TY - JOUR
T1 - Non-typhoidal salmonella bloodstream infections in Kisantu, DR Congo
T2 - Emergence of O5-negative salmonella typhimurium and extensive drug resistance
AU - Tack, Bieke
AU - Phoba, Marie France
AU - Barbé, Barbara
AU - Kalonji, Lisette M.
AU - Hardy, Liselotte
AU - Van Puyvelde, Sandra
AU - Ingelbeen, Brecht
AU - Falay, Dadi
AU - Ngonda, Dauly
AU - van der Sande, Marianne A.B.
AU - Deborggraeveid, Stijn
AU - Jacobsid, Jan
AU - Lunguya, Octavie
N1 - Funding Information:
This work was funded by the Belgian Directorate of Development Cooperation (DGD) through Project 2.01 of the Third Framework Agreement between the Belgian DGD and the Institute of Tropical Medicine, Belgium, and by the Baillet-Latour fund. B.T. has a scholarship from Research foundation Flanders (FWO, 1153220N). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
© 2020 Tack et al.
PY - 2020/4
Y1 - 2020/4
N2 - BACKGROUND: Non-typhoidal Salmonella (NTS) are a major cause of bloodstream infection (BSI) in sub-Saharan Africa. This study aimed to assess its longitudinal evolution as cause of BSI, its serotype distribution and its antibiotic resistance pattern in Kisantu, DR Congo.METHODS: As part of a national surveillance network, blood cultures were sampled in patients with suspected BSI admitted to Kisantu referral hospital from 2015-2017. Blood cultures were worked-up according to international standards. Results were compared to similar data from 2007 onwards.RESULTS: In 2015-2017, NTS (n = 896) represented the primary cause of BSI. NTS were isolated from 7.6% of 11,764 suspected and 65.4% of 1371 confirmed BSI. In children <5 years, NTS accounted for 9.6% of suspected BSI. These data were in line with data from previous surveillance periods, except for the proportion of confirmed BSI, which was lower in previous surveillance periods. Salmonella Typhimurium accounted for 63.1% of NTS BSI and Salmonella Enteritidis for 36.4%. Of all Salmonella Typhimurium, 36.9% did not express the O5-antigen (i.e. variant Copenhagen). O5-negative Salmonella Typhimurium were rare before 2013, but increased gradually from then onwards. Multidrug resistance was observed in 87.4% of 864 NTS isolates, decreased ciprofloxacin susceptibility in 7.3%, ceftriaxone resistance in 15.7% and azithromycin resistance in 14.9%. A total of 14.2% of NTS isolates, that were all Salmonella Typhimurium, were multidrug resistant and ceftriaxone and azithromycin co-resistant. These Salmonella isolates were called extensively drug resistant. Compared to previous surveillance periods, proportions of NTS isolates with resistance to ceftriaxone and azithromycin and decreased ciprofloxacin susceptibility increased.CONCLUSION: As in previous surveillance periods, NTS ranked first as the cause of BSI in children. The emergence of O5-negative Salmonella Typhimurium needs to be considered in the light of vaccine development. The high proportions of antibiotic resistance are worrisome.
AB - BACKGROUND: Non-typhoidal Salmonella (NTS) are a major cause of bloodstream infection (BSI) in sub-Saharan Africa. This study aimed to assess its longitudinal evolution as cause of BSI, its serotype distribution and its antibiotic resistance pattern in Kisantu, DR Congo.METHODS: As part of a national surveillance network, blood cultures were sampled in patients with suspected BSI admitted to Kisantu referral hospital from 2015-2017. Blood cultures were worked-up according to international standards. Results were compared to similar data from 2007 onwards.RESULTS: In 2015-2017, NTS (n = 896) represented the primary cause of BSI. NTS were isolated from 7.6% of 11,764 suspected and 65.4% of 1371 confirmed BSI. In children <5 years, NTS accounted for 9.6% of suspected BSI. These data were in line with data from previous surveillance periods, except for the proportion of confirmed BSI, which was lower in previous surveillance periods. Salmonella Typhimurium accounted for 63.1% of NTS BSI and Salmonella Enteritidis for 36.4%. Of all Salmonella Typhimurium, 36.9% did not express the O5-antigen (i.e. variant Copenhagen). O5-negative Salmonella Typhimurium were rare before 2013, but increased gradually from then onwards. Multidrug resistance was observed in 87.4% of 864 NTS isolates, decreased ciprofloxacin susceptibility in 7.3%, ceftriaxone resistance in 15.7% and azithromycin resistance in 14.9%. A total of 14.2% of NTS isolates, that were all Salmonella Typhimurium, were multidrug resistant and ceftriaxone and azithromycin co-resistant. These Salmonella isolates were called extensively drug resistant. Compared to previous surveillance periods, proportions of NTS isolates with resistance to ceftriaxone and azithromycin and decreased ciprofloxacin susceptibility increased.CONCLUSION: As in previous surveillance periods, NTS ranked first as the cause of BSI in children. The emergence of O5-negative Salmonella Typhimurium needs to be considered in the light of vaccine development. The high proportions of antibiotic resistance are worrisome.
KW - Adolescent
KW - Adult
KW - Anti-Bacterial Agents/pharmacology
KW - Azithromycin
KW - Bacteremia/epidemiology
KW - Ceftriaxone
KW - Child
KW - Child, Preschool
KW - Ciprofloxacin
KW - Congo/epidemiology
KW - Drug Resistance, Multiple, Bacterial/drug effects
KW - Female
KW - Humans
KW - Infant
KW - Infant, Newborn
KW - Male
KW - Microbial Sensitivity Tests
KW - Salmonella Infections/diagnosis
KW - Salmonella enteritidis/drug effects
KW - Salmonella typhimurium/drug effects
KW - Salmonella/drug effects
KW - Serogroup
KW - Typhoid Fever/drug therapy
KW - Young Adult
UR - http://www.scopus.com/inward/record.url?scp=85086843385&partnerID=8YFLogxK
U2 - 10.1371/journal.pntd.0008121
DO - 10.1371/journal.pntd.0008121
M3 - Article
C2 - 32240161
AN - SCOPUS:85086843385
SN - 1935-2727
VL - 14
SP - e0008121
JO - PLoS Neglected Tropical Diseases
JF - PLoS Neglected Tropical Diseases
IS - 4
M1 - e0008121
ER -