Multi-drug resistant non-typhoidal Salmonella associated with invasive disease in western Kenya

PLoS Negl Trop Dis. 2018 Jan 12;12(1):e0006156. doi: 10.1371/journal.pntd.0006156. eCollection 2018 Jan.

Abstract

Non-typhoidal Salmonella (NTS) is a leading cause of bloodstream infections in Africa, but the various contributions of host susceptibility versus unique pathogen virulence factors are unclear. We used data from a population-based surveillance platform (population ~25,000) between 2007-2014 and NTS genome-sequencing to compare host and pathogen-specific factors between individuals presenting with NTS bacteremia and those presenting with NTS diarrhea. Salmonella Typhimurium ST313 and Salmonella Enteritidis ST11 were the most common isolates. Multi-drug resistant strains of NTS were more commonly isolated from patients presenting with NTS bacteremia compared to NTS diarrhea. This relationship was observed in patients under age five [aOR = 15.16, 95% CI (2.84-81.05), P = 0.001], in patients five years and older, [aOR = 6.70 95% CI (2.25-19.89), P = 0.001], in HIV-uninfected patients, [aOR = 21.61, 95% CI (2.53-185.0), P = 0.005], and in patients infected with Salmonella serogroup B [aOR = 5.96, 95% CI (2.28-15.56), P < 0.001] and serogroup D [aOR = 14.15, 95% CI (1.10-182.7), P = 0.042]. Thus, multi-drug-resistant NTS was strongly associated with bacteremia compared to diarrhea among children and adults. This association was seen in HIV-uninfected individuals infected with either S. Typhimurium or S. Enteritidis. Risk of developing bacteremia from NTS infection may be driven by virulence properties of the Salmonella pathogen.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bacteremia / epidemiology*
  • Bacteremia / microbiology
  • Child
  • Child, Preschool
  • DNA, Bacterial / chemistry
  • DNA, Bacterial / genetics
  • Diarrhea / epidemiology
  • Diarrhea / microbiology
  • Drug Resistance, Multiple, Bacterial*
  • Female
  • Humans
  • Infant
  • Kenya / epidemiology
  • Male
  • Middle Aged
  • Salmonella Infections / epidemiology*
  • Salmonella Infections / microbiology
  • Salmonella enterica / drug effects*
  • Salmonella enterica / genetics
  • Salmonella enterica / isolation & purification*
  • Sequence Analysis, DNA
  • Young Adult

Substances

  • DNA, Bacterial