PLoS Neglected Tropical Diseases (Jan 2018)

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

  • Adam Akullian,
  • Joel M Montgomery,
  • Grace John-Stewart,
  • Samuel I Miller,
  • Hillary S Hayden,
  • Matthew C Radey,
  • Kyle R Hager,
  • Jennifer R Verani,
  • John Benjamin Ochieng,
  • Jane Juma,
  • Jim Katieno,
  • Barry Fields,
  • Godfrey Bigogo,
  • Allan Audi,
  • Judd Walson

DOI
https://doi.org/10.1371/journal.pntd.0006156
Journal volume & issue
Vol. 12, no. 1
p. e0006156

Abstract

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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.