Nosocomial Outbreak of Salmonella enterica Serovar Typhimurium Primarily Affecting a Pediatric Ward in South Africa in 2012

Smith, Anthony M.; Mthanti, Mnikelwa A.; Haumann, Carel; Tyalisi, Nomalungisa; Boon, Gerald; Sooka, Arvinda; Keddy, Karen H.

doi:10.1128/jcm.02422-13

Cited by 24 publications

(29 citation statements)

References 17 publications

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“…Third, salmonellosis is principally a food-related infection largely of community setting origin [ 18 ]. Although there have been sporadic reports of health-care related Salmonella outbreaks [ 121 ], health-care associated infections in Africa [ 122 ] have been linked with Gram-negative bacilli other than Salmonella . Moreover, in a review of surveillance data of 33188 paediatric admissions in Kenya (2002–2009), Gram-negative bacilli other than Salmonella were the major causes of hospital-acquired bacteraemeia [ 123 ].…”

Section: Discussionmentioning

confidence: 99%

Molecular epidemiology of fluoroquinolone resistant Salmonella in Africa: A systematic review and meta-analysis

et al. 2018

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BackgroundWide-ranging evidence on the occurrence of fluoroquinolone (FQ) resistance genetic determinants in African Salmonella strains is not available. The main objectives of this study were to assess the heterogeneity, estimate pooled proportions and describe the preponderance of FQ-resistance determinants in typhoidal and non-typhoidal Salmonella (NTS) isolates of Africa.MethodsGenetic and phenotypic data on 6103 Salmonella isolates were considered. Meta- and frequency analyses were performed depending on the number of studies by category, number of isolates and risks of bias. A random effects model was used to assess heterogeneity and estimate pooled proportions. Relative and cumulative frequencies were calculated to describe the overall preponderance of FQ-resistance determinants in quinolone resistant isolates.ResultsThe pooled proportion of gyrA mutants (Salmonella enterica serovar Typhi, Salmonella enterica serovar Typhimurium, and Salmonella enterica serovar Enteritidis) was estimated at 5.7% (95% Confidence interval (CI) = 2.6, 9.8; Tau squared (T2) = 0.1105), and was higher in S. Typhi than in S. Typhimurium (odds ratio (OR) = 3.3, 95%CI = 2, 5.7). The proportions of each of gyrB and parC mutants, and strains with Plasmid Mediated Quinolone Resistance genes (qnrA, qnrB and qnrS) were low (≤ 0.3%). Overall, 23 mutant serotypes were identified, and most strains had mutations at codons encoding Ser83 and Asp87 of gyrA (82%, 95%CI = 78, 86).ConclusionsMutations at gyrA appear to account for ciprofloxacin non-susceptibility in most clinical Salmonella strains in Africa. The estimates could be harnessed to develop a mismatch-amplification mutation-assay for the detection of FQ-resistant strains in Africa.

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Section: Discussionmentioning

confidence: 99%

Molecular epidemiology of fluoroquinolone resistant Salmonella in Africa: A systematic review and meta-analysis

et al. 2018

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“…Data on long-term care facilities were also not always forthcoming; thus, this finding may not be truly reflective, as some HIV-infected patients in particular may have acquired iNTS while in these care facilities. Nosocomial salmonellosis is well described in South Africa, often affecting children [21,22] and nonetheless warrants careful monitoring. In contrast to invasive shigellosis, [23] we did not see an excess of adult women presenting with iNTS: intrinsic characteristics of Salmonella , in HIV-infected patients in particular, appear to be at play in the context of invasive disease, beyond human behavioral factors.…”

Section: Discussionmentioning

confidence: 99%

Clinical and microbiological features of invasive nontyphoidal Salmonella associated with HIV-infected patients, Gauteng Province, South Africa

Keddy

Musekiwa²,

Sooka

et al. 2017

Medicine

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The aim of this study was to define factors associated with HIV-infected versus uninfected patients with invasive nontyphoidal Salmonella (iNTS) and factors associated with mortality, which are inadequately described in Africa.Laboratory-based surveillance for iNTS was undertaken. At selected sentinel sites, clinical data (age, sex, HIV status, severity of illness, and outcome) were collected.Surveillance was conducted in Gauteng, South Africa, from 2003 to 2013. Clinical and microbiological differences between HIV-infected and uninfected patients were defined and risk factors for mortality established.Of 4886 iNTS infections in Gauteng from 2003 to 2013, 3106 (63.5%) were diagnosed at sentinel sites. Among persons with iNTS infections, more HIV-infected persons were aged ≥5 years (χ2 = 417.6; P < 0.001) and more HIV-infected children were malnourished (χ2 = 5.8; P = 0.02). Although 760 (30.6%) patients died, mortality decreased between 2003 [97/263 (36.9%)] and 2013 [926/120 (21.7%)]. On univariate analysis, mortality was associated with patients aged 25 to 49 years [odds ratio (OR) = 2.2; 95% confidence interval (CI) = 1.7–2.7; P < 0.001 and ≥50 years (OR = 3.0; 95% CI = 2.2–4.1; P < 0.001) compared with children < 5 years, HIV-infected patients (OR = 2.4; 95% CI = 1.7–3.4; P < 0.001), and severe illness (OR = 5.4; 95% CI = 3.6–8.1; P < 0.001). On multivariate analysis, mortality was associated with patients aged ≥50 years [adjusted OR (AOR) = 3.6, 95% CI = 2.1–6.1, P < 0.001] and severe illness (AOR = 6.3; 95% CI = 3.8–10.5; P < 0.001).Mortality due to iNTS in Gauteng remains high primarily due to disease severity. Interventions must be aimed at predisposing conditions, including HIV, other immune-suppressive conditions, and malignancy.

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“…Salmonella Typhimurium ST313 is well associated with HIV [27]; we found that the organism contributes significantly to NTS meningitis in HIV-infected patients. Besides ST313, representing 67% of typed Salmonella Typhimurium isolates, ST19 represented 31% of typed isolates; ST19 is commonly described worldwide, including from South Africa [39]. A stronger association between HIV infection and Salmonella meningitis due to Salmonella Typhimurium ST313, compared with Salmonella Typhimurium ST19, was noted.…”

Section: Discussionmentioning

confidence: 99%

“…A stronger association between HIV infection and Salmonella meningitis due to Salmonella Typhimurium ST313, compared with Salmonella Typhimurium ST19, was noted. In our previous report of predominantly noninvasive Salmonella Typhimurium ST19 infection, most of the patients were HIV uninfected [39]. …”

Section: Discussionmentioning

confidence: 99%

Clinical and Microbiological Features ofSalmonellaMeningitis in a South African Population, 2003–2013

Keddy

Sooka²,

Musekiwa³

et al. 2015

Clin Infect Dis.

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Background The clinical and microbiological characteristics of nontyphoidal Salmonella (NTS) meningitis in South Africa, where human immunodeficiency virus (HIV) prevalence is high (approximately 15% in persons ≥15 years of age), were reviewed. Methods From 2003 through 2013, 278 cases were identified through national laboratory-based surveillance. Clinical information (age, sex, outcome, Glasgow Coma Scale [GCS], and HIV status) was ascertained at selected sites. Isolates were serotyped; susceptibility testing and multilocus sequence typing on Salmonella enterica serovar Typhimurium isolates was performed. Multivariable logistic regression was used to determine factors associated with mortality outcome, using Stata software, version 13. Results Where age was ascertained, 139 of 256 (54.3%) patients were <15 years. Males represented 151 of 267 (56.6%). Mortality outcome was recorded for 112 of 146 (76.7%) enhanced surveillance patients; 53 of 112 (47.3%) died. Death was associated with GCS ≤13 (adjusted odds ratio [OR], 18.7; 95% confidence interval [CI], 3.0–118.5; P = .002) on multivariable analysis. Where data were available, all 45 patients aged >15 years were HIV infected, compared with 24 of 46 (52.2%) patients aged <5 years. Neonates were less likely to be HIV infected than infants aged 2–12 months (OR, 4.8; 95% CI, 1.1–21.1; P = .039). Salmonella Typhimurium represented 106 of 238 (44.5%) serotyped isolates: 65 of 95 (68.4%) were ST313 vs ST19, respectively, and significantly associated with HIV-infected patients (P = .03) and multidrug resistance (OR, 6.6; 95% CI, 2.5–17.2; P < .001). Conclusions NTS meningitis in South Africa is highly associated with HIV in adults, with neonates (irrespective of HIV status), and with Salmonella Typhimurium ST313. GCS is the best predictor of mortality: early diagnosis and treatment are critical. Focused prevention requires further studies to understand the sources and transmission routes.

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Nosocomial Outbreak of Salmonella enterica Serovar Typhimurium Primarily Affecting a Pediatric Ward in South Africa in 2012

Cited by 24 publications

References 17 publications

Molecular epidemiology of fluoroquinolone resistant Salmonella in Africa: A systematic review and meta-analysis

Molecular epidemiology of fluoroquinolone resistant Salmonella in Africa: A systematic review and meta-analysis

Clinical and microbiological features of invasive nontyphoidal Salmonella associated with HIV-infected patients, Gauteng Province, South Africa

Clinical and Microbiological Features ofSalmonellaMeningitis in a South African Population, 2003–2013

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