis; Streptococcus milleri; Streptococcus pneumoniae; Streptococcus pyogenes; Streptococcus sanguis; Streptococcus suis; tetracycline; Tropical medicine; Typhoid Fever - microbiology; Urban Health - statistics & numerical data; Viet Nam; Vietnam - epidemiology; α haemolytic streptococci
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1016/S0035-9203(98)90891-4

In a prospective study conducted between mid 1993 and 1994, 437 adults and children were admitted with community-acquired septicaemia to an infectious diseases hospital in southern Viet Nam. Gramnegative aerobes accounted for 90% of isolates and were predominantly Salmonella typhi (67%), Sal. paratyphi A (3%), Escherichia coli (10%), and Klebsiella spp. (5%). Other Salmonella spp. (1%), Pseudomonas aeruginosa (1%), Neisseria meningitidis (0·5%) and Haemophilus influenzae (0·2%) were uncommon. Staphylococcus aureus (5·5%) and Streptococcus pneumoniae (2%) were the most common Gram-positive isolates. Patients with enteric fever were younger (median age 16 years, range 1–63) than the other patients (median age 43 years, range 1–88) ( P < 0·001) and had a lower mortality rate (0·3% vs. 23%; relative risk 69·5, 95% confidence interval 9·5–507·8; P < 0·0001). Over 70% of the Sal. typhi isolated were multidrug-resistant, and 4% were resistant to nalidixic acid. Multidrug-resistant Sal. typhi is a major cause of community-acquired septicaemia in Viet Nam.