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- Title
Non-typhoidal Salmonella bloodstream infections in Kisantu, DR Congo: Emergence of O5-negative Salmonella Typhimurium and extensive drug resistance.
- Authors
Tack, Bieke; Phoba, Marie-France; Barbé, Barbara; Kalonji, Lisette M.; Hardy, Liselotte; Van Puyvelde, Sandra; Ingelbeen, Brecht; Falay, Dadi; Ngbonda, Dauly; van der Sande, Marianne A. B.; Deborggraeve, Stijn; Jacobs, Jan; Lunguya, Octavie
- Abstract
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. Author summary: We reviewed bloodstream infections caused by non-typhoidal Salmonella over a 10 year period (2007–2017) in the Democratic Republic of the Congo, with Kisantu in the Kongo Central province as the major sampling site. Non-typhoidal Salmonella were the most common cause of bloodstream infections in children in a sentinel network in DR Congo. The disease mainly occurred in young children and had a high mortality. We showed that non-typhoidal Salmonella persisted to frequently cause bloodstream infections in children under 5 years old. Salmonella Enteritidis and Salmonella Typhimurium were the main serotypes causing non-typhoidal Salmonella bloodstream infections. The emergence of O5-antigen negative Salmonella Typhimurium (i.e. variant Copenhagen) was observed and this needs to be considered when developing vaccines. Multidrug resistance to ampicillin, trimethoprim-sulfamethoxazole and chloramphenicol was widespread during the whole decade. From 2013 onwards, resistance to all other available antibiotics, i.e. third generation cephalosporins, fluoroquinolones and azithromycin, emerged. Likewise, extensive drug resistance (multidrug, ceftriaxone and azithromycin co-resistance) and multidrug resistance combined with decreased ciprofloxacin susceptibility in Salmonella Typhimurium emerged. Unfortunately, there are no clinical studies on antibiotic treatment in non-typhoidal Salmonella bloodstream infection that could allow the development of evidence based treatment guidelines. Therefore, dedicated observational studies and clinical studies are urgently needed to optimize antibiotic stewardship.
- Subjects
COPENHAGEN (Denmark); SALMONELLA typhimurium; SALMONELLA diseases; NATIONAL Trust for Scotland; SALMONELLA food poisoning; DRUG resistance; SALMONELLA enteritidis; DRUG resistance in bacteria
- Publication
PLoS Neglected Tropical Diseases, 2020, Vol 14, Issue 4, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0008121