Abstract
BackgroundNon-typhoidal Salmonella (NTS) cause the majority of bloodstream infections in Ghana, however the mode of transmission and source of invasive NTS in Africa are poorly understood. This study compares NTS from water sources and invasive bloodstream infections in rural Ghana.MethodsBlood from hospitalised, febrile children and samples from drinking water sources were analysed for Salmonella spp. Strains were serotyped to trace possible epidemiological links between human and water-derived isolates.. Antibiotic susceptibility testing was performed,ResultsIn 2720 blood culture samples, 165 (6%) NTS were isolated. S. Typhimurium (70%) was the most common serovar followed by S. Enteritidis (8%) and S. Dublin (8%). Multidrug resistance (MDR) was found in 95 (58%) NTS isolates, including five S. Enteritidis. One S. Typhimurium showed reduced fluroquinolone susceptibility. In 511 water samples, 19 (4%) tested positive for S. enterica with two isolates being resistant to ampicillin and one isolate being resistant to cotrimoxazole. Serovars from water samples were not encountered in any of the clinical specimens.ConclusionWater analyses demonstrated that common drinking water sources were contaminated with S. enterica posing a potential risk for transmission. However, a link between S. enterica from water sources and patients could not be established, questioning the ability of water-derived serovars to cause invasive bloodstream infections.
Highlights
Non-typhoidal Salmonella (NTS) cause the majority of bloodstream infections in Ghana, the mode of transmission and source of invasive NTS in Africa are poorly understood
In the rural Asante Akyem district in Ghana, we investigated contamination of drinking water with S. enterica to identify a potential source for strains causing invasive blood stream infections in hospitalized febrile children
This study indicates that contamination with S. enterica is frequent in the Asante Akyem District especially in dug well and river water
Summary
Non-typhoidal Salmonella (NTS) cause the majority of bloodstream infections in Ghana, the mode of transmission and source of invasive NTS in Africa are poorly understood. This study compares NTS from water sources and invasive bloodstream infections in rural Ghana. In sub-Saharan Africa (SSA), NTS are one of the most frequent causes of bacterial bloodstream infections in both adults and children, associated with high case fatality rates of 20 to 47%, in Ghana [2,3,4,5]. Studies from SSA on S. enterica isolated from livestock and animal products demonstrate a broad Salmonella serovar distribution of types not commonly associated with human infections suggesting other transmission routes [13,14,15]. Residents in many SSA regions often do not have access to safe drinking water, but use water from sources such as rivers, lakes, wells and boreholes, which may be contaminated
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