BMJ Global Health (Aug 2021)

The genomic epidemiology of multi-drug resistant invasive non-typhoidal Salmonella in selected sub-Saharan African countries

  • Gordon Dougan,
  • Stephen Baker,
  • Gi Deok Pak,
  • Robert F Breiman,
  • Justin Im,
  • Ellis Owusu-Dabo,
  • Jin Kyung Park,
  • Se Eun Park,
  • Mekonnen Teferi,
  • Raphaël Rakotozandrindrainy,
  • Florian Marks,
  • Ursula Panzner,
  • Mohammad Ali,
  • Leonard Cosmas,
  • Anna Jaeger,
  • Abraham Aseffa,
  • Barry Fields,
  • Morten Bjerregaard-Andersen,
  • John A Crump,
  • Julian T Hertz,
  • Jürgen May,
  • Adama Tall,
  • Yaw Adu-Sarkodie,
  • Duy Thanh Pham,
  • Ligia Maria Cruz Espinoza,
  • Vera von Kalckreuth,
  • Ondari D. Mogeni,
  • Heidi Schütt-Gerowitt,
  • Abdramane Bassiahi Soura,
  • Nagla Gasmelseed,
  • Arvinda Sooka,
  • Karen H Keddy,
  • Holly M Biggs,
  • Joel M Montgomery,
  • Beatrice Olack,
  • Nimako Sarpong,
  • Tsiriniaina Jean Luco Razafindrabe,
  • Tiana Mirana Raminosoa,
  • Leon Parfait Kabore,
  • Emmanuel Sampo,
  • Biruk Yeshitela,
  • Muna Ahmed El Tayeb,
  • Ralf Krumkamp,
  • Denise Myriam Dekker,
  • Amy Gassama,
  • Aissatou Niang,
  • Sandra Valborg Løfberg,
  • Jessica Fung Deerin,
  • Frank Konings,
  • Megan E Carey,
  • Sandra Van Puyvelde,
  • John Clemens

DOI
https://doi.org/10.1136/bmjgh-2021-005659
Journal volume & issue
Vol. 6, no. 8

Abstract

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Background Invasive non-typhoidal Salmonella (iNTS) is one of the leading causes of bacteraemia in sub-Saharan Africa. We aimed to provide a better understanding of the genetic characteristics and transmission patterns associated with multi-drug resistant (MDR) iNTS serovars across the continent.Methods A total of 166 iNTS isolates collected from a multi-centre surveillance in 10 African countries (2010–2014) and a fever study in Ghana (2007–2009) were genome sequenced to investigate the geographical distribution, antimicrobial genetic determinants and population structure of iNTS serotypes–genotypes. Phylogenetic analyses were conducted in the context of the existing genomic frameworks for various iNTS serovars. Population-based incidence of MDR-iNTS disease was estimated in each study site.Results Salmonella Typhimurium sequence-type (ST) 313 and Salmonella Enteritidis ST11 were predominant, and both exhibited high frequencies of MDR; Salmonella Dublin ST10 was identified in West Africa only. Mutations in the gyrA gene (fluoroquinolone resistance) were identified in S. Enteritidis and S. Typhimurium in Ghana; an ST313 isolate carrying blaCTX-M-15 was found in Kenya. International transmission of MDR ST313 (lineage II) and MDR ST11 (West African clade) was observed between Ghana and neighbouring West African countries. The incidence of MDR-iNTS disease exceeded 100/100 000 person-years-of-observation in children aged <5 years in several West African countries.Conclusions We identified the circulation of multiple MDR iNTS serovar STs in the sampled sub-Saharan African countries. Investment in the development and deployment of iNTS vaccines coupled with intensified antimicrobial resistance surveillance are essential to limit the impact of these pathogens in Africa.