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Wang Z, Zhou H, Liu Y, Huang C, Chen J, Siddique A, Yin R, Jia C, Li Y, Zhao G, Yue M. Nationwide trends and features of human salmonellosis outbreaks in China. Emerg Microbes Infect 2024; 13:2372364. [PMID: 38923510 PMCID: PMC11259058 DOI: 10.1080/22221751.2024.2372364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Abstract
Salmonellosis is one of the most common causes of diarrhea, affecting 1/10 of the global population. Salmonellosis outbreaks (SO) pose a severe threat to the healthcare systems of developing regions. To elucidate the patterns of SO in China, we conducted a systematic review and meta-analysis encompassing 1,134 reports across 74 years, involving 89,050 patients and 270 deaths. A rising trend of SO reports has been observed since the 1970s, with most outbreaks occurring east of the Hu line, especially in coastal and populated regions. It is estimated to have an overall attack rate of 36.66% (95% CI, 33.88-39.45%), and antimicrobial resistance towards quinolone (49.51%) and beta-lactam (73.76%) remains high. Furthermore, we developed an online website, the Chinese Salmonellosis Outbreak Database (CSOD), for visual presentation and data-sharing purposes. This study indicated that healthcare-associated SO required further attention, and our study served as a foundational step in pursuing outbreak intervention and prediction.
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Affiliation(s)
- Zining Wang
- Key Laboratory of Systems Health Science of Zhejiang Province, School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, People’s Republic of China
- Hainan Institute of Zhejiang University, Sanya, People’s Republic of China
| | - Haiyang Zhou
- Hainan Institute of Zhejiang University, Sanya, People’s Republic of China
| | - Yuhao Liu
- Hainan Institute of Zhejiang University, Sanya, People’s Republic of China
| | - Chenghu Huang
- Hainan Institute of Zhejiang University, Sanya, People’s Republic of China
| | - Jiaqi Chen
- Department of Veterinary Medicine, Zhejiang University College of Animal Sciences, Hangzhou, People’s Republic of China
| | - Abubakar Siddique
- Key Laboratory of Systems Health Science of Zhejiang Province, School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, People’s Republic of China
| | - Rui Yin
- Department of Veterinary Medicine, Zhejiang University College of Animal Sciences, Hangzhou, People’s Republic of China
| | - Chenghao Jia
- Department of Veterinary Medicine, Zhejiang University College of Animal Sciences, Hangzhou, People’s Republic of China
| | - Yan Li
- Hainan Institute of Zhejiang University, Sanya, People’s Republic of China
- Department of Veterinary Medicine, Zhejiang University College of Animal Sciences, Hangzhou, People’s Republic of China
| | - Guoping Zhao
- Key Laboratory of Systems Health Science of Zhejiang Province, School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, People’s Republic of China
- CAS Key Laboratory of Synthetic Biology, Institute of Plant Physiology and Ecology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, People’s Republic of China
- Department of Microbiology and Microbial Engineering, School of Life Sciences, Fudan University, Shanghai, People’s Republic of China
| | - Min Yue
- Key Laboratory of Systems Health Science of Zhejiang Province, School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, People’s Republic of China
- Hainan Institute of Zhejiang University, Sanya, People’s Republic of China
- Department of Veterinary Medicine, Zhejiang University College of Animal Sciences, Hangzhou, People’s Republic of China
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
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Tan S, Li X, Lu B, Lin Y, Cai Y, He J, Chen S, Gao J, Gao J, Qiang X. Genomic Insights into the First Emergence of blaNDM-5-Carrying Carbapenem-Resistant Salmonella enterica Serovar London Strain in China. Infect Drug Resist 2024; 17:1781-1790. [PMID: 38736433 PMCID: PMC11088413 DOI: 10.2147/idr.s458625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024] Open
Abstract
Carbapenem-resistant Salmonella enterica (S. enterica) pose a significant threat to public health, causing gastroenteritis and invasive infections. We report the first emergence of a carbapenem-resistant S. enterica serovar London strain, A132, carrying the blaNDM-5 gene in China. Whole-genome sequencing and bioinformatics analysis assigned A132 to be ST155, a multidrug-resistant clone frequently reported in China. The strain A132 exhibited resistance to multiple antibiotics, with 20 acquired antibiotic resistance genes (ARGs) identified, predominantly located on the IncFIB plasmid (pA132-1-NDM). Notably, the blaNDM-5 gene was located within an IS26 flanked-class 1 integron-ISCR1 complex, comprising two genetic cassettes. One cassette is the class 1 integron, which may facilitate the transmission of the entire complex, while the other is the blaNDM-5-containing ISCR1-IS26-flanked cassette, carrying multiple other ARGs. Genbank database search based on the blaNDM-5-carrying cassette identified a similar genetic context found in transmissible IncFIA plasmids from Escherichia coli (p91) and Enterobacter hormaechei (p388) with a shared host range, suggesting the potential for cross-species transmission of blaNDM-5. To our knowledge, this is the first reported case of Salmonella serovar London ST155 harboring blaNDM-5 gene. Phylogenetic analysis indicated a close relationship between A132 and eight S. London ST155 strains isolated from the same province. However, A132 differed by carrying the blaNDM-5 gene and four unique ARGs. Given the high transmissibility of the F-type plasmid harboring blaNDM-5 and 18 other ARGs, it is imperative to implement vigilant surveillance and adopt appropriate infection control measures to mitigate the threat to public health.
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Affiliation(s)
- Shaohua Tan
- Department of Clinical Laboratory, The First People’s Hospital of Huzhou, Huzhou, Zhejiang, 313000, People’s Republic of China
| | - Xiangchen Li
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou, Zhejiang, 310020, People’s Republic of China
| | - Bing Lu
- Department of Clinical Laboratory, The First People’s Hospital of Huzhou, Huzhou, Zhejiang, 313000, People’s Republic of China
- School of Medicine, Huzhou University, Huzhou, Zhejiang, 313000, People’s Republic of China
| | - Yibin Lin
- School of Medicine, Huzhou University, Huzhou, Zhejiang, 313000, People’s Republic of China
| | - Yunxiang Cai
- Department of Clinical Laboratory, The First People’s Hospital of Huzhou, Huzhou, Zhejiang, 313000, People’s Republic of China
| | - Jie He
- Department of Infectious Diseases, The First People’s Hospital of Huzhou, Huzhou, Zhejiang, 313000, People’s Republic of China
| | - Sisi Chen
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou, Zhejiang, 310020, People’s Republic of China
| | - Junli Gao
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou, Zhejiang, 310020, People’s Republic of China
| | - Junshun Gao
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou, Zhejiang, 310020, People’s Republic of China
| | - Xinhua Qiang
- Department of Clinical Laboratory, The First People’s Hospital of Huzhou, Huzhou, Zhejiang, 313000, People’s Republic of China
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Uzzell CB, Troman CM, Rigby J, Raghava Mohan V, John J, Abraham D, Srinivasan R, Nair S, Meschke JS, Elviss N, Kang G, Feasey NA, Grassly NC. Environmental surveillance for Salmonella Typhi as a tool to estimate the incidence of typhoid fever in low-income populations. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.17687.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: The World Health Organisation recommends prioritised use of recently prequalified typhoid conjugate vaccines in countries with the highest incidence of typhoid fever. However, representative typhoid surveillance data are lacking in many low-income countries because of the costs and challenges of diagnostic clinical microbiology. Environmental surveillance (ES) of Salmonella Typhi in sewage and wastewater using molecular methods may offer a low-cost alternative, but its performance in comparison with clinical surveillance has not been assessed. Methods: We developed a harmonised protocol for typhoid ES and its implementation in communities in India and Malawi where it will be compared with findings from hospital-based surveillance for typhoid fever. The protocol includes methods for ES site selection based on geospatial analysis, grab and trap sample collection at sewage and wastewater sites, and laboratory methods for sample processing, concentration and quantitative polymerase chain reaction (PCR) to detect Salmonella Typhi. The optimal locations for ES sites based on digital elevation models and mapping of sewage and river networks are described for each community and their suitability confirmed through field investigation. We will compare the prevalence and abundance of Salmonella Typhi in ES samples collected each month over a 12-month period to the incidence of blood culture confirmed typhoid cases recorded at referral hospitals serving the study areas. Conclusions: If environmental detection of Salmonella Typhi correlates with the incidence of typhoid fever estimated through clinical surveillance, typhoid ES may be a powerful and low-cost tool to estimate the local burden of typhoid fever and support the introduction of typhoid conjugate vaccines. Typhoid ES could also allow the impact of vaccination to be assessed and rapidly identify circulation of drug resistant strains.
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Yin L, Dai Y, Chen H, He X, Ouyang P, Huang X, Sun X, Ai Y, Lai S, Zhu L, Xu Z. Cinnamaldehyde Resist Salmonella Typhimurium Adhesion by Inhibiting Type I Fimbriae. Molecules 2022; 27:molecules27227753. [PMID: 36431853 PMCID: PMC9699031 DOI: 10.3390/molecules27227753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022] Open
Abstract
Salmonella Typhimurium (S. Typhimurium), a common foodborne pathogen, severely harms the public and food security. Type I fimbriae (T1F) of S. Typhimurium, plays a crucial role in the pathogenic processes; it mediates the adhesion of bacteria to the mannose receptor on the host cell, assists the bacteria to invade the host cell, and triggers an inflammatory response. Cinnamaldehyde is the main ingredient in cinnamon essential oil. In this study, cinnamaldehyde was demonstrated to inhibit the expression of T1F by hemagglutination inhibition test, transmission electron microscopy, and biofilms. The mechanism of cinnamaldehyde action was studied by proteomics technology, PCR and Western blotting. The results showed that cinnamaldehyde can inhibit T1F in S. typhimurium without the growth of bacteria, by regulating the level of expression and transcription of fimA, fimZ, fimY, fimH and fimW. Proteomics results showed that cinnamaldehyde downregulated the subunits and regulators of T1F. In addition, the invasion assays proved that cinnamaldehyde can indeed reduce the ability of S. typhimurium to adhere to cells. The results of animal experiments showed that the colonization in the intestinal tract and the expression levels of inflammatory cytokine were significantly decreased, and the intestinal mucosal immune factors MUC1 and MUC2 were increased under cinnamaldehyde treatment. Therefore, cinnamaldehyde may be a potential drug to target T1F to treat Salmonella infections.
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Affiliation(s)
- Lizi Yin
- College of Veterinary Medicine, Sichuan Agriculture University, Huimin Road 211, Chengdu 611130, China
| | - Yuyun Dai
- College of Veterinary Medicine, Sichuan Agriculture University, Huimin Road 211, Chengdu 611130, China
| | - Han Chen
- College of Veterinary Medicine, Sichuan Agriculture University, Huimin Road 211, Chengdu 611130, China
| | - Xuewen He
- College of Veterinary Medicine, Sichuan Agriculture University, Huimin Road 211, Chengdu 611130, China
| | - Ping Ouyang
- College of Veterinary Medicine, Sichuan Agriculture University, Huimin Road 211, Chengdu 611130, China
| | - Xiaoli Huang
- College of Animal Science and Technology, Sichuan Agriculture University, Huimin Road 211, Chengdu 611130, China
| | - Xiangang Sun
- College of Veterinary Medicine, Sichuan Agriculture University, Huimin Road 211, Chengdu 611130, China
| | - Yanru Ai
- College of Veterinary Medicine, Sichuan Agriculture University, Huimin Road 211, Chengdu 611130, China
| | - Siyuan Lai
- College of Veterinary Medicine, Sichuan Agriculture University, Huimin Road 211, Chengdu 611130, China
| | - Ling Zhu
- College of Veterinary Medicine, Sichuan Agriculture University, Huimin Road 211, Chengdu 611130, China
| | - Zhiwen Xu
- College of Veterinary Medicine, Sichuan Agriculture University, Huimin Road 211, Chengdu 611130, China
- Correspondence: ; Tel.: +86-13981604765
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Song W, Shan Q, Qiu Y, Lin X, Zhu C, Zhuo Z, Wang C, Tong J, Li R, Wan C, Zhu Y, Chen M, Xu Y, Lin D, Wu S, Jia C, Gao H, Yang J, Zhao S, Zeng M. Clinical profiles and antimicrobial resistance patterns of invasive Salmonella infections in children in China. Eur J Clin Microbiol Infect Dis 2022; 41:1215-1225. [PMID: 36040531 PMCID: PMC9489584 DOI: 10.1007/s10096-022-04476-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022]
Abstract
Invasive Salmonella infections result in a significant burden of disease including morbidity, mortality, and financial cost in many countries. Besides typhoid fever, the clinical impact of non-typhoid Salmonella infections is increasingly recognized with the improvement of laboratory detection capacity and techniques. A retrospective multicenter study was conducted to analyze the clinical profiles and antimicrobial resistance patterns of invasive Salmonella infections in hospitalized children in China during 2016-2018. A total of 130 children with invasive Salmonella infections were included with the median age of 12 months (range: 1-144 months). Seventy-nine percent of cases occurred between May and October. Pneumonia was the most common comorbidity in 33 (25.4%) patients. Meningitis and septic arthritis caused by nontyphoidal Salmonella (NTS) infections occurred in 12 (9.2%) patients and 5 (3.8%) patients. Patients < 12 months (OR: 16.04) and with septic shock (OR: 23.4), vomit (OR: 13.33), convulsion (OR: 15.86), C-reactive protein (CRP) ≥ 40 g/L (OR: 5.56), and a higher level of procalcitonin (PCT) (OR: 1.05) on admission were statistically associated to an increased risk of developing meningitis. Compared to 114 patients with NTS infections, 16 patients with typhoid fever presented with higher levels of CRP and PCT (P < 0.05). The rates of resistance to ampicillin, sulfamethoxazole/trimethoprim, ciprofloxacin, and ceftriaxone among Salmonella Typhi and NTS isolates were 50% vs 57.3%, 9.1% vs 24.8%, 0% vs 11.2%, and 0% vs 9.9%, respectively. NTS has been the major cause of invasive Salmonella infections in Chinese children and can result in severe diseases. Antimicrobial resistance among NTS was more common.
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Affiliation(s)
- Wen Song
- Department of Infectious Diseases, Hangzhou Children's Hospital, 195 Wenhui Road, Hangzhou, 310014, China
- Department of Hospital Infection Management, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006, China
| | - Qingwen Shan
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yue Qiu
- Department of Infectious Diseases, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Xianyao Lin
- Department of Infectious Diseases, Hangzhou Children's Hospital, 195 Wenhui Road, Hangzhou, 310014, China
| | - Chunhui Zhu
- Department of Infectious Diseases, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Zhiqiang Zhuo
- Department of Infectious Diseases, Xiamen Children's Hospital, Xiamen, China
| | - Caihong Wang
- Department of Infectious Diseases, Xiamen Children's Hospital, Xiamen, China
| | - Jianning Tong
- Department of Pediatric, Gastroenterology and Infectious Diseases, Qingdao Women and Children's Hospital, Qingdao, China
| | - Rui Li
- Department of Pediatric, Gastroenterology and Infectious Diseases, Qingdao Women and Children's Hospital, Qingdao, China
| | - Chaomin Wan
- Department of Pediatrics, Sichuan University West China Second Hospital (West China Women's and Children's Hospital), Chengdu, China
| | - Yu Zhu
- Department of Pediatrics, Sichuan University West China Second Hospital (West China Women's and Children's Hospital), Chengdu, China
| | - Minxia Chen
- Department of Infectious Diseases, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yi Xu
- Department of Infectious Diseases, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Daojiong Lin
- Department of Infectious Diseases, Hainan Women and Children's Medical Center, Haikou, China
| | - Shouye Wu
- Department of Infectious Diseases, Hainan Women and Children's Medical Center, Haikou, China
| | - Chunmei Jia
- Department of Pharmacy, The Forth Hospital of Baotou, Baotou, China
| | - Huiling Gao
- Department of Pharmacy, The Forth Hospital of Baotou, Baotou, China
| | - Junwen Yang
- Department of Microbiology Laboratory, Children's Hospital Affiliated to Zhengzhou University (Henan Children's Hospital), Zhengzhou, China
| | - Shiyong Zhao
- Department of Infectious Diseases, Hangzhou Children's Hospital, 195 Wenhui Road, Hangzhou, 310014, China.
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
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Stepien TA, Libby SJ, Karlinsey JE, Brehm MA, Greiner DL, Shultz LD, Brabb T, Fang FC. Analysis of Salmonella Typhi Pathogenesis in a Humanized Mouse Model. Methods Mol Biol 2022; 2427:215-234. [PMID: 35619037 PMCID: PMC9682973 DOI: 10.1007/978-1-0716-1971-1_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Efforts to understand molecular mechanisms of pathogenesis of the human-restricted pathogen Salmonella enterica serovar Typhi, the causative agent of typhoid fever, have been hampered by the lack of a tractable small animal model. This obstacle has been surmounted by a humanized mouse model in which genetically modified mice are engrafted with purified CD34+ stem cells from human umbilical cord blood, designated CD34+ Hu-NSG (formerly hu-SRC-SCID) mice. We have shown that these mice develop a lethal systemic infection with S. Typhi that is dependent on the presence of engrafted human hematopoietic cells. Immunological and pathological features of human typhoid are recapitulated in this model, which has been successfully employed for the identification of bacterial genetic determinants of S. Typhi virulence. Here we describe the methods used to infect CD34+ Hu-NSG mice with S. Typhi in humanized mice and to construct and analyze a transposon-directed insertion site sequencing S. Typhi library, and provide general considerations for the use of humanized mice for the study of a human-restricted pathogen.
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Affiliation(s)
- Taylor A Stepien
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Stephen J Libby
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, USA
| | - Joyce E Karlinsey
- Department of Microbiology, University of Washington, Seattle, WA, USA
| | - Michael A Brehm
- Department of Molecular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Dale L Greiner
- Department of Molecular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Thea Brabb
- Department of Comparative Medicine, University of Washington, Seattle, WA, USA
| | - Ferric C Fang
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, USA.,Department of Microbiology, University of Washington, Seattle, WA, USA
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Non-Typhoidal Salmonella Infection in Children: Influence of Antibiotic Therapy on Postconvalescent Excretion and Clinical Course-A Systematic Review. Antibiotics (Basel) 2021; 10:antibiotics10101187. [PMID: 34680768 PMCID: PMC8532930 DOI: 10.3390/antibiotics10101187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022] Open
Abstract
(1) Background: Although published recommendations are available, the use of antibiotics in non-typhoidal Salmonella (NTS) infections in children is still controversially debated in clinical practice. Patients might even be put at risk, with necessary antibiotic therapy being withheld due to the widespread concern of prolonged post-convalescent shedding. The authors conducted a systematic review to assess whether antibiotic treatment influences fecal excretion or the clinical course in children with NTS infection. (2) Methods: The review was carried out following the PRISMA guidelines. In a Medline database search, studies assessing the influence of antibiotic therapy on excretion and/or the clinical course of NTS infections were selected. Studies reporting on adults only were not considered. Out of 532 publications which were identified during the systematic literature search, 14 publications were finally included (3273 patients in total). Quality and bias assessment was performed using the Newcastle-Ottawa scale (NOS) or the Cochrane risk-of bias tool (ROB-2). (3) Results: Four early studies from decades ago demonstrated a prolongation of intestinal NTS excretion in children after antibiotic treatment, whereas most studies published more recently observed no significant influence, which might be due to having used more “modern” antibiotic regimes (n = 7 studies). Most studies did not describe significant differences regarding the severity and duration of symptoms between untreated patients and those treated with antibiotics. Quality and bias were mainly moderate (NOS) or variable (ROB-2), respectively. (4) Conclusions: There is no substantial evidence of prolonged excretion of NTS in pediatric patients after treatment with newer antimicrobials. Consequently, clinicians should not withhold antibiotics in NTS infection for children at risk, such as for very young children, children with comorbidities, and those with suspected invasive disease due to concerns about prolonged post-convalescent bacterial excretion. In the majority of cases with uncomplicated NTS diarrhea, clinicians should refrain from applying antibiotics.
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