Multidrug resistance of Salmonella enterica serovars Typhi and Typhimurium isolated from clinical samples at two rural hospitals in Western Kenya

Abstract

The threat to human health posed by antibiotic resistance is of growing concern. Many commensals and pathogenic organisms have developed resistance to well established and newer antibiotics. This is a cross-sectional study within two hospital settings to determine in vitro antibiotic susceptibilities of Salmonella species isolated in blood, cerebral spinal fluid, pus and stool collected from in- and out-patients. The inclusion criteria was non restrictive to in- and out-patient but preference to severe diarrhea cases with negligible changes to previous treatment regimen was observed. The study was carried out from February 2004 - June 2005. Fifty-three diarrhea patients within the hospital who were chosen by convenient sampling and consented to participate in the study were considered. Either blood or pus was collected using vacutainer tubes and syringe, swabs respectively, and cerebral spinal fluid by lumbar puncture from patients who had fever (temp > or =38 degrees C) and diarrhea. Stool samples were also collected and all specimens analyzed for the presence of Salmonella by routine microbiological procedures. The isolates were subjected to antibiotic susceptibility testing using disc diffusion technique. In St. Elizabeth Mukumu Mission Hospital, Salmonella enterica serovar Typhi was most common (56.6%, n=33), followed by S. typhimurium (34%, n=18), while in Maseno Mission Hospital only S. typhimurium was isolated. Whereas S. typhi was more commonly isolated in male adults and female children (P = 0.9), S. typhimurium was more common in female and male children (P=0.1). All the isolates were sensitive to ciprofloxacin. However, S. typhi was resistant to streptomycin, ampicillin, chloramphenical and cotrimoxazole; S. typhimurium to tetracycline, sulfamethoxazole, cotrimoxazole, ampicillin, chloramphenical and streptomycin. S. typhi displayed a high resistance pattern to most antibiotic screened than S. typhimurium.