Abstract
BackgroundNon-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.MethodsAs 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.ResultsIn 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.ConclusionAs 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.
Highlights
Non-typhoidal Salmonella (NTS) is one of the predominant pathogens causing bloodstream infections (BSI) in sub-Saharan Africa [1,2]
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%
Summary
Non-typhoidal Salmonella (NTS) is one of the predominant pathogens causing bloodstream infections (BSI) in sub-Saharan Africa [1,2]. In 2017, it was estimated that sub-Saharan Africa accounted for 421,600 of the 535,000 cases of invasive NTS infections in the world. The geographical distribution of NTS BSI is linked to the geographical distribution of its risk factors. NTS BSI mainly occurs in individuals with underlying medical conditions, e.g. HIV-infected individuals and (young) children with Plasmodium falciparum malaria infections, anemia and/or malnutrition. The underlying medical conditions and age of the affected individual influence the case-fatality rate of NTS BSI. Non-typhoidal Salmonella (NTS) are a major cause of bloodstream infection (BSI) in subSaharan 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
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