Objective: To study Salmonella enterica serotype Typhi by pulsed-field gel electrophoresis in Hong Kong.
Materials and Methods: One hundred thirty four isolates of Salmonella enterica serotype Typhi collected from 17 public hospitals and clinics in Hong Kong from 2000 to 2004 were studied in relation to epidemiological and clinical events. Isolates originated from 80 patients, with 29 patients providing multiple isolates. Susceptibility to six antibiotics was tested: ampicillin, trimethoprim-sulfamethoxazole, tetracycline, chloramphenicol, nalidixic acid, and ciprofloxacin. Strains were further subtyped by pulsed-field gel electrophoresis (PFGE) by separating XbaI-restricted genomic DNA of isolates. PFGE patterns that were shared between strains were further examined using restriction enzyme BlnI.
Results: Of 134 S. Typhi isolates, 29 (21.6%) were resistant to at least one and up to five of the antibiotics tested. Using restriction fragments between 20 and 700 kb for analysis, the number of fragments generated by XbaI ranged from 14 to 20. Sixty-six distinct subtypes were identified in the first isolates of all 80 patients (epidemiologically unrelated) with a Simpson index of 0.993, indicating a high degree of diversity among these S. Typhi isolates. Multidrug-resistant and travel-associated S. Typhi appeared to cluster more closely than the rest of strains. Further analysis of PFGE patterns investigated the temporal relationships between the 83 strains collected from the 29 patients who gave multiple isolates.
Conclusion: Dual infections or variants of the same isolates in the same patient occurred during the course of follow-up. These findings imply that PFGE data could be a valuable tool in predicting relapse, evaluating new antimicrobial drugs, and controlling the spread of typhoid disease. A regional, as well as global, typhoid bacillus fingerprint database should be set up to improve epidemiological investigations, as clinical cases easily move across national boundaries.
