Prevalence of enteric non-typhoidal Salmonella in humans in the Middle East and North Africa: A systematic review and meta-analysis

High prevalence and genomic features of multidrug-resistant Salmonella enterica isolated from chilled broiler chicken on retail sale in the United Arab Emirates

Non-typhoidal Salmonella represents a significant global concern for food safety and One Health. Despite the United Arab Emirates (UAE) being a leading consumer of chicken meat globally, there is a lack of comprehensive understanding regarding the prevalence and genomic characteristics of Salmonella within the country. This study aims to address this gap by conducting a thorough analysis of Salmonella prevalence, antimicrobial resistance, and genomic profiles of isolates obtained from whole broiler carcasses retailed under chilled conditions in the UAE. Our findings reveal that Salmonella was detected in 41.2 % (130/315) of the sampled chilled broiler carcasses, with notable variability observed among samples sourced from six different companies. Phenotypic antimicrobial resistance (AMR) testing, among 105 isolates, highlighted high resistance rates to tetracycline (97.1 %), nalidixic acid (93.3 %), ampicillin (92.4 %), azithromycin (75.2 %), ciprofloxacin (63.8 %), and ceftriaxone (54.3 %). Furthermore, a concerning 99 % (104/105) of the isolates exhibited multidrug resistance. Whole-genome sequencing (WGS) of 60 isolates identified five serovars, with S. infantis/Sequence Type (ST) 32 (55 %) and S. Minnesota/ST-458 (28.3 %) being the most prevalent. WGS analysis unveiled 34 genes associated with antimicrobial resistance, including mcr-1.1 (only in two isolates), conferring resistance to colistin. The two major serovars, Infantis and Minnesota, exhibited significant variation (P-values <0.001) in the distribution of major AMR genes (aadA1, blaCMY-2, blaSHV-12, qnrB19, qnrS1, sul1, and sul2). Notably, the gene qacEdelta, conferring resistance to quaternary ammonium compounds commonly found in disinfectants, was universally present in all S. Infantis isolates (n = 33), compared to only one S. Minnesota isolate. Additionally, all S. Infantis isolates harbored the IncFIB (pN55391) plasmid replicon type. Major serovars exhibited distinct distributions of antimicrobial resistance genes, underscoring the importance of serovar-specific surveillance. These findings emphasize the critical need for continuous surveillance and intervention measures to address Salmonella contamination risks in poultry products, providing valuable insights for public health and regulatory strategies not only in the UAE but also globally.

Salmonella Prevalence and antibiotic resistance profile in raw poultry meat sold in North Lebanon: Insights from the COVID-19 pandemic and economic crisis

Salmonella-related foodborne illness is a significant public health concern, with the primary source of human infection being animal-based food products, particularly chicken meat. Lebanon is currently experiencing a dual crisis: the COVID-19 pandemic and an unprecedented economic crisis, which has resulted in substantial challenges to the public health system and food safety. This study aims to assess the prevalence and antibiotic resistance profile of Salmonella in raw poultry meat sold in North Lebanon during this dual crisis. A cross-sectional study was carried out between May 2021 and April 2022 across six different districts in North Lebanon. A total of 288 whole, unprocessed chickens were examined. The isolation and identification of Salmonella isolates were done based on cultural and biochemical properties. All isolates were subjected to antimicrobial susceptibility testing and phenotypic assays for Extended-Spectrum Beta-lactamase (ESBL) detection. The prevalence of Salmonella in raw poultry meat purchased in North Lebanon reached 18.05 % (52/288). The dry season and chilled chicken were significantly associated with an increased risk of Salmonella contamination (P < 0.05). Additionally, 34.61 % of the isolates were potential ESBL producers, and 57.69 % exhibited multidrug resistance (MDR). This study highlights the existence of MDR in chicken meat in North Lebanon, posing a potential health risk if undercooked chicken meat is consumed. This emphasizes the importance of the implementation of preventive strategies and hygienic procedures throughout the food chain to reduce the risk of Salmonella spp. contamination in chicken meats and its potential transmission to humans.

Salmonella in the food chain within the Gulf Cooperation Council countries

Infections caused by bacteria originating from tainted food sources are a widespread concern due to their large economic impact and detrimental effects on public health. We aimed to explore literature focusing on the presence of Salmonella in the food supply chains of Gulf Cooperation Council (GCC) countries and to provide an overview of available information concerning health-related issues and the status of salmonellosis in humans in GCC countries. The reviewed evidence underscored a gap in our comprehensive understanding of the prevalence of Salmonella in the food supply of GCC countries. Molecular characterization efforts to pinpoint the sources of Salmonella in these nations were limited. Surveys targeting Salmonella in the food supply of GCC countries have been infrequent. While qualitative data indicated the presence or absence of Salmonella, there was a noticeable lack of quantitative data detailing the actual quantities of these bacteria in chicken meat supplies across GCC countries. Although reports regarding Salmonella in animal-derived foods were common, the literature highlighted in this review emphasized the persistent challenge that Salmonella pose to food safety and public health in GCC countries. Addressing this issue requires concerted efforts to enhance surveillance, improve control measures, and promote greater awareness among stakeholders in the food supply chain.

Characteristics of Nontyphoid Salmonella Isolated from Human, Environmental, Animal, and Food Samples in Burkina Faso: A Systematic Review and Meta-Analysis

Salmonella is one of the world's leading causes of zoonotic and foodborne illnesses. Recently, antimicrobial resistance (AMR) has become one of the most critical challenges to public health and food safety. Herein, we employed a meta-analysis to determine the pooled prevalence and spatiotemporal distribution of serovars and antimicrobial resistance in NTS in Burkina Faso. To find eligible articles, a comprehensive literature search of PubMed, African Journals Online, ScienceDirect, Google Scholar, and the gray literature (university libraries) in Burkina was conducted for the period from 2008 to 2020. Studies meeting the inclusion criteria were selected and assessed for risk of bias. To assess the temporal and spatial relationships between serotypes and resistant strains from humans, animals, food, and the environment, a random-effects statistical model meta-analysis was carried out using the Comprehensive Meta-Analysis Version 3.0 program. The NTS prevalence rates were 4.6% (95% CI: 3-7) and 20.1% (95% CI: 6.6-47.4) in humans and animals, respectively, and 16.8% (95% CI: 10.5-25.8) and 15.6% (95% CI: 8.2-27.5) in food and the environment, respectively. Most NTS serovars were S. Derby, reported both in food and animals, and S. Typhimurium, reported in humans, while S. Croft II, S. Jodpur II, and S. Kentucky were the most prevalent in the environment. NTS isolates were highly resistant to erythromycin, amoxicillin, cefixime, and cephalothin, with a pooled prevalence of multidrug resistance of 29% (95% CI: 14.5-49.5). The results of this review show a high diversity of Salmonella serotypes, as well as high antibiotic resistance in Salmonella isolates from animal, human, food, and environmental samples in Burkina, calling for a consolidated "One Health" approach to better understand the drivers of pathogen emergence, spread, and antimicrobial resistance, as well as the formulation of intervention measures needed to limit the risk associated with the disease.

A review and meta-analysis of non-typhoidal Salmonella in Vietnam: Challenges to the control and antimicrobial resistance traits of a neglected zoonotic pathogen

Non-typhoidal Salmonella (NTS) is a food-borne zoonotic pathogen with important implications for human health. Despite its importance, the burden of NTS infections in Vietnam is unknown. We conducted a systematic review and a meta-analysis to describe the prevalence and phenotypic antimicrobial resistance (AMR) for NTS over time in Vietnam. Following PRISMA guidelines, we identified 72 studies from PubMed and Google Scholar containing data relevant to 'Salmonella', 'Salmonellosis', and 'Vietnam', or 'Viet Nam'. Of those, forty-two papers reporting prevalence of NTS, and twenty-six including data on phenotypic resistance were selected for meta-analysis. The prevalence of NTS ranged from 2% to 5% in humans and from 30% to 41% in samples from animals and the farm/slaughterhouse environment. Between 2000 and 2020 we observed a 27.3% (p = 0.044) increase in absolute terms in prevalence among individuals with enteric diseases and a 12.0% (p = 0.047) increase in aquaculture/seafood samples. The most commonly serovars identified across studies included S. Weltevreden (12.0%), followed by S. Typhimurium (10.1%), S. Derby (6.4%), S. London (5.8%), S. Anatum (4.4%), S. Rissen (3.9%), S. Enteritidis (3.7%), S. Albany (3.3%) and S. 4,[5],12:i:- (3.0%). Over the same period, there was an increasing trend in the pooled AMR prevalence for quinolones (15.6% relative increase), 3rd-, 4th-, and 5th-generation cephalosporins (23.7%), penicillins (16.1%), tetracyclines (12.9%), sulfonamides (8.8%), amphenicol (17.8%), and multidrug resistance (11.4%) (all p ≤ 0.014). A broad range of AMR genes (ARGs) were detected in both human and animal populations. The observed prevalence and AMR trends in Vietnam underscore the need of adopting a One Health strategy encompassing surveillance systems, research initiatives, and awareness campaigns to effectively address the challenges posed by NTS.

Prevalence and Antimicrobial Resistance Profile of Salmonella Isolated from Human, Animal and Environment Samples in South Asia: A 10-Year Meta-analysis

Salmonella is a foodborne zoonotic bacterium, and the antimicrobial-resistant strains of Salmonella are a worldwide health concern. Herein, we employed a meta-analysis to determine the pooled prevalence of Salmonella and its antimicrobial resistance status in human, animal, and environmental isolates in South Asia. To this end, we followed the standard guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements for searching literature in three databases namely PubMed, Google Scholar, and CAB abstracts, and a total of 100 eligible datasets were finally included which were published from January 2010 to June 2021. In the pooled prevalence of Salmonella in South Asia, the random model effect was 14.47% (95% CI: 10.17-20.19) with a high degree of heterogeneity (I2, 99.8%) and overall antimicrobial resistance was 70% (95% CI: 63.0-76.0) with a heterogeneity of 23.6%. The temporal distribution of the overall antimicrobial resistance (%) against Salmonella was increased from 53 to 77% within 10 years. Out of 18 distinct Salmonella serotypes, S. enterica was highly prevalent (14.22%, 95% CI: 4.02-39.64) followed by S. pullorum (13.50%, 95% CI: 5.64-29.93) with antimicrobial resistance (%) were 86.26 and 90.06, respectively. Noteworthy, nalidixic acid (74.25%) and tetracycline (37.64%) were found mostly resistant to Salmonella whereas ceftriaxone (1.07%) and cefixime (1.24%) were sensitive. This systematic review demonstrated that overall antibiotic resistance profiles of Salmonella are increasing over time in South Asia. Thus, adequate hygienic practices, proper use of antimicrobials, and implementation of antibiotic stewardship are imperative for halting the Salmonella spread and its antimicrobial resistance.

Human Salmonellosis: A Continuous Global Threat in the Farm-to-Fork Food Safety Continuum

Salmonella is one of the most common zoonotic foodborne pathogens and a worldwide public health threat. Salmonella enterica is the most pathogenic among Salmonella species, comprising over 2500 serovars. It causes typhoid fever and gastroenteritis, and the serovars responsible for the later disease are known as non-typhoidal Salmonella (NTS). Salmonella transmission to humans happens along the farm-to-fork continuum via contaminated animal- and plant-derived foods, including poultry, eggs, fish, pork, beef, vegetables, fruits, nuts, and flour. Several virulence factors have been recognized to play a vital role in attaching, invading, and evading the host defense system. These factors include capsule, adhesion proteins, flagella, plasmids, and type III secretion systems that are encoded on the Salmonella pathogenicity islands. The increased global prevalence of NTS serovars in recent years indicates that the control approaches centered on alleviating the food animals' contamination along the food chain have been unsuccessful. Moreover, the emergence of antibiotic-resistant Salmonella variants suggests a potential food safety crisis. This review summarizes the current state of the knowledge on the nomenclature, microbiological features, virulence factors, and the mechanism of antimicrobial resistance of Salmonella. Furthermore, it provides insights into the pathogenesis and epidemiology of Salmonella infections. The recent outbreaks of salmonellosis reported in different clinical settings and geographical regions, including Africa, the Middle East and North Africa, Latin America, Europe, and the USA in the farm-to-fork continuum, are also highlighted.

One Health Perspective of Salmonella Serovars in South Africa Using Pooled Prevalence: Systematic Review and Meta-Analysis

Salmonella is a bacterium that is commonly associated with food-borne infections and is regarded as one of the most important pathogens in public health. Salmonella serovars, particularly Typhimurium and Enteritidis, which are widely distributed globally, mainly result in outbreaks commonly linked to the consumption of animal products. This study is a systematic review and meta-analysis of studies reporting the prevalence of Salmonella serovars from one health perspective that included human, environmental, and animal samples in South Africa. PubMed, ScienceDirect, African Journals Online, and Scopus databases were used to conduct extensive searches of articles which were ultimately included or excluded following the Systematic Reviews and Meta-Analysis (PRISMA) guidelines. According to the data obtained in this review, the overall pooled prevalence estimates (PPE) of Salmonella serovars detection were 79.6%, 61.6%, 56.5%, and 43.2% for human, environment, animal, and environment/animal samples in South Africa, respectively. The majority of the studies (50%) used the polymerase chain reaction (PCR) technique for the detection of Salmonella serovars, followed by culture methods (26.7%), while 20% used serotyping. The PPE for nontyphoidal Salmonellae (NTS) was 65.6% and 34.4% for Salmonella Typhimurium and Salmonella Enteritidis, respectively. Our data further shows that 3 serovars, namely, Salmonella Typhimurium, Salmonella Enteriditis, and Salmonella Hadar, have been isolated from animals, humans, and the environment in South Africa. Our results highlight the ongoing spread of Salmonella spp. especially on animals which might end up infecting humans via direct contact with infected animals or eating infected animal products. This calls for deliberate “One Health” epidemiological studies in order to document information on the transmission between humans, animals, and the environment. This will ultimately result in the formulation of a consolidated salmonellosis control policy by the environmental, human, and veterinary health sectors.

Systematic Review and Meta-Analysis of Integrated Studies on Salmonella and Campylobacter Prevalence, Serovar, and Phenotyping and Genetic of Antimicrobial Resistance in the Middle East—A One Health Perspective

Background:Campylobacter and Salmonella are the leading causes of foodborne diseases worldwide. Recently, antimicrobial resistance (AMR) has become one of the most critical challenges for public health and food safety. To investigate and detect infections commonly transmitted from animals, food, and the environment to humans, a surveillance–response system integrating human and animal health, the environment, and food production components (iSRS), called a One Health approach, would be optimal. Objective: We aimed to identify existing integrated One Health studies on foodborne illnesses in the Middle East and to determine the prevalence, serovars, and antimicrobial resistance phenotypes and genotypes of Salmonella and Campylobacter strains among humans and food-producing animals. Methods: The databases Web of Science, Scopus, and PubMed were searched for literature published from January 2010 until September 2021. Studies meeting inclusion criteria were included and assessed for risk of bias. To assess the temporal and spatial relationship between resistant strains from humans and animals, a statistical random-effects model meta-analysis was performed. Results: 41 out of 1610 studies that investigated Campylobacter and non-typhoid Salmonella (NTS) in the Middle East were included. The NTS prevalence rates among human and food-producing animals were 9% and 13%, respectively. The Campylobacter prevalence rates were 22% in humans and 30% in food-producing animals. The most-reported NTS serovars were Salmonella Enteritidis and Salmonella Typhimurium, while Campylobacter jejuni and Campylobacter coli were the most prevalent species of Campylobacter. NTS isolates were highly resistant to erythromycin, amoxicillin, tetracycline, and ampicillin. C. jejuni isolates showed high resistance against amoxicillin, trimethoprim–sulfamethoxazole, nalidixic acid, azithromycin, chloramphenicol, ampicillin, tetracycline, and ciprofloxacin. The most prevalent Antimicrobial Resistance Genes (ARGs) in isolates from humans included tetO (85%), Class 1 Integrons (81%), blaOXA-61 (53%), and cmeB (51%), whereas in food-producing animals, the genes were tetO (77%), Class 1 integrons (69%), blaOXA-61 (35%), and cmeB (35%). The One Health approach was not rigorously applied in the Middle East countries. Furthermore, there was an uneven distribution in the reported data between the countries. Conclusion: More studies using a simultaneous approach targeting human, animal health, the environment, and food production components along with a solid epidemiological study design are needed to better understand the drivers for the emergence and spread of foodborne pathogens and AMR in the Middle East.

Climate change impacts on infectious diseases in the Eastern Mediterranean and the Middle East (EMME)-risks and recommendations

The Eastern Mediterranean and Middle East (EMME) region has rapid population growth, large differences in socio-economic levels between developed and developing countries, migration, increased water demand, and ecosystems degradation. The region is experiencing a significant warming trend with longer and warmer summers, increased frequency and severity of heat waves, and a drier climate. While climate change plays an important role in contributing to political instability in the region through displacement of people, food insecurity, and increased violence, it also increases the risks of vector-, water-, and food-borne diseases. Poorer and less educated people, young children and the elderly, migrants, and those with long-term health problems are at highest risk. A result of the inequalities among EMME countries is an inconsistency in the availability of reliable evidence about the impacts on infectious diseases. To help address this gap, a search of the literature was conducted as a basis for related recommended responses and suggested actions for preparedness and prevention. Since climate change already impacts the health of vulnerable populations in the EMME and will have a greater impact in future years, risk assessment and timely design and implementation of health preparedness and adaptation strategies are essential. Joint national and cross-border infectious diseases management systems for more effective preparedness and prevention are needed, supported by interventions that improve the environment. Without such cooperation and effective interventions, climate change will lead to an increasing morbidity and mortality in the EMME from infectious diseases, with a higher risk for the most vulnerable populations.

Current State of Salmonella, Campylobacter and Listeria in the Food Chain across the Arab Countries: A Descriptive Review

Foodborne infections caused by bacterial pathogens are a common cause of human illness in the Middle East, with a substantial burden of economic loss and public health consequences. This review aims at elucidating recent literature on the prevalence of Non-Typhoidal Salmonella (NTS), Campylobacter and Listeria monocytogens in the food chain in the Arab countries, and to consolidate available evidence on the public health burden and the status of antimicrobial resistance (AMR) among the concerned three pathogens. The reviewed evidence points to a scarcity of understanding of the magnitude of NTS in the food chain in the Arab countries. Additionally, not much work has been done at the molecular characterization level to address the source-attribution of NTS in the Arab World. Very few surveys have been done on Campylobacter in the food chain in the Gulf Cooperation Council (GCC) countries. There is a gap in quantitative (counts/numbers) surveillance efforts for Campylobacter in the chicken meat supply across all Arab countries, despite the availability of some qualitative (presence/absence) surveillance data. While there are several reports on L. monocytogenes in animal-sourced foods, notably in North African Arab countries, fewer are published on L. monocytogenes in plant-sourced foods. Information on the L. monocytogenes serotypes and strain diversity circulating in the Arab region is widely lacking. Antibiotic resistance in the three pathogens is not fully understood across the Arab region, despite some reports indicating varying trends at the human-food interface. The literature evidence presented in this review stresses that Salmonella, Campylobacter and L. monocytogenes continue to challenge food safety and public health in the Arab countries.

Surveillance of foodborne diseases in Taiwan: A retrospective study

ABSTRACT

Foodborne pathogens cause diseases and death, increasing the economic burden. It needs to identify incident places, media food and pathgens. Our aim is to survey empirical data that provide a retrospective historical perspective on foodborne diseases and explore the causes and trends of outbreaks.We examined publicly available annual summary data on reported foodborne disease outbreaks in Taiwan from 2014 to 2018. We calculated the percentage of places, media food, bacteria and natural toxin sources in foodborne diseases and performed a chi-square test for difference evaluation. The higher risk of places and causes in 2018 compared with 2014 was empolyzed with univariate logistic regression.There were 26847 patients with foodborne diseases during the period from 2014 to 2018. The top 2 primary source locations of the foodborne diseases were schools and restaurants. The top 2 primary food media classifications of the foodborne diseases were boxed meals and compounded foods. The top 2 primary incident bacterial classifications of the observed foodborne diseases were Bacillus cereus and Staphylococcus aureus. The top 2 primary natural toxin classifications of the foodborne diseases were plants and histamines. The incidence of foodborne disease in military facilities, fruits and vegetables, and Staphylococcus aureus was increased in our study.Our study confirmed the high risk and increased incidence of foodborne diseases, food media classifications, bacterial classifications, and natural toxins in Taiwan. It is worthy of attention for the government health department-designed policy to promote disease prevention.

Pattern of increased antimicrobial resistance of Salmonella isolates in the Eastern Province of KSA

OBJECTIVES

The antimicrobial resistance of Salmonella species is increasing worldwide. This study was conducted to determine the pattern of antimicrobial susceptibility of Salmonella species in a tertiary hospital from 2011 to 2018.

METHODS

In this retrospective study, the medical records of all patients with Salmonella infections were reviewed. The clinical, demographic, and microbiological data of the selected patients were analysed.

RESULTS

A total of 752 patients were included. The resistance of Salmonella species to antimicrobial drugs increased from 24.6% in 2011 to 37.8% in 2018 (p = 0.002). By 2018 all Salmonella isolates were completely resistant to cefalotin, cefuroxime, and cefoxitin, while we found some susceptibility to other cephalosporins and ciprofloxacin. The most commonly isolated Salmonella serogroups were groups D (36.5%), C (23.5%), and B (11.7%).

CONCLUSIONS

The incidence of resistance of Salmonella to antibiotics is on the rise. The results of this study highlight the need for an active monitoring system of antibiotic usage in humans and domestic animals.