Abstract
BackgroundThis study gives an overview of a decade (2007–2017) of hospital-based Salmonella Typhi bloodstream infection (BSI) surveillance in the Democratic Republic of the Congo (DRC), at 4 main sampling sites.MethodsBlood cultures were sampled in hospital-admitted patients with suspected BSI, according to standardized clinical indications. The results of the surveillance period 2015–2017 were compiled with those of previous surveillance periods (2007–2010 and 2011–2014). Whole genome sequencing of isolates with decreased ciprofloxacin susceptibility (DCS) was performed.Results Salmonella Typhi was isolated in 1.4% (531/37 388) and 10.3% (531/5177) of suspected and culture-confirmed BSI episodes, respectively. Salmonella Typhi ranked first among the BSI pathogens in adults (n = 220), but was mostly (n = 301 [56.7%]) isolated from children, of which 72.1% (217/301) and 31.6% (95/301) were <10 years and <5 years old, respectively. Multidrug resistance (MDR), DCS, and combined MDR/DCS were found in 38.3% (n = 180), 24.5% (n = 115), and 11.9% (n = 56) of 470 first isolates, respectively. MDR and DCS rates had increased since 2007, but remained stable during 2015–2017 with no geographical clustering at the province level. Most (91/93 [97.8%]) DCS isolates sequenced belonged to Genotyphi genotype 2.5.1, and gyr S83 was the most frequent DCS mutation (76/93 [81.7%]). Infections occurred perennially, but increased during the rainy season.Conclusions Salmonella Typhi was a frequent cause of BSI in adults and children in DRC, with high rates of antibiotic resistance. Sustainable surveillance and implementation of vaccination are compelling.
Highlights
This study gives an overview of a decade (2007–2017) of hospital-based Salmonella Typhi bloodstream infection (BSI) surveillance in the Democratic Republic of the Congo (DRC), at 4 main sampling sites
The present study reports, for the period 2007–2017 in DRC, the cumulative temporal, spatial, and age distributions of Salmonella Typhi blood culture isolates, their antimicrobial resistance patterns, and their genetic relatedness to the global Salmonella Typhi population
For the entire period (2007–2017), blood cultures sampled in 37 388 BSI episodes yielded 13.9% pathogens; for the period
Summary
Blood cultures were sampled in hospital-admitted patients with suspected BSI, according to standardized clinical indications. Blood cultures were collected and processed free of charge in healthcare facilities in the capital, Kinshasa, and the Bas-Congo province (referral hospital of Kisantu) and later extended to sentinel hospitals in the Oriental Province (University Hospital Kisangani with affiliated hospitals and health centers) and the Equateur Province (referral hospital of Bwamanda). Over the years, this network was extended with other partners, and blood cultures were added to the diagnostic tools of the outbreak investigation teams of INRB in collaboration with the. Supplementary Document 1 provides a detailed overview of the workflow, criteria, and definitions used in the sampling, and the processing and reporting of the blood cultures
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