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Salmonella enterica subspecies enterica serovar Choleraesuis (S. Choleraesuis) is a nontyphoidal Salmonella pathogen that causes swine paratyphoids. S. Choleraesuis is a zoonotic pathogen transmitted to humans via contaminated food and causes sepsis. Here, we report a rare case of pyelonephritis caused by S. Choleraesuis in a Japanese patient with a carcinoma of unknown primary origin. On the day of admission, the patient was diagnosed with pyelonephritis associated with ureteral stent obstruction. He had no history of raw pork consumption or gastrointestinal symptoms. Gram-negative rods were isolated from urine and blood cultures, identified as Salmonella enterica subsp. enterica using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The serological typing results were O7: -: 1 and 5; however, the serotypes could not be determined. The isolate was identified as S. Choleraesuis using multilocus sequence typing, nucleotide sequence analysis of the fliC gene, and biochemical examination. Four days after a 14-day course of intravenous piperacillin-tazobactam (9 g/day), the patient showed relapse of the condition. Subsequently, the patient was treated with intravenous ceftriaxone (2 g/day) and oral amoxicillin (1000 mg/day) for 14 days each; recurrence was not observed. This novel case of pyelonephritis with bacteremia was caused by S. Choleraesuis in Japan. Conventional testing methods could not identify the serotypes; however, the case highlights the importance of adopting advanced diagnostic techniques based on molecular biology to ensure accurate pathogen identification. [ABSTRACT FROM AUTHOR]

Background: The number of patients with diarrheal diseases admitted to the hospital was reduced during the COVID-19 lockdown. Following the relaxation of the lockdown, admissions of nontyphoidal Salmonella (NTS) infection showed a two-fold rise compared to pre-COVID-19 years. This retrospective study aimed to detect the incidence of NTS in the pre-COVID-19 and post-COVID-19 outbreak periods, along with describing the antibiogram and comorbid conditions of the patients. Materials and Methods: Using a retrospective design, from January 2015 to December 2022, we studied stool samples for the presence of NTS. Antibiogram with ampicillin, co-trimoxazole, ceftriaxone, chloramphenicol, and ciprofloxacin were studied. The presence of comorbid conditions was noted. Results: We examined 2312 and 937 stool samples collected during the pre-COVID-19 and post-COVID-19 outbreak period, respectively. The number of samples collected during the outbreak (2020) was 273. During the pre-COVID-19 period (2015–2019), the average annual isolation rate of NTS was 5.63%. During the lockdown of 2020, the corresponding rate was 5.49%. The isolation rate showed a significant rise (11.45%) during the relaxation of the lockdown (P < 0.001). No significant change in resistance to antibiotics other than ciprofloxacin was noted in the present study. Malignancy was the leading comorbid condition (11.91%) followed by chronic liver diseases (10.31%). Conclusions: A significant rise in NTS diarrheal cases was detected following the COVID-19 outbreak. During this period, people were attending more celebrations and feasts. No significant change in antibiotic resistance was noted when comparing pre-COVID-19 and COVID-19 periods. Malignancy was the leading comorbid condition.

Background The pathogenesis of atopic dermatitis (AD) remains unclear. Nontyphoidal Salmonella (NTS) infection might trigger immune-mediated reactions. We aimed to examine NTS and the risk of subsequent AD. Methods From 2002 to 2015, eligible patients (aged 0–100 years) with NTS were identified. NTS and non-NTS groups were matched at a 1:10 ratio on age and sex. We utilized conditional multivariable Cox proportional hazard models to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for AD development. Subgroup analyses were conducted based on age, sex, and severity of NTS infection. We utilized landmark analysis to explore the time-dependent hazard of AD following NTS. Results In the NTS group (N = 6624), 403 developed AD. After full adjustment of demographics and comorbidities, the NTS group had a higher risk of AD than the reference group (aHR = 1.217, 95% CI = 1.096–1.352). Age-stratified analysis revealed that NTS group exhibited an elevated risk compared to the reference group, particularly among those aged 13–30 years (aHR = 1.25, 95% CI = 1.017–1.559), individuals aged 31–50 years (aHR = 1.388, 95% CI = 1.112–1.733), those aged 51–70 years (aHR = 1.301, 95% CI = 1.008–1.679), and individuals aged 71 years and over (aHR = 1.791, 95% CI = 1.260–2.545). Severe NTS was associated with a higher risk of AD than the reference group (aHR = 2.411, 95% CI = 1.577–3.685). Landmark analysis showed generally consistent findings. Conclusions Minimizing exposure to NTS infection may represent a prospective strategy for averting the onset and progression of atopic dermatitis. Key messages What is already known on this topic AD is particularly susceptible to affronts from the environment. NTS infection has been associated with dysbiosis and autoimmune reactions, which may have a common pathogenesis with AD. What this study adds NTS had a higher risk of AD than the reference group. Additionally, this risk was even more pronounced in those with severe NTS. How this study might affect research, practice, or policy Minimizing exposure to NTS infection could be a potential strategy for preventing the onset and progression of AD. The study offers a promising avenue for further investigation into the underlying pathogenesis of AD. [ABSTRACT FROM AUTHOR]

Background: The number of patients with diarrheal diseases admitted to the hospital was reduced during the COVID-19 lockdown. Following the relaxation of the lockdown, admissions of nontyphoidal Salmonella (NTS) infection showed a two-fold rise compared to pre-COVID-19 years. This retrospective study aimed to detect the incidence of NTS in the pre-COVID-19 and post-COVID-19 outbreak periods, along with describing the antibiogram and comorbid conditions of the patients. Materials and Methods: Using a retrospective design, from January 2015 to December 2022, we studied stool samples for the presence of NTS. Antibiogram with ampicillin, co-trimoxazole, ceftriaxone, chloramphenicol, and ciprofloxacin were studied. The presence of comorbid conditions was noted. Results: We examined 2312 and 937 stool samples collected during the pre-COVID-19 and post-COVID-19 outbreak period, respectively. The number of samples collected during the outbreak (2020) was 273. During the pre-COVID-19 period (2015–2019), the average annual isolation rate of NTS was 5.63%. During the lockdown of 2020, the corresponding rate was 5.49%. The isolation rate showed a significant rise (11.45%) during the relaxation of the lockdown (P < 0.001). No significant change in resistance to antibiotics other than ciprofloxacin was noted in the present study. Malignancy was the leading comorbid condition (11.91%) followed by chronic liver diseases (10.31%). Conclusions: A significant rise in NTS diarrheal cases was detected following the COVID-19 outbreak. During this period, people were attending more celebrations and feasts. No significant change in antibiotic resistance was noted when comparing pre-COVID-19 and COVID-19 periods. Malignancy was the leading comorbid condition. [ABSTRACT FROM AUTHOR]

ABSTRACT Nontyphoidal Salmonella (NTS) is the main etiological agent of human nontyphoidal salmonellosis. The aim of this study was to analyze the epidemiological characteristics and horizontal transfer mechanisms of antimicrobial resistance (AMR) genes from eight strains of NTS detected in Zhenjiang City, Jiangsu Province, China. Fecal samples from outpatients with food-borne diarrhea were collected in 2022. The NTS isolates were identified, and their susceptibility was tested with the Vitek 2 Compact system. The genomes of the NTS isolates were sequenced with the Illumina NovaSeq platform and Oxford Nanopore Technologies platform. The AMR genes and mobile genetic elements (MGEs) were predicted with the relevant open access resources. Eight strains of NTS were isolated from 153 specimens, and Salmonella Typhimurium ST19 was the most prevalent serotype. The AMR gene with the highest detection rate was AAC(6')-Iaa (10.5%) followed by TEM-1 (7.9%), sul2 (6.6%), and tet(A) (5.3%). Eleven MGEs carrying 34 AMR genes were identified on the chromosomes of 3 of the 8 NTS, including 3 resistance islands, 6 composite transposons (Tns), and 2 integrons. Eighteen plasmids carrying 40 AMR genes were detected in the 8 NTS strains, including 6 mobilizable plasmids, 3 conjugative plasmids, and 9 nontransferable plasmids, 7 of which carried 10 composite Tns and 3 integrons. This study provided a theoretical basis, from a genetic perspective, for the prevention and control of NTS resistance in Zhenjiang City.IMPORTANCEHuman nontyphoidal salmonellosis is one of the common causes of bacterial food-borne illnesses, with significant social and economic impacts, especially those caused by invasive multidrug-resistant nontyphoidal Salmonella, which entails high morbidity and mortality. Antimicrobial resistance is mainly mediated by drug resistance genes, and mobile genetic elements play key roles in the capture, accumulation, and dissemination of antimicrobial resistance genes. Therefore, it is necessary to study the epidemiological characteristics and horizontal transfer mechanisms of antimicrobial resistance genes of nontyphoidal Salmonella to prevent the spread of multidrug-resistant nontyphoidal Salmonella.

Objectives: Species distribution and antibiotic resistance pattern of Salmonella varies with time and place. Rapid and correct use of antibiotics requires understanding of the distribution and drug resistance patterns. Therefore, we aimed to study the clinical profile of patients along with speciation and antibiogram of Salmonella isolates from blood. Materials and Methods: It is an observational study, conducted from December 2019 to December 2021 at our university hospital. Blood cultures were processed by automated blood culture system. Salmonella isolates were identified by their morphological properties, biochemical reaction, and serological tests. Antibiotic susceptibility pattern was assessed by Kirby–Bauer's disc diffusion method and Phoenix automated system. Results: The male-to-female ratio of the patients in the study was 2.5:1 and the mean age of the patients was 11.7 years (1–27 years). Salmonella spp. was isolated from 21 patients out of 1,350 positive blood cultures. Nine isolates were identified as S. Typhi seven as S. Choleraesuis three as S. Paratyphi A and two as S. Paratyphi B. Immuno-compromised conditions were significantly associated in nontyphoidal Salmonella bacteremia (p = 0.0253). Isolates showed maximum resistance toward nalidixic acid (100%) followed by fluoroquinolones (52.4%). Multidrug resistance, extreme drug resistance, and azithromycin resistance was seen in 14.3, 4.8, and 4.8% isolates, respectively. Posttreatment recovery was observed in 20 patients. Conclusions: Emergence of S. Choleraesuis among Salmonella spp. in blood stream infection, next only to S. Typhi was noted. Rising drug resistance is a matter of concern. [ABSTRACT FROM AUTHOR]

ObjectiveTo understand the contamination and drug resistance characteristics of non-typhoidal Salmonella （NTS） during pig slaughter.MethodsA total of 170 carcasses and environmental samples were collected from two large-scale pig slaughterhouses in May and August 2021 in Shandong Province， China. Whole genome sequencing （WGS） combined with bioinformatics was used to analyze the data of the NTS isolates.ResultsNTS was detected in 29 of 170 pork samples， detection rate was 17.1%. Salmonella typhimurium was the predominant serotype （58.6%， 17/29） in the samples. The results of the drug sensitivity analysis showed that 29 NTS strains had 15 drug resistance spectra， with the highest rate of tetracycline resistance （100.0%， 29/29）， followed by ampicillin and chloramphenicol （79.3%， 23/29）. The multidrug resistance rate was 86.2% （25/29 patients）. Multilocus sequence typing （MLST） showed that ST19 was the main type， accounting for 48.3% （14/29） of cases. Analysis of drug resistance genes showed that they carried mainly tet（A）， tet（B）， tet（M）， blaTEM-1B， blaCMY-97， floR， cmlA1， etc.ConclusionThe phenomenon of NTS contamination exists in some pig slaughterhouses in Shandong Province. NTS has shown resistance to multiple antibiotics， suggesting that attention should be paid to the prevention of NTS in pig slaughterhouses.

ObjectiveThis study aimed to provide scientific evidence for precise prevention measures by utilizing a frequency matching model to identify the primary food sources contributing to sporadic cases of nontyphoidal Salmonella （NTS） in a Chinese province from 2016 to 2020.MethodsData on NTS serotypes from both patients and food sources were collected and analyzed through the Foodborne Disease Surveillance Report System and the Food Contaminant Risk Surveillance System. Source attribution was determined using the Hald model， considering serotypes common to human cases and food sources.ResultsThe analysis revealed that livestock meat was responsible for 35.67% of NTS sporadic cases， with pork contributing significantly at 22.37%. Eggs and egg products accounted for 33.83% of NTS sporadic cases， while poultry and aquatic animals contributed 19.28% and 11.22%， respectively. According to the source attribution analysis， monophasic Salmonella typhimurium appeared to be the dominant serotype causing NTS cases in the province.ConclusionThis study concluded that pork plays a crucial role as an etiological food source for sporadic NTS cases in the province， as determined by the Hald model. These findings provide valuable insights into the prevention and control of NTS-related contamination. Moreover， the application of frequency matching models to address source attribution in sporadic cases can be extended to other provinces for similar investigations.

Objective: Nontyphoidal Salmonella is a significant public health concern due to its ability to cause foodborne illnesses worldwide. This study aims to characterize the nontyphoidal Salmonella strains isolated from patients in China. Methods: A total of 19 nontyphoidal Salmonella strains were characterized through serovar identification, antimicrobial susceptibility testing (AST), biofilm formation assessment. Genetic relatedness was determined using pulsed-field gel electrophoresis (PFGE). WGS was employed to decipher the resistance mechanism and to contextualize the S. serovar Mbandaka strains among previously sequenced isolates in China. The biofilm associated mrkA gene was examined by PCR. Results: The predominant serovar identified was S. Enteritidis, followed by S. Mbandaka, S. Thompson, S. Livingston, S. Alachua, and S. Infantis. PFGE analysis indicated a notable genetic similarity among the S. Mbandaka isolates. Phylogenetic analysis suggested that these strains were likely derived from a single source that had persisted in China for over five years. One multidrug resistance (MDR) S. Enteritidis isolate carried a highly transferable IncB/O/K/Z plasmid with blaCTX-M-15. One S. Thompson strain, harboring the mrkABCDF operon in an IncX1 plasmid, isolated from cutaneous lesions, demonstrated robust biofilm formation. However, no mrkABCDF loci were detected in other strains. Conclusion: Our study emphasizes the importance of persisted surveillance and prompt response to Salmonella infections to protect public health. The dissemination of blaCTX-M-15-harboring IncB/O/K/Z plasmid and the spread of virulent mrkABCDF operon among Salmonella in China and other global regions warrant close monitoring. [ABSTRACT FROM AUTHOR]

Subdural empyema can be precipitated by a range of pathogens. Common clinical symptoms include fever, headache, seizures, and changed mental status. Yet, cerebral infections caused by Salmonella are relatively uncommon as it is rare for Salmonella to invade the central nervous system. We present the first reported case of Salmonella enterica serovar Dublin causing subdural empyema in an 83-year-old female, which was successfully managed with surgical burr hole and drainage in addition to prolonged targeted antimicrobial therapy consisting of 2 g of intravenous Ceftriaxone twice daily for a total of 56 days. This report demonstrates the course of her illness and the corresponding treatment plan; which may help guide medical providers when encountering similar cases.

Salmonella Isangi is an infrequent serovar that has recently been reported in several countries due to nosocomial infections. A considerable number of reports indicate Salmonella Isangi multidrug resistance, especially to cephalosporins, which could potentially pose a risk to public health worldwide. Genomic analysis is an excellent tool for monitoring the emergence of microorganisms and related factors. In this context, the aim of this study was to carry out a genomic analysis of Salmonella Isangi isolated from poultry in Brazil, and to compare it with the available genomes from the Pathogen Detection database and Sequence Read Archive. A total of 142 genomes isolated from 11 different countries were investigated. A broad distribution of extended-spectrum beta-lactamase (ESBL) genes was identified in the Salmonella Isangi genomes examined (blaCTX-M-15, blaCTX-M-2, blaDHA-1, blaNDM-1, blaOXA-10, blaOXA-1, blaOXA-48, blaSCO-1, blaSHV-5, blaTEM-131, blaTEM-1B), primarily in South Africa. Resistome analysis revealed predicted resistance to aminoglycoside, sulfonamide, macrolide, tetracycline, trimethoprim, phenicol, chloramphenicol, and quaternary ammonium. Additionally, PMQR (plasmid-mediated quinolone resistance) genes qnr19, qnrB1, and qnrS1 were identified, along with point mutations in the genes gyrAD87N, gyrAS83F, and gyrBS464F, which confer resistance to ciprofloxacin and nalidixic acid. With regard to plasmids, we identified 17 different incompatibility groups, including IncC, Col(pHAD28), IncHI2, IncHI2A, IncM2, ColpVC, Col(Ye4449), Col156, IncR, IncI1(Alpha), IncFIB (pTU3), Col(B5512), IncQ1, IncL, IncN, IncFIB(pHCM2), and IncFIB (pN55391). Phylogenetic analysis revealed five clusters grouped by sequence type and antimicrobial gene distribution. The study highlights the need for monitoring rare serovars that may become emergent due to multidrug resistance. [ABSTRACT FROM AUTHOR]

Foodborne disease caused by nontyphoidal Salmonella (NTS) is one of the most important food safety issues worldwide. The objectives of this study were to carry out microbial monitoring on the prevalence of NTS in commercial ground pork, investigate consumption patterns, and conduct a quantitative microbiological risk assessment (QMRA) that considers cross‐contamination to determine the risk caused by consuming ground pork and ready‐to‐eat food contaminated during food handling in the kitchen in Chengdu, China. The food pathway of ground pork was simplified and assumed to be several units according to the actual situation and our survey data, which were collected from our research or references and substituted into the QMRA model for simulation. The results showed that the prevalence of NTS in ground pork purchased in Chengdu was 69.64% (95% confidence interval [CI], 60.2–78.0), with a mean contamination level of −0.164 log CFU/g. After general cooking, NTS in ground pork could be eliminated (contamination level of zero). The estimated probability of causing salmonellosis per day was 9.43E‐06 (95% CI: 8.82E‐06–1.00E‐05), while the estimated salmonellosis cases per million people per year were 3442 (95% CI: 3218–3666). According to the sensitivity analysis, the occurrence of cross‐contamination was the most important factor affecting the probability of salmonellosis. To reduce the risk of salmonellosis caused by NTS through ground pork consumption, reasonable hygiene prevention and control measures should be adopted during food preparation to reduce cross‐contamination. This study provides valuable information for household cooking and food safety management in China. [ABSTRACT FROM AUTHOR]

Nonty p ho Ida L Salmonella is a major foodborne pathogen, with the highest percentages of Salmonella positive samples reported in broilers (14%), turkeys (7.4%), pigs (1.7%) and sheep (1.2%), as reported by EFSA annual report on zoonoses for 2023. For 2022 - 2023, three major foodborne outbreaks were reported, caused by serovars Mbandaka, Ball ST 3502 and Virchow ST16, which are not common, but due to the wide host range, that they invade and the food matrices from which they are isolated, they entered the top 20 most common Salmonella serovars. More than 99.5% of Isolates carry virulence factor Um encoded by 9 genes (fimA, C, D, F, H, L, W, YandZ). A large set of resistance genes have been identified in the genome of 5. Mbandaka, Virchow STI6 and Ball ST 3502 isolates. Avian Isolates contain the largest number of resistance determinants. It is necessary to implement molecular biological methods, with the aim of rapid diagnosis, taking adequate and timely measures and decisions related to the control and reduction of the spread of Salmonella. Surveillance should be expanded and hygiene control and disinfection measures should be strengthened at each stage of the agrifood chain, in order to be able to take adequate, timely and effective measures in case of possible detection of Salmonella serovars Mbandaka, Virchow and Ball in Bulgaria. [ABSTRACT FROM AUTHOR]

ABSTRACT Mobile colistin resistance (mcr) genes are present mainly in plasmids and can disseminate clonally or horizontally via either plasmids or insertion sequences in different genomic locations among the Enterobacteriaceae. A nationwide large-scale study on mcr prevalence and transmission in nontyphoidal Salmonella isolates is still lacking. Here, we identified 140 mcr-positive Salmonella isolates out of 7,106 isolates from 29 provinces in China from 2011 to 2020. We aligned short reads to putative plasmids from long-read hybrid assemblies and predicted the plasmid backbones of non-long-read sequencing isolates to elucidate mcr transmission patterns. The mcr-1 and mcr-3 genes are transmitted on similar high-risk clones (sequence type 34 [ST34]) but through plasmids of various replicon types. Furthermore, the ban on colistin use in food animals can lead to a decrease in the mcr-positive Salmonella prevalence among diarrheal patients, related mainly to IncHI2A_IncHI2 plasmids. We provide a framework for plasmid data incorporation into genomic surveillance systems, contributing to a better understanding of mcr spread and transmission. IMPORTANCE Nontyphoidal Salmonella is one of four major causative agents of diarrheal diseases globally, with most cases of salmonellosis being mild. Antimicrobial treatments are required for cases of life-threatening infections, and colistin is one of the last-line antibiotics for the treatment of multidrug-resistant Salmonella infections. However, the efficacy of colistin has been compromised by the emergence of various mcr genes. To elucidate the transmission of mcr genes in Salmonella isolates, our study analyzed 7,106 Salmonella strains from 29 provinces in China from 2011 to 2020. The results showed that mcr genes are transmitted on similar high-risk clones (ST34) but through plasmids of various replicon types. In addition, our data illustrated that the ban on the use of colistin in food animals led to a significant decrease in mcr-positive isolates. Our findings offer an essential step toward a more comprehensive understanding of the spread and transmission of mcr genes.

Salmonella Typhimurium and Salmonella Enteritidis are leading causative agents of invasive nontyphoidal Salmonella (iNTS) disease, which represents one of the major causes of death and morbidity in sub-Saharan Africa, still partially underestimated. Large sero-epidemiological studies are necessary to unravel the burden of disease and guide the introduction of vaccines that are not yet available. Even if no correlate of protection has been determined so far for iNTS, the evaluation of complement-mediated functionality of antibodies generated towards natural infection or elicited upon vaccination may represent a big step towards this achievement. Here we present the setup and the intra-laboratory characterization in terms of repeatability, intermediate precision, linearity, and specificity of a high-throughput luminescence-based serum bactericidal assay (L-SBA). This method could be useful to perform sero-epidemiological studies across iNTS endemic countries and for evaluation of antibodies raised against iNTS vaccine candidates in upcoming clinical trials. [ABSTRACT FROM AUTHOR]

Background: Stroke is a significant cause of morbidity and mortality worldwide, contributing substantially to the global burden of disease. In low- and middle-income countries, stroke tends to occur at younger ages, with infection being one of the notable contributing factors. Previous studies have explored the impact of nontyphoidal Salmonella (NTS) on vascular and blood-related diseases, with animal experiments confirming related mechanisms. This study aims to investigate the association between NTS and cerebrovascular diseases (CVD), with a focus on identifying specific patient populations more susceptible to stroke due to infection., Methods: This retrospective cohort study utilized the TriNetX database, including 4,708 patients infected with NTS compared to a healthy population, with disease risk tracked over six months, one year, and lifelong periods. The primary outcome was cerebrovascular diseases (ICD-10-CM: I60-I69), while secondary outcomes examined hemorrhagic stroke (ICD-10-CM: I60-I62) and ischemic stroke (ICD-10-CM: I63). Subgroup analyses were conducted based on gender and age at index, with sensitivity analysis performed by comparing hospitalized patients, utilizing different databases, and evaluating the specificity of the NTS-CVD association by examining patients with a higher risk of acute myocardial infarction (AMI)., Results: The lifelong hazard ratios (HRs) for cardiovascular disease (CVD), hemorrhagic stroke, and ischemic stroke following nontyphoidal Salmonella (NTS) infection were 1.606 (95% CI, 1.410-1.830), 1.866 (95% CI, 1.304-2.669), and 1.717 (95% CI, 1.385-2.130), respectively. A significant increase in the risk of hemorrhagic stroke was observed in the short-term and mid-term, with HRs of 3.345 (95% CI, 1.091-10.259) and 2.816 (95% CI, 1.184-6.699), respectively. Subgroup analyses indicated statistically significant associations with the primary outcomes across all age groups. Males demonstrated a higher risk of hemorrhagic stroke, with an HR of 1.891 (95% CI, 1.142-3.310), whereas females exhibited a stronger association with ischemic stroke, with an HR of 1.592 (95% CI, 1.189-2.132). These associations remained significant among hospitalized patients, while no significant relationship was observed between NTS infection and acute myocardial infarction (AMI). The findings of this study were reproducible in a US-based database., Conclusion: There is a significant association between NTS and CVD, with a particularly important impact on the occurrence of stroke in younger populations, especially regarding the elevated risk of hemorrhagic stroke.

Subdural empyema can be precipitated by a range of pathogens. Common clinical symptoms include fever, headache, seizures, and changed mental status. Yet, cerebral infections caused by Salmonella are relatively uncommon as it is rare for Salmonella to invade the central nervous system. We present the first reported case of Salmonella enterica serovar Dublin causing subdural empyema in an 83-year-old female , which was successfully managed with surgical burr hole and drainage in addition to prolonged targeted antimicrobial therapy consisting of 2 g of intravenous Ceftriaxone twice daily for a total of 56 days. This report demonstrates the course of her illness and the corresponding treatment plan; which may help guide medical providers when encountering similar cases., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

ABSTRACT Salmonella enterica serovar Enteritidis is one of the most commonly reported serovars of nontyphoidal Salmonella causing human disease and is responsible for both gastroenteritis and invasive nontyphoidal Salmonella (iNTS) disease worldwide. Whole-genome sequence (WGS) comparison of Salmonella Enteritidis isolates from across the world has identified three distinct clades, global epidemic, Central/East African, and West African, all of which have been implicated in epidemics: the global epidemic clade was linked to poultry-associated gastroenteritis, while the two African clades were related to iNTS disease. However, the distribution and epidemiology of these clades across Africa are poorly understood because identification of these clades currently requires whole-genome sequencing capacity. Here, we report a sensitive, time- and cost-effective real-time PCR assay capable of differentiating between the Salmonella Enteritidis clades to facilitate surveillance and to inform public health responses. The assay described here is limited to previously confirmed S. Enteritidis isolates. IMPORTANCE Challenges in the diagnosis and treatment of invasive Salmonella Enteritidis bloodstream infections in sub-Saharan Africa are responsible for a case fatality rate of approximately 15%. It is important to identify distinct clades of S. Enteritidis in diagnostic laboratories in the African setting to determine the different health outcomes associated with particular outbreaks. Here, we describe the development of a high-quality molecular classification assay for clade typing of S. Enteritidis that is ideal for use in public health laboratories in resource-limited settings.

Salmonella Isangi is an infrequent serovar that has recently been reported in several countries due to nosocomial infections. A considerable number of reports indicate Salmonella Isangi multidrug resistance, especially to cephalosporins, which could potentially pose a risk to public health worldwide. Genomic analysis is an excellent tool for monitoring the emergence of microorganisms and related factors. In this context, the aim of this study was to carry out a genomic analysis of Salmonella Isangi isolated from poultry in Brazil, and to compare it with the available genomes from the Pathogen Detection database and Sequence Read Archive. A total of 142 genomes isolated from 11 different countries were investigated. A broad distribution of extended-spectrum beta-lactamase (ESBL) genes was identified in the Salmonella Isangi genomes examined (blaCTX-M-15, blaCTX-M-2, blaDHA-1, blaNDM-1, blaOXA-10, blaOXA-1, blaOXA-48, blaSCO-1, blaSHV-5, blaTEM-131, blaTEM-1B), primarily in South Africa. Resistome analysis revealed predicted resistance to aminoglycoside, sulfonamide, macrolide, tetracycline, trimethoprim, phenicol, chloramphenicol, and quaternary ammonium. Additionally, PMQR (plasmid-mediated quinolone resistance) genes qnr19, qnrB1, and qnrS1 were identified, along with point mutations in the genes gyrAD87N, gyrAS83F, and gyrBS464F, which confer resistance to ciprofloxacin and nalidixic acid. With regard to plasmids, we identified 17 different incompatibility groups, including IncC, Col(pHAD28), IncHI2, IncHI2A, IncM2, ColpVC, Col(Ye4449), Col156, IncR, IncI1(Alpha), IncFIB (pTU3), Col(B5512), IncQ1, IncL, IncN, IncFIB(pHCM2), and IncFIB (pN55391). Phylogenetic analysis revealed five clusters grouped by sequence type and antimicrobial gene distribution. The study highlights the need for monitoring rare serovars that may become emergent due to multidrug resistance.

Abstract Background Infections with nontyphoidal Salmonella most commonly cause a self-limited gastroenteritis in humans and are the leading source of foodborne illness. In the USA, the incidence of culture-confirmed invasive Salmonella is extremely rare. Here, we present a unique case of enteric nontyphoidal Salmonella enteritidis infection that progressed to an invasive bacteremia in a patient with Roux-en-Y gastric bypass and gastrostomy feeding tube. Case presentation A 58-year-old Caucasian woman with a past medical history of Roux-en-Y gastric bypass with revision and recent gastrostomy feeding tube insertion was admitted with fever and diarrhea. During her inpatient stay, two sets of blood cultures grew Salmonella enteritidis and she was promptly treated with intravenous antibiotics. Her hospital course was also complicated by acute kidney injury. The patient recovered after treatment with a third-generation cephalosporin and supportive treatment. Conclusion We present an unusual case of nontyphoidal Salmonella enteritidis bacteremia complicated by acute kidney injury in a middle-aged woman with a previous history of Roux-en-Y gastric bypass and gastrostomy feeding tube insertion. Further investigation is needed to identify whether gastric surgeries or procedures are independent risk factors for invasive nontyphoidal salmonellosis.

Multidrug-resistant (MDR) Salmonella enterica can be spread from cattle to humans through direct contact with animals shedding Salmonella as well as through the food chain, making MDR Salmonella a serious threat to human health. The objective of this study was to use whole-genome sequencing to compare antimicrobial-resistant (AMR) Salmonella enterica serovars Typhimurium, Newport, and Dublin isolated from dairy cattle and humans in Washington State and New York State at the genotypic and phenotypic levels. A total of 90 isolates were selected for the study (37 S Typhimurium, 32 S Newport, and 21 S Dublin isolates). All isolates were tested for phenotypic antibiotic resistance to 12 drugs using Kirby-Bauer disk diffusion. AMR genes were detected in the assembled genome of each isolate using nucleotide BLAST and ARG-ANNOT. Genotypic prediction of phenotypic resistance resulted in a mean sensitivity of 97.2 and specificity of 85.2. Sulfamethoxazole-trimethoprim resistance was observed only in human isolates (P < 0.05), while resistance to quinolones and fluoroquinolones was observed only in 6 S Typhimurium isolates from humans in Washington State. S Newport isolates showed a high degree of AMR profile similarity, regardless of source. S Dublin isolates from New York State differed from those from Washington State based on the presence/absence of plasmid replicons, as well as phenotypic AMR susceptibility/nonsusceptibility (P < 0.05). The results of this study suggest that distinct factors may contribute to the emergence and dispersal of AMR S. enterica in humans and farm animals in different regions.IMPORTANCE The use of antibiotics in food-producing animals has been hypothesized to select for AMR Salmonella enterica and associated AMR determinants, which can be transferred to humans through different routes. Previous studies have sought to assess the degree to which AMR livestock- and human-associated Salmonella strains overlap, as well as the spatial distribution of Salmonella's associated AMR determinants, but have often been limited by the degree of resolution at which isolates can be compared. Here, a comparative genomics study of livestock- and human-associated Salmonella strains from different regions of the United States shows that while many AMR genes and phenotypes were confined to human isolates, overlaps between the resistomes of bovine and human-associated Salmonella isolates were observed on numerous occasions, particularly for S Newport. We have also shown that whole-genome sequencing can be used to reliably predict phenotypic resistance across Salmonella isolated from bovine sources.

Genome degradation correlates with host adaptation and systemic disease in Salmonella. Most lineages of the S. enterica subspecies Typhimurium cause gastroenteritis in humans; however, the recently emerged ST313 lineage II pathovar commonly causes systemic bacteremia in sub-Saharan Africa. ST313 lineage II displays genome degradation compared to gastroenteritis-associated lineages; yet, the mechanisms and causal genetic differences mediating these infection phenotypes are largely unknown. We find that the ST313 isolate D23580 hyperdisseminates from the gut to systemic sites, such as the mesenteric lymph nodes (MLNs), via CD11b+ migratory dendritic cells (DCs). This hyperdissemination was facilitated by the loss of sseI, which encodes an effector that inhibits DC migration in gastroenteritis-associated isolates. Expressing functional SseI in D23580 reduced the number of infected migratory DCs and bacteria in the MLN. Our study reveals a mechanism linking pseudogenization of effectors with the evolution of niche adaptation in a bacterial pathogen.

Salmonella infections are prevalent globally and cause invasive infections in adults and children alike. Here, we present a rare case report and literature review based on a complicated presentation of S. enteritidis endocarditis in an immunocompetent 8-year-old child with a mechanical aortic valve. The child initially presented with gastrointestinal symptoms, leading to an 11-day hospitalization for gastroenteritis and bacteremia caused by Salmonella. After a 1.5-week hospitalization, receiving intravenous Ceftriaxone and oral Ciprofloxacin, the child was discharged and underwent another week of treatment. Two weeks post-discharge, recurrent fever led to rehospitalization. During this admission, the diagnosis of infective endocarditis was made, revealing complications including pseudoaneurysms and aortic root abscesses. This diagnosis necessitated cardiac surgery and an extended course of antibiotic treatment for an additional seven weeks. The child made a full recovery and was well at follow up. This is the twelfth reported case of Salmonella endocarditis in a child. The overall mortality rate of Salmonella Endocarditis in children is approximately 50 %, and it predominantly affects males. Though rare, Salmonella endocarditis can lead to severe cardiovascular complications. Therefore, it is important to maintain a high index of suspicion for endocarditis when risk factors are present and promptly initiate treatment. • Salmonella endocarditis, though rare, poses significant risks with high mortality. • When untreated, it leads to severe cardiac complications, requiring early treatment. • Increase suspicion for patients with prosthetic valves and congenital heart defects [ABSTRACT FROM AUTHOR]

Nontyphoidal Salmonella (NTS) in children remains a growing burden on public health and often causes children to be hospitalized with diarrheic symptoms. In this work, 260 strains of human Salmonella isolated from Jilin, China were characterized by serotypes and antimicrobial resistance using whole genome sequencing (WGS). The most prevalent serotype was Salmonella enteritidis (47.3%), followed by S. I 4,[5],12:i:- (33.1%), and Salmonella Typhimurium (7.3%). Furthermore, the consistency between resistance phenotype and genotype was confirmed. Similarly, strains harbored bla TEM −1 B and tetA genes were detected, which verified the level of resistant phenotype in β-lactams and tetracyclines. The presence of a single mutation in parC, gyrA , and qnrS1 genes corresponding to quinolones was also observed. In our work, multilocus sequence typing (MLST) and core genome multilocus sequence typing (cgMLST) were found to have a high resolution to molecular traceability, and the combination of both was conducive to practical application in an actual situation. Taking all of this into account, we suggested that the comprehensive surveillance of Salmonella infection in children should be carried out to monitor antimicrobial-resistant trends from various sources and to alert on outbreaks of foodborne diseases to protect public health. [ABSTRACT FROM AUTHOR]

Background: Salmonella enterica is a group of bacteria that cause enteric and systemic infection in animals and human worldwide. Objectives: The study was conducted to determine prevalence, characterization and antimicrobial susceptibility profiles of Non-Typhoidal Salmonella in indigenous free range and broiler chickens in Morogoro Municipality. Methodology: A cross-sectional study was conducted from November 2019 to May 2020 whereby 384 cloaca swab samples from health chickens from Magadu, Mzinga and Bigwa wards were collected. Identification was done by standard bacteriological methods, serotyping and genetically confirmed by PCR using Salmonella specific primers pair and Salmonella enterica primer pair (invA and iroB gene primers). Sensitivity test was done using Ampicillin, Tetracycline, Imipenem, Gentamycin, Ciprofloxacin, Sulfamethoxazole trimethoprim and Cefaclor antimicrobial discs. Descriptive statistic method was used for analysis, and paired t-test assuming unequal variance was used for comparing overall prevalence of Salmonella spp between free range and broiler chickens. Results: Out of 384 samples, 11 (2.9%) samples confirmed to be Salmonella of which 8(4%) were from broilers and 3(1.6%) were from free range chickens. Of the 11 isolates 8 were from group B serotypes and 3 isolates were from group D serotypes. Susceptibility results showed variable level of sensitivity to majority of antibiotics tested however, level of resistance were also found in 7/11 isolates resistant to Ampicillin, 4/11 isolates resistant to sulfamethoxazole-trimethoprim and 3/11 isolates resistant to tetracycline. Three isolates were found to harbor Sulfamethoxazole(sulII) resistant gene. Conclusion: This study revealed the presence of Salmonella carrier among chicken kept in Morogoro with antimicrobial resistances from both free range and broilers chickens. The results underline the importance of the biosecurity measures in the production and processing of chicken for human consumption, similarly improvement of management is recommended to stop transmission of Salmonella from natural carriers to chicken as indicated by fecal carriers found. [ABSTRACT FROM AUTHOR]

Li-juan Wu,1,* Yan Luo,2,* Guo-lu Shi,3,* Zhong-yue Li1 1Department of Gastroenterology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, People’s Republic of China; 2Department of Pediatrics, Wushan County People’s Hospital of Chongqing, Chongqing, People’s Republic of China; 3Department of Pediatrics, Suining Central Hospital, Sichuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhong-yue LiDepartment of Gastroenterology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing, People’s Republic of ChinaTel +86-18225022855Fax +86-68370225Email lizhongyue1001@hotmail.comPurpose: Nontyphoidal Salmonella (NTS) is a leading bacterial cause for acute gastroenteritis in children. With the increasing use of antibiotics worldwide, antibiotic resistance has become a global problem. However, data on NTS infections and changes in antibiotic resistance among children remain limited in China. We aimed to characterize the prevalence, clinical feature, serotype and the changes of antibiotic resistance of NTS in children in Chongqing.Methods: 501 hospitalized children with NTS infections (confirmed by positive NTS culture) in Children’s Hospital of Chongqing Medical University from January 2009 to December 2018 were included. The clinical data and drug sensitivity test results were retrospectively reviewed and analyzed. Antibiotic resistance in NTS infections was compared between 2009– 2013 and 2014– 2018.Results: A total of 501 isolates were detected. Most NTS infections occurred in children under three years old, which mainly occurred between July and October. The numbers of patients with diarrhea, fever, and vomiting were 472 (94.2%), 422 (84.2%) and 146 (29.1%), respectively. Serogroup B (67.5%) was the predominant serogroup isolates. And Salmonella Typhimurium was the most common serotype (79.2%). The study compared the drug resistance of NTS from 2009 to 2013 with that from 2014 to 2018. We found the drug resistance rates of NTS to cefazolin, cefotaxime, ciprofloxacin, levofloxacin and imipenem showed an upward trend. The drug resistance rates of NTS to chloramphenicol, ampicillin, ceftriaxone, cefepime and compound sulfamethoxazole decreased slightly, but still showed high drug resistance rates. And drug resistance rates of NTS to piperacillin/tazobactam and ceftazidime decreased significantly in the last ten years. Multi-drug resistance (MDR) isolates, were detected among 69 cases (13.7%) of 501 children with NTS infections.Conclusion: The overall antibiotic resistance rates remained at a high level in Chongqing. Continuous surveillance of antibiotic resistance in NTS and control measures such as avoiding unnecessary antibiotic therapy in general NTS gastroenteritis are important. For severe or invasive infections caused by NTS infection in Southwest China, the use of ceftazidime is recommended until antibiotic sensitivity test results are available. And the choice of antibiotics should be based on the curative effect and the antibiotics sensitivity results.Keywords: nontyphoidal Salmonella, pediatric, prevalence, antibiotic resistance

Nontyphoidal Salmonella (NTS) in children remains a growing burden on public health and often causes children to be hospitalized with diarrheic symptoms. In this work, 260 strains of human Salmonella isolated from Jilin, China were characterized by serotypes and antimicrobial resistance using whole genome sequencing (WGS). The most prevalent serotype was Salmonella enteritidis (47.3%), followed by S. I 4,[5],12:i:- (33.1%), and Salmonella Typhimurium (7.3%). Furthermore, the consistency between resistance phenotype and genotype was confirmed. Similarly, strains harbored blaTEM−1B and tetA genes were detected, which verified the level of resistant phenotype in β-lactams and tetracyclines. The presence of a single mutation in parC, gyrA, and qnrS1 genes corresponding to quinolones was also observed. In our work, multilocus sequence typing (MLST) and core genome multilocus sequence typing (cgMLST) were found to have a high resolution to molecular traceability, and the combination of both was conducive to practical application in an actual situation. Taking all of this into account, we suggested that the comprehensive surveillance of Salmonella infection in children should be carried out to monitor antimicrobial-resistant trends from various sources and to alert on outbreaks of foodborne diseases to protect public health.

Purpose: Antimicrobial resistance of nontyphoidal Salmonella (NTS) is a threat to public health worldwide. Methods: A study on longitudinally collected NTS isolates from a medical center in Taiwan from 2011 to 2019 was undertaken. The multidrug resistance (MDR) and extensively drug resistance (XDR) phenotypes were determined according to internationally used definitions. Molecular serotyping was performed on the resistant NTS. Results: Notably 16.1% (870/5412) of the isolates were MDR, while XDR accounted for 2.1% (111/5412). Both MDR and XDR NTS have increased significantly from 2011 to 2019, especially from 2015 to 2017 (MDR from 9.6% in 2015 to 23.1% 2017; XDR from 1.4% in 2016 to 4.7% in 2017). S. Anatum was the commonest NTS serotype expressing MDR and XDR, in 256/559 (45.8%) and 81/111 (73.0%) of the isolates, respectively, followed by S. Typhimurium and S. Goldcoast. Children < 18 years old contributed to 69.0% of all MDR cases and 64.0% of all XDR cases; majority of them aged less than 5 years. Conclusions: Increasing MDR and XDR NTS is a threat to public health. MDR and XDR NTS usually caused gastroenteritis in children < 5 years old. Multiple NTS serotypes expressing MDR and XDR indicate multiple food vehicles involved in the transmission. Proper food hygiene practice should never be over-reinforced. [ABSTRACT FROM AUTHOR]

Enteric viral and bacterial infections continue to be a leading cause of mortality and morbidity in young children in low-income and middle-income countries, the elderly, and immunocompromised individuals. Vaccines are considered an effective and practical preventive approach against the predominantly fecal-to-oral transmitted gastroenteritis particularly in the resource-limited countries or regions where implementation of sanitation systems and supply of safe drinking water are not quickly achievable. While vaccines are available for a few enteric pathogens including rotavirus and cholera, there are no vaccines licensed for many other enteric viral and bacterial pathogens. Challenges in enteric vaccine development include immunological heterogeneity among pathogen strains or isolates, a lack of animal challenge models to evaluate vaccine candidacy, undefined host immune correlates to protection, and a low protective efficacy among young children in endemic regions. In this article, we briefly updated the progress and challenges in vaccines and vaccine development for the leading enteric viral and bacterial pathogens including rotavirus, human calicivirus, Shigella, enterotoxigenic Escherichia coli (ETEC), cholera, nontyphoidal Salmonella, and Campylobacter, and introduced a novel epitope- and structure-based vaccinology platform known as MEFA (multiepitope fusion antigen) and the application of MEFA for developing broadly protective multivalent vaccines against heterogenous pathogens.

Objective Understanding of bacterial antibiotic resistance is the basis for guiding clinical anti-infective therapy and monitoring antimicrobial resistance trends. The study was aimed to investigate the antibiotic resistance characteristics of nontyphoidal Salmonella isolates from foodborne disease cases in Jiangxi Province in 2018, study the correlations between resistance phenotypes and genotypes, and evaluate the application prospects of whole genome sequencing (WGS) in antimicrobial resistance surveillance. Methods In this study, 58 nontyphoidal Salmonella strains were isolated from foodborne disease patients in Jiangxi Province in 2018 and were tested for susceptibility to 14 antimicrobials using broth microdilution. The 58 isolates were subjected to WGS, and resistance genes were identified from assembled sequences that compared with ResFinder database. Results 77.59% (45/58) of isolates were resistant to tetracycline, and 72.41% (42/58) were resistant to ampicillin. 100.00% of isolates were susceptible to imipenem. 56.90% (33/58) of isolates displayed resistance to at least 3 classes of antibiotics, and 3.45% (2/58) of isolates had resistance to at least 6 of 8 classes tested. A total of 47 unique resistance genes referred to 11 classes of antibiotics, plus mutations in gyrA, gyrB and parC structural of quinolone resistance-determining region (QRDR), were identified. 100.00% (58/58) of isolates had aminoglycoside resistance genes, and 72.41% (42/58) of isolates harboured tetracycline resistance genes. Macrolide resistance genes were presented in 3.45% (2/58) of isolates. 77.59% (45/58) of isolates were contained at least 3 classes of antibiotics resistance genes, and 1.72% (1/58) of isolates harboured at least 9 classes of resistance genes. The overall resistance genotypes and phenotypes were consistent in 93.43% (611/654) of cases. Except quinolones, the correlations were above 91% for tested antibiotics. Correlations were 100% for some classes of antibiotics. Conclusion The antibiotic resistance phenomenon of these isolates was serious. The resistance phenotypes were in good accordance with genotypes, and WGS can be used as an effective tool to predict the antibiotic resistance of nontyphoidal Salmonella. As more new antibiotic resistance genes were discovered, the consistency of resistance genotypes and phenotypes will be further improved.

Background: The epidemiology of nontyphoidal Salmonella (NTS) resistant to ciprofloxacin or ceftriaxone and its impact on patients’ clinical course are rarely reported. Methods: Children with culture-proven salmonellosis treated in a medical center in northern Taiwan in 2017 were enrolled. To trace the source of Salmonella, Salmonella isolated from food samples were collected from markets. Antimicrobial susceptibility and serotypes were determined. Results: Among the 453 isolates, 122 (26.9%) were highly antimicrobial-resistant, as defined by resistance to ciprofloxacin or ceftriaxone or both. The most prevalent highly resistant serotype was S. Anatum (66, 54.1%). Salmonella was detected in 94.1%, 66.7%, and 8.6% of examined pork, chicken, and vegetables examined, respectively. S. Anatum (6, 21.4%) and S. Derby (6, 21.4%) were the major serotypes isolated. Majority of the S. Anatum (5, 83.3%) were highly antimicrobial-resistant. More patients infected by highly resistant Salmonella required carbapenem treatment (OR = 23.5, 95% confidence interval [CI] 2.8–192.7, P

ABSTRACT While differences in human virulence have been reported across nontyphoidal Salmonella (NTS) serovars and associated subtypes, a rational and scalable approach to identify Salmonella subtypes with differential ability to cause human diseases is not available. Here, we used NTS serovar Saintpaul (S. Saintpaul) as a model to determine if metadata and associated whole-genome sequence (WGS) data in the NCBI Pathogen Detection (PD) database can be used to identify (i) subtypes with differential likelihoods of causing human diseases and (ii) genes and single nucleotide polymorphisms (SNPs) potentially responsible for such differences. S. Saintpaul SNP clusters (n = 211) were assigned different epidemiology types (epi-types) based on statistically significant over- or underrepresentation of human clinical isolates, including human associated (HA; n = 29), non-human associated (NHA; n = 23), and other (n = 159). Comparative genomic analyses identified 384 and 619 genes overrepresented among isolates in 5 HA and 4 NHA SNP clusters most significantly associated with the respective isolation source. These genes included 5 HA-associated virulence genes previously reported to be present on Gifsy-1/Gifsy-2 prophages. Additionally, premature stop codons in 3 and 7 genes were overrepresented among the selected HA and NHA SNP clusters, respectively. Tissue culture experiments with strains representing 4 HA and 3 NHA SNP clusters did not reveal evidence for enhanced invasion or intracellular survival for HA strains. However, the presence of sodCI (encoding a superoxide dismutase), found in 4 HA and 1 NHA SNP clusters, was positively correlated with intracellular survival in macrophage-like cells. Post hoc analyses also suggested a possible difference in intracellular survival among S. Saintpaul lineages. IMPORTANCE Not all Salmonella isolates are equally likely to cause human disease, and Salmonella control strategies may unintentionally focus on serovars and subtypes with high prevalence in source populations but are rarely associated with human clinical illness. We describe a framework leveraging WGS data in the NCBI PD database to identify Salmonella subtypes over- and underrepresented among human clinical cases. While we identified genomic signatures associated with HA/NHA SNP clusters, tissue culture experiments failed to identify consistent phenotypic characteristics indicative of enhanced human virulence of HA strains. Our findings illustrate the challenges of defining hypo- and hypervirulent S. Saintpaul and potential limitations of phenotypic assays when evaluating human virulence, for which in vivo experiments are essential. Identification of sodCI, an HA-associated virulence gene associated with enhanced intracellular survival, however, illustrates the potential of the framework and is consistent with prior work identifying specific genomic features responsible for enhanced or reduced virulence of nontyphoidal Salmonella.

Background: Nontyphoidal Salmonella (NTS) outbreaks of invasive diseases are increasing. Whether the genetic diversity of invasive NTS correlates with the clinical characteristics and bacteremia development in NTS infections remains unclear. In this study, we compared the global transcriptomes between bacteremic and nonbacteremic NTS strains after their interaction with human intestinal epithelial cells in vitro., Methods: We selected clinical isolates obtained from stool and blood samples of patients with or without bacteremia and patients with high and low C-reactive protein (CRP) levels. The bacterial RNA samples were isolated after coculturing with Caco-2 cells for RNA sequencing and subsequent analyses., Results: CRP is an unreliable predictive maker for NTS bacteremia with a median CRP level of 1.6 mg/dL. Certain Salmonella Pathogenicity Island (SPI)-1 genes (sipC, sipA, sicA, sipD, and sipB), SPI-2 genes (ssaP, ssrA, and ssaS), and six SPI-4 genes (siiA, siiB, siiC, siiD, siiE, and siiF) remained upregulated in the bacteremic blood-derived strains but significantly downregulated in the nonbacteremic strains after their interaction with Caco-2 cells. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways analysis identified that arginine biosynthesis, ascorbate and aldarate metabolism, and phosphotransferase system pathways were activated in bacteremic NTS strains after Caco-2 cell priming., Conclusion: CRP levels were not correlated with bacteremia development. Significant regulation of certain SPI genes in bacteremic NTS strains after Caco-2 cell priming; bacteremia development might be influenced by the host immune response and the extent to which specific metabolism pathways in NTS strains can be prevented from invading the bloodstream., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Nontyphoidal Salmonella (NTS) is the main etiological agent of human nontyphoidal salmonellosis. The aim of this study was to analyze the epidemiological characteristics and horizontal transfer mechanisms of antimicrobial resistance (AMR) genes from eight strains of NTS detected in Zhenjiang City, Jiangsu Province, China. Fecal samples from outpatients with food-borne diarrhea were collected in 2022. The NTS isolates were identified, and their susceptibility was tested with the Vitek 2 Compact system. The genomes of the NTS isolates were sequenced with the Illumina NovaSeq platform and Oxford Nanopore Technologies platform. The AMR genes and mobile genetic elements (MGEs) were predicted with the relevant open access resources. Eight strains of NTS were isolated from 153 specimens, and Salmonella Typhimurium ST19 was the most prevalent serotype. The AMR gene with the highest detection rate was AAC(6 ' )-Iaa (10.5%) followed by TEM-1 (7.9%), sul2 (6.6%), and tet(A) (5.3%). Eleven MGEs carrying 34 AMR genes were identified on the chromosomes of 3 of the 8 NTS, including 3 resistance islands, 6 composite transposons (Tns), and 2 integrons. Eighteen plasmids carrying 40 AMR genes were detected in the 8 NTS strains, including 6 mobilizable plasmids, 3 conjugative plasmids, and 9 nontransferable plasmids, 7 of which carried 10 composite Tns and 3 integrons. This study provided a theoretical basis, from a genetic perspective, for the prevention and control of NTS resistance in Zhenjiang City., Importance: Human nontyphoidal salmonellosis is one of the common causes of bacterial food-borne illnesses, with significant social and economic impacts, especially those caused by invasive multidrug-resistant nontyphoidal Salmonella , which entails high morbidity and mortality. Antimicrobial resistance is mainly mediated by drug resistance genes, and mobile genetic elements play key roles in the capture, accumulation, and dissemination of antimicrobial resistance genes. Therefore, it is necessary to study the epidemiological characteristics and horizontal transfer mechanisms of antimicrobial resistance genes of nontyphoidal Salmonella to prevent the spread of multidrug-resistant nontyphoidal Salmonella ., Competing Interests: The authors declare no conflict of interest.

The prevalence of Non-typhoidal Salmonella (NTS) and extended-spectrum ß-lactamase (ESBL) producing bacteria was assessed in samples of imported prawn and shrimp obtained from retail markets in Japan. The overall prevalence of NTS and ESBL producing bacteria was 4%, and 14%, respectively. We identified 4 NTS isolates, including S. enterica subspecies salamae, and 3 serovars of S. enterica subspecies enterica, including Weltevreden, Abony, and Stanley. ESBL producing bacteria were isolated from 14 of 100 samples, thirteen of which harbored Stenotrophomonas maltophilia and that harbored Chryseobacterium indologenes. Among the S. maltophilia-positive samples, six had been imported from India, five samples came from Indonesia, one sample was from Thailand, and 1 was from Vietnam. These 14 ESBL isolates were susceptible to moxalactam, chloramphenicol, nalidixic acid, ofloxacin, and sulfamethoxazoletrimethoprim; however, all isolates were resistant to carbapenems. These findings indicate that to increase food safety, information regarding contamination by foodborne pathogens including Salmonella should be provided as feedback to the food's country of origin. Additionally, more detailed studies regarding the epidemiological significance of S. maltophilia and C. indologenes contamination of imported food are needed for both food-exporting and -importing countries. [ABSTRACT FROM AUTHOR]

Objectives: Although nontyphoidal Salmonella infections have a prevalence of 0.2-1.8%. It is mostly described in veterinary medicine; it could be responsible for severe intra-amniotic infections in humans. The objective of this review is to describe the clinical and microbiological aspects of intrauterine infection (IUI) caused by nontyphoidal Salmonella.Methods: We reported a case analysis and subsequently conducted a systematic literature review of IUI caused by nontyphoidal Salmonella between 1966 and 2018.Results: In literature nine cases have been reported, and were confirmed by the identification of a nontyphoidal Salmonella in the biological samples. Our review reveals severe clinical presentations in pregnant women. Indeed, sepsis, spontaneous abortions, and fatal outcomes for fetuses were described in 90, 60, and 80% of the cases, respectively. The major clinical symptoms were in majority acute, with high fever, abdominal pain, metrorrhagia, and premature membranes ruptures. Nulliparity is a risk factor and the prognosis depends on the pregnancy stage. All mothers received antibiotics and their outcomes were favorable.Conclusions: Nontyphoidal Salmonella infections can be responsible for severe pregnancy complications. Considering the severe neonatal prognosis, in case of a history of diarrhea and/or sepsis, a search for this pathogen should be considered, and a preventive strategy could be discussed during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: We investigated the correlation between nontyphoidal S almonella (NTS) infection and systemic lupus erythematosus (SLE) risk. Methods: This case-control study comprised 6,517 patients with newly diagnosed SLE between 2006 and 2013. Patients without SLE were randomly selected as the control group and were matched at a case-control ratio of 1:20 by age, sex, and index year. All study individuals were traced from the index date back to their NTS exposure, other relevant covariates, or to the beginning of year 2000. Conditional logistic regression analysis was used to analyze the risk of SLE with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) between the NTS and control groups. Results: The mean age was 37.8 years in the case and control groups. Females accounted for 85.5%. The aOR of having NTS infection were significantly increased in SLE relative to controls (aOR, 9.20; 95% CI, 4.51-18.78) in 1:20 sex-age matching analysis and (aOR, 7.47; 95% CI=2.08-26.82) in propensity score matching analysis. Subgroup analysis indicated that the SLE risk was high among those who dwelled in rural areas; had rheumatoid arthritis, multiple sclerosis, or Sjogren's syndrome; and developed intensive and severe NTS infection during admission. Conclusions: Exposure to NTS infection is associated with the development of subsequent SLE in Taiwanese individuals. Severe NTS infection and other autoimmune diseases such as rheumatoid arthritis, multiple sclerosis, or Sjogren's syndrome also contributed to the risk of developing SLE. [ABSTRACT FROM AUTHOR]

ObjectiveWe investigated the correlation between nontyphoidal Salmonella (NTS) infection and systemic lupus erythematosus (SLE) risk.MethodsThis case-control study comprised 6,517 patients with newly diagnosed SLE between 2006 and 2013. Patients without SLE were randomly selected as the control group and were matched at a case-control ratio of 1:20 by age, sex, and index year. All study individuals were traced from the index date back to their NTS exposure, other relevant covariates, or to the beginning of year 2000. Conditional logistic regression analysis was used to analyze the risk of SLE with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) between the NTS and control groups.ResultsThe mean age was 37.8 years in the case and control groups. Females accounted for 85.5%. The aOR of having NTS infection were significantly increased in SLE relative to controls (aOR, 9.20; 95% CI, 4.51-18.78) in 1:20 sex-age matching analysis and (aOR, 7.47; 95% CI=2.08-26.82) in propensity score matching analysis. Subgroup analysis indicated that the SLE risk was high among those who dwelled in rural areas; had rheumatoid arthritis, multiple sclerosis, or Sjogren’s syndrome; and developed intensive and severe NTS infection during admission.ConclusionsExposure to NTS infection is associated with the development of subsequent SLE in Taiwanese individuals. Severe NTS infection and other autoimmune diseases such as rheumatoid arthritis, multiple sclerosis, or Sjogren’s syndrome also contributed to the risk of developing SLE.

Salmonella Typhimurium and Salmonella Enteritidis are leading causative agents of invasive nontyphoidal Salmonella (iNTS) disease, which represents one of the major causes of death and morbidity in sub-Saharan Africa, still partially underestimated. Large sero-epidemiological studies are necessary to unravel the burden of disease and guide the introduction of vaccines that are not yet available. Even if no correlate of protection has been determined so far for iNTS, the evaluation of complement-mediated functionality of antibodies generated towards natural infection or elicited upon vaccination may represent a big step towards this achievement. Here we present the setup and the intra-laboratory characterization in terms of repeatability, intermediate precision, linearity, and specificity of a high-throughput luminescence-based serum bactericidal assay (L-SBA). This method could be useful to perform sero-epidemiological studies across iNTS endemic countries and for evaluation of antibodies raised against iNTS vaccine candidates in upcoming clinical trials.

ABSTRACT The number of bacterial genomes deposited each year in public databases is growing exponentially. However, efforts to use these genomes to track trends in antimicrobial resistance (AMR) have been limited thus far. We used 22,102 genomes from public databases to track AMR trends in nontyphoidal Salmonella in food animals in the United States. In 2018, genomes deposited in public databases carried genes conferring resistance, on average, to 2.08 antimicrobial classes in poultry, 1.74 in bovines, and 1.28 in swine. This represents a decline in AMR of over 70% compared to the levels in 2000 in bovines and swine, and an increase of 13% for poultry. Trends in resistance inferred from genomic data showed good agreement with U.S. phenotypic surveillance data (weighted mean absolute difference ± standard deviation, 5.86% ± 8.11%). In 2018, resistance to 3rd-generation cephalosporins in bovines, swine, and poultry decreased to 9.97% on average, whereas in quinolones and 4th-generation cephalosporins, resistance increased to 12.53% and 3.87%, respectively. This was concomitant with a decrease of blaCMY-2 but an increase in blaCTX-M-65 and gyrA D87Y (encoding a change of D to Y at position 87). Core genome single-nucleotide polymorphism (SNP) phylogenies show that resistance to these antimicrobial classes was predominantly associated with Salmonella enterica serovar Infantis and, to a lesser extent, S. enterica serovar Typhimurium and its monophasic variant I 4,[5],12:i:−, whereas quinolone resistance was also associated with S. enterica serovar Dublin. Between 2000 and 2018, trends in serovar prevalence showed a composition shift where S. Typhimurium decreased while S. Infantis increased. Our findings illustrate the growing potential of using genomes in public databases to track AMR in regions where sequencing capacities are currently expanding. IMPORTANCE Next-generation sequencing has led to an exponential increase in the number of genomes deposited in public repositories. This growing volume of information presents opportunities to track the prevalence of genes conferring antimicrobial resistance (AMR), a growing threat to the health of humans and animals. Using 22,102 public genomes, we estimated that the prevalence of multidrug resistance (MDR) in the United States decreased in nontyphoidal Salmonella isolates recovered from bovines and swine between 2000 and 2018, whereas it increased in poultry. These trends are consistent with those detected by national surveillance systems that monitor resistance using phenotypic testing. However, using genomes, we identified that genes conferring resistance to critically important antimicrobials were associated with specific MDR serovars that could be the focus for future interventions. Our analysis illustrates the growing potential of public repositories to monitor AMR trends and shows that similar efforts could soon be carried out in other regions where genomic surveillance is increasing.

Background: This study analyzed the antimicrobial resistance phenotypes and mechanisms of quinolone, cephalosporins, and colistin resistance in nontyphoidal Salmonella from patients with diarrhea in Jiangsu, China.Methods: A total of 741 nontyphoidal Salmonella isolates were collected from hospitals in major cities of Jiangsu Province, China between 2016 and 2017. Their susceptibility to commonly used antibiotics was evaluated by broth micro-dilution and sequencing analysis of resistance genes screened by a PCR method. For mcr-1 positive isolates, genetic relationship study was carried out by pulsed-field gel electrophoresis and multiloci sequence typing analysis. The transferability of these plasmids was measured with conjugation experiments and the genetic locations of mcr-1 were analyzed by pulsed-field gel electrophoresis profiles of S1-digested genomic DNA and subsequent Southern blot hybridization.Results: Among 741 nontyphoidal Salmonella isolates, the most common serotypes identified were S. Typhimurium (n=257, 34.7%) and S. Enteritidis (n=127, 17.1%), and the isolates showed 21.7, 20.6, and 5.0% resistance to cephalosporins, ciprofloxacin, and colistin, respectively. Among the 335 nalidixic acid-resistant Salmonella, 213 (63.6%) and 45 (13.4%) had at least one mutation in gyrA and parC. Among the plasmid-borne resistance, qnrS1 (85; 41.9%) and aac(6')-Ib-cr4 (75; 36.9%) were the most common quinolone resistance (PMQR) genes, while blaCTX-M-14 (n=35) and blaCTX-M-55 (n=46) were found to be dominant extended-spectrum beta-lactamase (ESBL) genes in nontyphoidal Salmonella. In addition, eight mcr-1-harboring strains were detected since 2016 and they were predominate in children under the age of 7years. Conjugation assays showed the donor Salmonella strain has functional and transferable colistin resistance and Southern blot hybridization revealed that mcr-1 was located in a high molecular weight plasmid.Conclusion: In nontyphoidal Salmonella, there is a rapidly increasing trend of colistin resistance and this is the first report of patients harboring mcr-1-positive Salmonella with a new ST type ST155 and new serotype S. Sinstorf. These findings demonstrate the necessity for cautious use and the continuous monitoring of colistin in clinical applications.

ABSTRACT Nontyphoidal Salmonella (NTS) gastroenteritis in children remains a significant burden on health care and constitutes a majority of all admissions for Salmonella infections in public hospitals in Hong Kong. In this prospective study, 41% of 241 children hospitalized with gastroenteritis from three public hospitals during 2019 were culture confirmed to have NTS infection. These Salmonella isolates were whole-genome sequenced and in silico predicted for their serovars/serotypes using the Salmonella In Silico Typing Resource (SISTR) and SeqSero1, and the antimicrobial resistance (AMR) genes were determined. Phylogenetic analysis revealed three major clades belonging to Salmonella enterica serovar Enteritidis sequence type 11 (ST11) (43%), multidrug-resistant (MDR) S. Typhimurium ST19 (12%) and its monophasic variant ST34 (25%), and mostly singletons of 15 other serovars. MDR S. Typhimurium and its variant were more common in infants

Aims: Quinolone-resistant nontyphoidal Salmonella having serine replaced by isoleucine at the 83rd amino acid in GyrA (GyrA-Ser83Ile) has recently been found in Asian countries. In this study, we aimed to examine the direct effect of substitution Ser83Ile on DNA gyrase activity and/or resistance to quinolones. Materials and Methods: Using 50% of the maximal inhibitory concentrations (IC50s) of quinolones, recombinant wild type (WT) and seven mutant DNA gyrases having amino acid substitutions, including Ser83Ile, were screened for enzymatic activity that causes supercoils in relaxed plasmid DNA and resistance to quinolones. Results: Little differences in supercoiling activity were observed between WT and mutant DNA gyrases. By contrast, the IC50s of ciprofloxacin and norfloxacin against GyrA-Ser83Ile/GyrB-WT were 11.6 and 73.3 μg/mL, respectively, which were the highest used against the DNA gyrases examined in this study. Conclusion: Ser83Ile in GyrA was shown to confer high-level quinolone resistance to DNA gyrases of nontyphoidal Salmonella, with no loss of supercoiling activity. Salmonella strain carrying GyrA with Ser83Ile may emerge under a high-concentration pressure of quinolones and easily spread even with no selection bias by quinolones. Hence, avoiding the overuse of quinolones is needed to prevent the spread of Salmonella with Ser83Ile in GyrA. [ABSTRACT FROM AUTHOR]

Background: This study analyzed the antimicrobial resistance phenotypes and mechanisms of quinolone, cephalosporins, and colistin resistance in nontyphoidal Salmonella from patients with diarrhea in Jiangsu, China. Methods: A total of 741 nontyphoidal Salmonella isolates were collected from hospitals in major cities of Jiangsu Province, China between 2016 and 2017. Their susceptibility to commonly used antibiotics was evaluated by broth micro-dilution and sequencing analysis of resistance genes screened by a PCR method. For mcr-1 positive isolates, genetic relationship study was carried out by pulsed-field gel electrophoresis and multiloci sequence typing analysis. The transferability of these plasmids was measured with conjugation experiments and the genetic locations of mcr-1 were analyzed by pulsed-field gel electrophoresis profiles of S1-digested genomic DNA and subsequent Southern blot hybridization. Results: Among 741 nontyphoidal Salmonella isolates, the most common serotypes identified were S. Typhimurium (n =257, 34.7%) and S. Enteritidis (n =127, 17.1%), and the isolates showed 21.7, 20.6, and 5.0% resistance to cephalosporins, ciprofloxacin, and colistin, respectively. Among the 335 nalidixic acid-resistant Salmonella , 213 (63.6%) and 45 (13.4%) had at least one mutation in gyrA and parC. Among the plasmid-borne resistance, qnrS1 (85; 41.9%) and aac(6')-Ib-cr4 (75; 36.9%) were the most common quinolone resistance (PMQR) genes, while bla CTX-M-14 (n =35) and bla CTX-M-55 (n =46) were found to be dominant extended-spectrum beta-lactamase (ESBL) genes in nontyphoidal Salmonella. In addition, eight mcr-1 -harboring strains were detected since 2016 and they were predominate in children under the age of 7years. Conjugation assays showed the donor Salmonella strain has functional and transferable colistin resistance and Southern blot hybridization revealed that mcr-1 was located in a high molecular weight plasmid. Conclusion: In nontyphoidal Salmonella , there is a rapidly increasing trend of colistin resistance and this is the first report of patients harboring mcr-1 -positive Salmonella with a new ST type ST155 and new serotype S. Sinstorf. These findings demonstrate the necessity for cautious use and the continuous monitoring of colistin in clinical applications. [ABSTRACT FROM AUTHOR]

Background: Infections with nontyphoidal Salmonella most commonly cause a self-limited gastroenteritis in humans and are the leading source of foodborne illness. In the USA, the incidence of culture-confirmed invasive Salmonella is extremely rare. Here, we present a unique case of enteric nontyphoidal Salmonella enteritidis infection that progressed to an invasive bacteremia in a patient with Roux-en-Y gastric bypass and gastrostomy feeding tube.Case Presentation: A 58-year-old Caucasian woman with a past medical history of Roux-en-Y gastric bypass with revision and recent gastrostomy feeding tube insertion was admitted with fever and diarrhea. During her inpatient stay, two sets of blood cultures grew Salmonella enteritidis and she was promptly treated with intravenous antibiotics. Her hospital course was also complicated by acute kidney injury. The patient recovered after treatment with a third-generation cephalosporin and supportive treatment.Conclusion: We present an unusual case of nontyphoidal Salmonella enteritidis bacteremia complicated by acute kidney injury in a middle-aged woman with a previous history of Roux-en-Y gastric bypass and gastrostomy feeding tube insertion. Further investigation is needed to identify whether gastric surgeries or procedures are independent risk factors for invasive nontyphoidal salmonellosis. [ABSTRACT FROM AUTHOR]

An auxotrophic mutant of nontyphoidal Salmonella (NTS) strain (Salmonella Oslo) was phenotypically characterized in this study. The characterization was based on phenotype, morphology, motility, biofilm forming ability, growth kinetics, etc. The phenotypic results from the above experiments determined that the mutant showed variation in phenotypic characters from that of wild-type strain. Subsequently, mutant and wild-type NTS were subjected to epithelial cell invasion and intracellular replication assays. The real-time PCR analysis was also performed to analyse expression of tumor inhibiting cytokine genes and virulence genes post-bacterial infection in cell lines. The mutant showed highest invasion potential than wild-type NTS whereas the replication of mutant was slower in both the cell lines. Similar to the wild-type strain, the mutant also retained the cytotoxic potential when analysed in vitro. Furthermore, the expression of proinflammatory cytokine genes such as TNF-α and IL-1β was upsurged with the downregulation of anti-inflammatory cytokine genes like TGF-β, IL-6 and IL-10 post-infection of the mutant strain in cell lines. In addition, virulence genes of Salmonella pathogenicity island one and two of mutant were downregulated in vitro except invA in HeLa cell line. Therefore, the auxotrophic mutant showed positive attributes of a potential antitumor agent in terms of expressing tumor inhibiting cytokine genes when assessed in vitro. Though the study did not check the tumor inhibitory effect of NTS strain directly, findings of the study emphasizes on the development of a novel strain of NTS with less virulence and more immunogenic traits to inhibit tumor cells. [ABSTRACT FROM AUTHOR]

• Nontyphoidal Salmonella has the potential to cause invasive infections, particularly in immunocompromised patients. • Patients with systemic lupus erythematosus experiencing pain in multiple joints may be prone to misdiagnosis in the absence of fever. • It is crucial to rule out infection as immunosuppressive therapy can potentially worsen the condition. • The analysis of blood or joint fluid culture is essential for making a differential diagnosis. • Surgical drainage is indicated for septic arthritis if the infection is unresponsive to antibiotic therapy. We report a case of septic arthritis in a 43-year-old female patient. Despite initial treatment with ceftriaxone for Nontyphoidal Salmonella based on blood and joint fluid culture results, the shoulder joint pain worsened. Suspected systemic lupus erythematosus associated synovitis did not respond to immunosuppressive therapy including methylprednisolone, hydroxychloroquine and methotrexate. Subsequent radiograph revealed a shoulder joint abscess, leading to arthroscopic joint debridement. Ceftriaxone was administered post-operatively until analgesic efficacy was attained. This case highlights the significance of accurate diagnosis and appropriate treatment for nontyphoidal Salmonella septic arthritis. [ABSTRACT FROM AUTHOR]

Summary: Iron is essential for DNA synthesis, respiration, energy metabolism, and key metabolic reactions intrinsic to life because of its capability to accept and release electrons easily and its indispensability for most of the creatures on the earth including bacteria and poultry. Salmonella species, the gram-negative foodborne facultative anaerobes, are notorious enteric pathogens that have a wild range of animal hosts, causing the deterioration of animal health, compromised animal welfare, enormous agricultural loss and medical burden around the world. Nontyphoidal Salmonella enterica (NTS) infections in poultry are the important cause of human salmonellosis. Poultry can be infected by NTS and have no obvious symptoms and are sold, transported and slaughtered as healthy animals. However, birds may carry in their intestine this organism undetected into the abattoir at the time of slaughter, thereby representing a food-safety risk for consumers. To reduce the risk of salmonellosis, the prevention of S. enterica serovars from colonization and invasion of the gut through limiting their iron acquisition can be an effective approach. This review summarizes the biological roles of iron and iron homeostasis in both Salmonella and poultry, competition for iron between Salmonella and hosts, and potential strategies targeting iron acquisitions to control Salmonella infection in poultry.

Introduction: Clostridium difficile infection (CDI) and nontyphoidal Salmonella infection (NSI) have similar clinical manifestations and are seldom seen simultaneously. The decision-making in terms of antibiotic therapy becomes difficult when both the pathogens are isolated from the same patient. Case Presentation: We describe a case of Clostridium difficile (CD) enterocolitis in a healthcare provider who concomitantly tested positive for nontyphoidal Salmonella. Discussion: To the best of our knowledge after extensive literature review (English), this is only the fourth report highlighting this association. Conclusion: Although Salmonella is not a risk factor for CDI, it can cause intestinal inflammation and alteration in the intestinal flora. When two pathogens are isolated from the same patient, it is tempting to treat both with antibiotics as highlighted. When it involves healthcare workers, there is no difference in guidelines and should not be prescribed antibiotics with intent of reducing secondary transmission.