Community-acquired septicaemia in southern Viet Nam: the importance of multidrug-resistant Salmonella typhi

In a prospective study conducted between mid 1993 and 1994, 437 adults and children were admitted with community-acquired septicaemia to an infectious diseases hospital in southern Viet Nam. Gramnegative aerobes accounted for 90% of isolates and were predominantly Salmonella typhi (67%), Sal. paratyphi A (3%), Escherichia coli (10%), and Klebsiella spp. (5%). Other Salmonella spp. (1%), Pseudomonas aeruginosa (1%), Neisseria meningitidis (0·5%) and Haemophilus influenzae (0·2%) were uncommon. Staphylococcus aureus (5·5%) and Streptococcus pneumoniae (2%) were the most common Gram-positive isolates. Patients with enteric fever were younger (median age 16 years, range 1–63) than the other patients (median age 43 years, range 1–88) (P < 0·001) and had a lower mortality rate (0·3% vs. 23%; relative risk 69·5, 95% confidence interval 9·5–507·8; P < 0·0001). Over 70% of the Sal. typhi isolated were multidrug-resistant, and 4% were resistant to nalidixic acid. Multidrug-resistant Sal. typhi is a major cause of community-acquired septicaemia in Viet Nam.