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TYPE Original Research

PUBLISHED 15 March 2023
DOI 10.3389/fped.2023.1077158

Prevalence, serotype, and

antimicrobial resistance profiles of
children infected with Salmonella
EDITED BY
Zikria Saleem,
Bahauddin Zakariya University, Pakistan

REVIEWED BY
Romain Basmaci,
in Guangzhou, southern China,
Hôpital Louis-Mourier, France
Muhammad Sajeel Ahmed Malik, 2016–2021
University of Lahore, Pakistan

*CORRESPONDENCE Fei Gao†, Zhenting Huang†, Zhile Xiong, Hao Zheng, Qiulian Deng,
Jielin Wang;
[email protected]
Huamin Zhong, Sufei Zhu, Yan Long#* and Jielin Wang#*
Yan Long Clinical Laboratory Department, Guangzhou Women and Children’s Medical Center, Guangzhou Medical
[email protected] University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
†
These authors have contributed equally to this
work
Purpose: Salmonella infection is a key global public health concern and has lead
SPECIALTY SECTION to an increased economic burden on society. We investigated the epidemiological
This article was submitted to Pediatric
characteristics and antimicrobial resistance profiles of clinically isolated Salmonella
Infectious Diseases, a section of the journal
Frontiers in Pediatrics
strains in Guangzhou Women and Children’s Medical Center.
Patients and methods: This was a retrospective study of 1,338 Salmonella strains
RECEIVED 22 October 2022
ACCEPTED 03 February 2023
collected from children in Guangzhou Women and Children’s Medical Center
PUBLISHED 15 March 2023 during 2016 to 2021.
CITATION
Results: The results revealed that 1,338 cases of Salmonella were mainly isolated
Gao F, Huang Z, Xiong Z, Zheng H, Deng Q, from feces and blood samples. The age distribution was dominated by infants
Zhong H, Zhu S, Long Y and Wang J (2023) under 3 years old. The seasonal distribution was high in summer and autumn.
Prevalence, serotype, and antimicrobial 48 serotypes were detected, and S. typhimurium (78.7%) was the predominant
resistance profiles of children infected with
serogroup. The results of antimicrobial susceptibility showed that the highest
Salmonella in Guangzhou, southern China,
2016–2021.
resistance was observed in ampicillin (84.5%), while lower resistance was observed
Front. Pediatr. 11:1077158. in piperacillin/tazobactam, cefoperazone/sulbactam and ciprofloxacin. The
doi: 10.3389/fped.2023.1077158 antimicrobial resistance rate of fecal isolates was higher than that of blood isolates.
COPYRIGHT The five-year average detection rate of multi-drug resistant Salmonella was 8.5%
© 2023 Gao, Huang, Xiong, Zheng, Deng, (114/1338) and the MDR rate of S. typhimurium was the lowest (6.9%; 73/1053).
Zhong, Zhu, Long and Wang. This is an open-
Conclusion: We concluded that antibacterial treatment should be carefully selected
access article distributed under the terms of the
Creative Commons Attribution License (CC BY). according to serotype and antimicrobial sensitivity results in children. Antimicrobial
The use, distribution or reproduction in other resistance monitoring for multi-drug resistant Salmonella is still required.
forums is permitted, provided the original
author(s) and the copyright owner(s) are
credited and that the original publication in this KEYWORDS
journal is cited, in accordance with accepted
children, salmonella, bacterial resistance rate, multi-drug resistant, serotypes
academic practice. No use, distribution or
reproduction is permitted which does not
comply with these terms.
Introduction
Salmonella is a rod-shaped, gram-negative bacterium with no capsule and spore and is a
member of the Enterobacterales (1). It can be transmitted via contaminated food products
including meat, beef, potatoes and cucumbers, which may lead to foodborne outbreaks,
and results in about 23,000 deaths every year (2–4). Moreover, Salmonella is the main
pathogenic cause of diarrhea in children, with the largest proportion of infections in
pediatric patients < 5 years old and most commonly occurs between summer and autumn
(5, 6). Currently, more than 2,500 Salmonella serotypes have been reported and among
them, over 20 serotypes can cause zoonotic diseases (7). S. typhimurium and S. enteritidis
are the major Salmonella serotypes responsible for gastroenteritis and diarrhea in both
children and adults (8).

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Gao et al. 10.3389/fped.2023.1077158

The pathogenicity of Salmonella is mainly related to its toxic in culture plates. Then, suspected colonies were tested using
factors, including pathogenic islands, toxic plasmids, pili and standard biochemical methods and colonies considered to be
enterotoxins (9, 10). Different serotypes carrying different virulence Salmonella had the following biochemical phenotypes: growth on
genes can exhibit different sensitivity to antibiotics (11). In recent tripler-sugar-iron agar (acid from glucose, gas, production of H2S);
years, studies have shown that Salmonella antibiotic resistance has negative for lactose, sucrose, urease, oxidase,salicin, -galactosidase
markedly increased, due to long-term antibiotic use in the poultry and indole production; positive for nitrate reduction and lysine
industry and animal laboratory products (12, 13). Furthermore, decarboxylase (14). Matrix-Assisted Laser Desorption Ionization-
there are many contraindications to clinical medication for Time of Flight Mass Spectrometry (MALDI-TOF-MS) and VITEK
children, which brings great challenges to clinical diagnosis and 2-Compact automatic bacterial identification antimicrobial
treatment. In order to understand Salmonella serotype distribution susceptibility system were used for identification and antimicrobial
and antimicrobial resistance in Guangzhou, Southern China and to susceptibility testing(ampicillin; piperacillin/ tazobactam; aztreonam;
identify potential control strategies for formulating prevention and ceftazidime; ceftriaxone; cefotaxime; cefepime; cefoperazone/
treatment plans, a retrospective study of 1,338 Salmonella strains sulbactam; ciprofloxacin; imipenem; chloramphenicol). The K-B
isolated in Guangzhou Women and Children’s Medical Center antimicrobial susceptibility test method and Clinical and
(National Children’s Medical Center for South Central Region) Laboratory Standards Institute (CLSI, 2021) on Antimicrobial
from 2016 to 2021 was conducted in this study. Susceptibility Testing breakpoints were used to assess the results.
Escherichia coli ATCC 25,922, Pseudomonas aeruginosa ATCC
27,853 and Salmonella ATCC 14,028 (all from the Clinical
Materials and methods Laboratory Center of the Ministry of Health) were used as the
quality control strains for validation of antimicrobial susceptibility
Ethical approval testing. Multidrug-resistant (MDR) strains were defined by
resistance to three or more antimicrobial classes.
This study has been approved by the Ethics Committee of
Guangzhou Women’s and Children’s Medical Center (No.
176A01, 2021). Salmonella serotyping

Salmonella isolates serotyping was conducted by using a classic

Sample, clinical data collection and slide agglutination assay with anti-Salmonella (A∼F), anti-O and
isolation of Salmonella strains anti-H serum (Tianrun Bio-Pharmaceutical, Ningbo, China). We
used Phosphate Buffered Saline (PBS) as negative control and
Between January 2016 and December 2021, 1,388 Salmonella Salmonella ATCC 14,028 as positive control.
were isolated from 12,361 pediatric patients samples at
Guangzhou Women and Children’s Medical Center (National
Children’s Medical Center for South Central Region). Clinical Statistical analysis
information, including gender, age, main clinical manifestations,
laboratory examinations, etiology, and antimicrobial sensitivity WHONET 5.6 was used to analyze antimicrobial susceptibility
test results was collected in electronic medical review system data. SPSS 23.0 was used for statistical analysis. Briefly, we
from January 2016 to December 2021. performed a normality test on the measurement data, and those
The diagnostic criteria for diarrhea refer to the “Standards for that did not conform to the normal distribution were described
the Diagnosis and Treatment of Acute Infectious Diarrheal by the median (interquartile range). The counting data was
Diseases in Children” issued in 2020. Within 2 weeks of the expressed as number of cases and percentages. The comparison
disease course, changes in fecal characteristics and increased fecal used χ 2 -value test or Fisher’s exact probability method. P < 0.05
frequency can be diagnosed for acute diarrhea. Exclusion criteria indicates statistically significant differences.
is 1) incomplete clinical medical records; 2) children with
diarrhea caused by nosocomial infection during hospitalization
due to other diseases; 3) if the same child has the same strains Results
isolated from the multiple fecal culture during the same
hospitalization period, only the first result was included for Clinical information and distribution of
analysis, and duplicate strains was eliminated. Salmonella isolates

From January 2016 to December 2021, a total of 1,338

Salmonella identification and antimicrobial Salmonella strains were isolated from 12,361 children samples at
susceptibility testing in Guangzhou Women and Children’s Medical Center
(Figure 2). As shown in Figure 1, the majority of Salmonella
Salmonella culture was performed according to the methods isolates were collected from children under 3 years old [92.9%
previously described (14). Briefly, clinical samples were inoculated (1244/1338)], with an average age of 13 (6.3–34.7) months

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Gao et al. 10.3389/fped.2023.1077158

FIGURE 1
Age distribution of children with 1,338 Salmonella strains. Children are divided into four groups by age. The different bars represent different years. Age
distribution of children with Salmonella infection was mostly under 3 years old.

FIGURE 2
Annual distribution of Salmonella isolated from feces from 2016 to 2021. The bar chart represents the total number of fecal samples and Salmonella
positive strains from feces. The Salmonella isolation rate of 6 years is shown in the line graph. Salmonella exhibited an increasing trend year by year.

(Table 2). The isolate numbers of all serogroups increased Distribution of serotypes for Salmonella
dramatically over time. The isolate number in 2020 was 335 isolates
strains and 316 strains in 2021 (Figure 1). As shown in Table 1,
the total isolation number was 93 in spring, 356 in summer, 608 Among the identified 1,338 Salmonella isolates, 48 serotypes
in autumn, and 281 in winter. were detected, with group B (1110, 82.88%) and D (124, 9.27%)
Among the isolated strains, 92.8% (1241/1338) of strains were the top 2 predominant serogroups. The S. typhimurium (group
collected from feces, 5.2% (71/1338) from blood, 1.0% (13/1338) B) serotype was detected in 78.69% (1053/1338), followed by
from pus, and 1.0% (13/1338) from other kinds of samples 7.17% (96/1338) of S. enteritidis (group D) and 2.17% (29/1338)
(Figure 2). As shown in Table 2, 670 strains were isolated from of S. neurangium (group E). Other rare serotypes were also
inpatients and 668 strains from outpatients; 826 from male and detected, including 23 strains of S. dublin, 16 strains of
512 from female (ratio 1.6:1). Symptoms were mainly fever and S. Argona, 14 strains of S. stanley, 13 strains each of S. saintpaul
diarrhea, with some patients experiencing vomiting, respiratory and S. london, 11 strains of S. spp, 10 strains S. newport, and
infection and leukemia (Table 2). 6 strains S. potsdam (Figure 3).

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Gao et al. 10.3389/fped.2023.1077158

TABLE 1 Seasonal distribution of 1,338 Salmonella strains. MDR rate of S. typhimurium was the lowest at 6.9% (73/1053),
and it was statistically significant compared to S. enteritidis
Seasons 2016 2017 2018 2019 2020 2021 Total
(12/97, 12.4%) and other serotypes of Salmonella (χ 2 = 21.855,
Spring (Jan. to 5 19 6 22 13 28 93
Mar.) P < 0.01) (Table 5).
Summer (Apr. to 19 39 76 63 74 85 356
Jun.)
Autumn (Jul. to
Sept.)
55 43 105 99 171 135 608
Discussion
Winter (Oct. to 15 30 47 44 77 68 281
Dec.) Salmonella is a zoonotic intestinal pathogen with many
Total 94 131 234 228 335 316 1338 serotypes, mainly causing food-borne infections which lead to
corresponding clinical symptoms (15). Salmonella infections are
primarily divided into typhoidal and non-typhoidal (16). The
TABLE 2 The clinical information of 1,338 Salmonella isolates. former manifests as bloodstream infections, which are more
common in adults; While the latter usually manifests as intestinal
Variable Value
Sex na (%) infections, which cause symptoms such as diarrhea, fever and
Male 826 (61.73%) abdominal pain and are more common in children (17, 18). This
Female 512 (38.27%) study demonstrated that the main specimen type of children with
Source n (%) Salmonella infection was feces (92.75%), and fecal Salmonella
Inpatient 670 (50.07%) isolation rate was increasing year by year, mainly in infants and
Outpatient 668 (49.93%)
toddlers under 3 years old (92.97%), consistent with domestic
Age Median (range)b
reports (19). This may be related to the fact that children are
13 (6.3–34.7)
Clinical symptoms n (%)
more susceptible than adults due to their lower immunity and
Fever 832 (62.18%) weak gastrointestinal resistance (20). On the other hand, infant
Diarrhea 805 (60.16%) milk products have been reported as related to Salmonella
Fever and diarrhea 363 (27.13%) outbreaks worldwide (21). This study also showed that
Vomiting 598 (44.69%) Salmonella infections in children tend to have a high incidence
Respiratory symptoms 164 (12.25%) in summer and autumn, which was consistent with domestic
Leukemia 72 (5.38%)
reports (22). However, the winter Salmonella infection rate in
a
Represents the number of strains. Guangzhou is still relatively high compared with that in northern
b
Represents months.
China. This may be related to the geographical location of
Guangzhou, which has a south subtropical maritime monsoon
Phenotypic antimicrobial resistance climate, with an average annual temperature of 21.5–22.2°C and
abundant rainwater resources. Hot and humid weather promotes
As shown in Table 3, the resistance rate of Salmonella the growth of Salmonella and insufficient heat treatment of food
isolated from children from 2016 to 2021 to ampicillin can increase the risk of Salmonella infection.
(AMP) was 84.5%. Resistance rates against 3rd generation In this study, we conducted a study of the clinical
cephalosporins were as follows: ceftriaxone (CRO, 40.1%), manifestations of Salmonella infection in children. 1,338 children
cefotaxime (CTX, 35.4%), ceftazidime (CAZ, 26.7%) and with intestinal Salmonella infection had fever (62.18%) and
cefepime (FEP, 23.5%). Lower resistance rates were observed diarrhea (60.16%) as prominent symptoms, but some children
in piperacillin/tazobactam (PIP, 4.8%), cefoperazone/ did not present with gastrointestinal symptoms. Previous reports
sulbactam (SCF, 4.1%) and ciprofloxacin (CIP, 6.7%). All of domestic Salmonella invasive infections mainly concentrated
strains were sensitive to imipenem (IPM) (Table 3). 97 on typhoid or paratyphoid bloodstream infections (23, 24). In
strains of Salmonella isolated from blood and sterile body recent years, improvements in living standards and sanitation
fluids demonstrated higher resistance to AMP (69.7%), and facilities have maintained Salmonella typhoid and paratyphoid
lower resistance to SCF (2.3%) and PIP (1.4%). 1,241 strains infections at a low level. The increase in detection rate of
of Salmonella isolated from feces also exhibited the highest invasive non-typhoid Salmonella (iNTS) has gradually attracted
resistance to AMP (83.6%) and the lowest to SCF (3.8%) and attention. The main diagnosis of invasive Salmonella infection is
PIP (3.6%). For all strains, the resistance rate of fecal based on systemic multi-system clinical manifestations,
isolates to the tested antibiotic agent was higher than that of symptoms of infection and poisoning, and Salmonella cultured in
blood and sterile body fluid isolates (Table 4). sterile body fluids (25). Extraintestinal infections caused by iNTS
have also been reported, and the clinical features are similar to
Multidrug-resistant (MDR) Salmonella those of typhoid fever. It usually does not cause diarrhea, but
isolates causes bloodstream infections (such as bacteremia) or secondary
systemic focal infections (such as meningitis), and failure to treat
A total of 114 MDR strains were detected between 2016 and can often lead to death. The main reported serotypes are
2021, with a detection rate of 8.5% (114/1338). Among them, the typhimurium, enteritidis, dublin and swine cholera. S.

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FIGURE 3
Serotype distribution of 1,338 Salmonella strains. 48 Salmonella serotypes were detected. This chart displays the major serotypes with different bar colors.
Groups B and D were the top 2 predominant serogroups and S. Typhimurium was the predominant strain.

typhimurium ST313 is the main epidemic type of iNTS Unlike common NTS infections, patients rarely displayed
internationally, especially in Africa (26, 27). Specific susceptible gastroenteritis symptoms, but all had fever symptoms. Combined
populations of iNTS include HIV patients, immunodeficiency, with the gradual increase in detection rate of Salmonella in
hematological malignancies, young children, and malnourished recent years, the trend of increasing iNTS in Guangzhou cannot
or anemic adolescents, with a fatality rate as high as 20% (28). be ruled out. In addition, this study showed that there some

TABLE 3 Antimicrobial resistance rates of the 1,338 Salmonella strains.

Antibiotic 2016 2017 2018 2019 2020 2021 2016–2020

agent (n = 94) (n = 131) (n = 234) (n = 228) (n = 335) (n = 316) (n = 1338)
No. R (%) No. R (%) No. R (%) No. R (%) No. R (%) No. R (%) No. R (%)
AMP 72 76.6 113 86.3 201 85.9 191 83.8 301 89.9 253 80.1 1131 84.5
ATM 0 0 47 35.9 59 25.2 73 32 69 20.6 51 16.1 299 22.30%
PIP 24 25.5 11 8.4 16 6.8 10 4.4 0 0 3 0.9 64 4.80%
CAZ 32 34 37 28.2 75 32.1 53 23.2 71 21.2 48 15.2 357 26.7
CRO 41 43.6 64 48.9 107 45.7 81 35.5 100 29.9 77 24.4 536 40.1
CTX 46 48.9 67 51.1 140 59.8 83 36.4 129 38.5 65 20.6 473 35.4
FEP 32 34 45 34.4 81 34.6 55 24.1 47 14 35 11.1 314 23.5
SCF 6 6.4 11 8.4 20 8.5 14 6.1 10 3 0 0 55 4.1
CIP 7 7.4 12 9.2 23 9.8 24 10.5 49 14.6 16 5.1 90 6.7
IPM 0 0 0 0 0 0 0 0 0 0 0 0 0 0
CHL 29 30.9 57 43.5 101 43.2 118 51.8 192 57.3 157 49.7 654 48.9

AMP, ampicillin; PIP, piperacillin/tazobactam; ATM, aztreonam; CAZ, ceftazidime; CRO, ceftriaxone; CTX, cefotaxime; FEP, cefepime; SCF, cefoperazone/sulbactam; CIP,
ciprofloxacin; IPM, imipenem; CHL, chloramphenicol; R, resistant; No. represents the number of resistant strains.

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TABLE 4 Analysis of antimicrobial resistance rate of Salmonella isolates Different Salmonella serotypes exhibit differences in antibiotic
from blood and feces.
resistance. AMP resistance was mainly manifested in Salmonella
Antibiotic agent Feces Blood and χ2 P value typhimurium, enteritidis, indiana and delby as AMP was the
(n = 1241) sterile earliest and most widely used antibiotic in livestock in China
body fluids (31). The diversification of serotype distribution will lead to
(n = 97)
broadening of the MDR phenotype and antimicrobial resistance
No. R (%) No. R (%) spectrum, and the trend of pan-drug resistance will become more
AMP 1037 83.6 68 69.7 15.322 <0.001
evident. In previous studies, MDR strains mainly existed in
ATM 299 24.1 7 7.1 1.641 0.518
S. typhimurium, but this study demonstrated that S. typhimurium
PIP 45 3.6 1 1.4 5.663 0.017
CAZ 257 20.7 15 15.1 5.778 0.016
had the lowest MDR rate among MDR Salmonella. Therefore, it
CRO 397 32 20 20.3 16.188 <0.001 is necessary to continuously and regularly monitor Salmonella
CTX 417 33.6 0 0 12.856 <0.001 serotypes in children to detect changes in the main types as early
FEP 249 20.1 16 16.7 6.599 0.01 as possible.
SCF 47 3.8 2 2.3 1.717 0.307 Due to the excessive use of antibiotics in animal husbandry and
CIP 103 8.3 16 16 0.955 0.328 clinical practice, Salmonella resistance is increasing, especially to
IPM 0 0 0 0 / /
AMP and 3rd generation cephalosporins (32). Generally,
CHL 612 49.3 16 16.7 21.232 <0.001
Salmonella has been resistant to previously used first-line
R, resistant; No. represents the number of resistant strains.
antimicrobial drugs such as AMP, CHL, sulfamethoxazole, and
amoxicillin. In this study, Salmonella presented the highest
children experienced diarrhea with clinical manifestations similar resistance rate against AMP of 84.5%, which was greater than
to viral diarrhea, no symptoms of high fever and diarrhea, other domestic scholars and regions to AMP. The resistance rate
routine stool microscopy, a significant increase in the number of to 3rd generation cephalosporins (CRO, CTX, CAZ) was about
stools, accompanied by obvious electrolyte metabolism disorders, 40.0%. Salmonella mainly produces ESBL, extended-spectrum
and fecal culture detects Salmonella positive. Therefore, the β-lactamase and AmpC enzymes to generate resistance to
necessity of early fecal culture detection in the diagnosis and cephalosporin antimicrobial drugs. Synthesis of Salmonella ESBL
treatment of children with diarrhea should be emphasized to will indirectly reduce its sensitivity to quinolones, leading to the
avoid misdiagnosis. generation of multi-drug resistant strains resistant to
The serotypes of 1,338 Salmonella strains in this study covered cephalosporins and quinolones (33). Although the antimicrobial
groups A to E, mainly group B (1110, 82.88%) and group D (124, resistance rate of CIP in this study was low (6.7%), due to the
9.27%), of which S. typhimurium had the highest detection rate side effects of central nervous and joint toxicity, it is no longer a
(1053, 78.69%), followed by S. enteritidis (7.17%) and suitable drug for children with Salmonella infection. CLSI 2020
S. neurangium (2.17%). The detection rate of S. typhimurium was recommends that only AMP, quinolones and trimethoprim-
higher than that reported by the CHINET Bacterial Resistance sulfamethoxazole are required for regular reports for fecal-
Surveillance Network (27.4%), and also higher than that of isolated Salmonella. According to the antimicrobial sensitivity
Tongji Hospital affiliated to Tongji Medical College of Huazhong results of this study and the poor therapeutic effect of AMP in
University of Science and Technology (51.6%) and the Affiliated clinical use for S. Typhimurium, AMP is unsuitable for clinical
Children’s Hospital to Zhengzhou University (36.5%) (29, 30). In promotion and application. At present, Salmonella still maintains
addition, the serotypes detected in this study were different to high sensitivity to enzyme inhibitor compound preparations, 4th
serotypes collected in Wuhan, Beijing, Zhengzhou and other generation cephalosporins and IPM. When choosing
locations, indicative of regional differences in Salmonella antimicrobial treatment, drugs with antibacterial activity against
serotypes. A total of 48 serotypes were detected in this study and Salmonella should be selected. Antimicrobial spectrum does not
the distribution was diversified, with some rare serotypes. include gastrointestinal infections and drugs with unknown

TABLE 5 Prevalence of multidrug-resistant (MDR) Salmonella isolates from 2016 to 2021.

Years All serotypes of S. Typhimurium S. Enteritidis Other serotypes of χ2 P value

Salmonella Salmonella
MDR/Total % MDR/Total % MDR/Total % MDR/Total %
2016 1/94 1.1 1/77 1.3 0/13 0 0/4 0 21.86 <0.01
2017 9/131 6.9 3/101 3 2/11 18.2 3/19 15.8
2018 69/234 29.5 44/197 22.3 6/13 46.2 18/27 66.7
2019 7/228 3.1 4/187 2.1 1/15 6.7 2/25 8
2020 5/335 1.5 4/256 1.6 0/20 0 1/57 1.8
2021 23/316 7.3 17/235 7.2 1/25 4 5/56 8.9
Total 114/1338 8.5 73/1053 6.9 12/97 12.4 29/188 15.4

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antimicrobial activity against Salmonella may lead to drug Data availability statement
resistance. In order to decrease antibiotic consumption and
AMR, the majority of gastroenteritis caused by Salmonella should The original contributions presented in the study are included
not be treated with antibiotics (23, 34). In general, the current in the article/Supplementary Material, further inquiries can be
resistance rate of 3rd generation cephalosporins and quinolone directed to the corresponding author/s.
antibiotics is still low, but there is an upward trend.
Antimicrobial susceptibility studies to azithromycin are lacking.
There have been disagreements regarding the selection, use,
and timing of antibiotics for Salmonella infection in children Author contributions
(35). At present, most of the 3rd generation cephalosporins are
the first choice for clinical use, with azithromycin as an GF designed the study. LB, LY, and HZ: performed the PCR,
alternative. Quinolone antibiotics are generally not recommended MLST, and antibiotic sensitivity tests. ZS and DQ: conducted
for children, but can be considered for severe infections when no bacterial culture and isolation. ZH, LY, and WJ: prepared the
other antibiotics can be substituted. For MDR Salmonella, samples. FG: wrote the manuscript. LB, XZ, and FG: revised the
carbapenem antibiotics are suggested. The use of multiple manuscript. All authors contributed to the article and approved
antibiotics in combination is not recommended, and specific the submitted version.
antibiotic selection should be based on the local epidemiology
and antimicrobial susceptibility results. recommended course of
treatment for intestinal infections is within 1 week, while the
Conflict of interest
course of treatment for extra-intestinal infections needs to be
extended. It is worth noting that there are few studies with large
The authors declare that the research was conducted in the
samples on the comparison of treatment effects between
absence of any commercial or financial relationships that could
azithromycin, 3rd generation cephalosporins and quinolone
be construed as a potential conflict of interest.
antibiotics in children’s NTS, and more extensive and in-depth
research is required.

Publisher’s note
Conclusion
All claims expressed in this article are solely those of the
In summary, under the current pressure of antibiotic selection, authors and do not necessarily represent those of their affiliated
the typing and continuous monitoring of antimicrobial resistance organizations, or those of the publisher, the editors and the
of intestinal Salmonella is important research work to provide reviewers. Any product that may be evaluated in this article, or
clear epidemiological evidence for clinical diagnosis, treatment, claim that may be made by its manufacturer, is not guaranteed
and prevention of infection. or endorsed by the publisher.

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