TY - JOUR
T1 - Salmonella bloodstream infections in hospitalized children with acute febrile illness-Uganda, 2016-2019
AU - Appiah, Grace D.
AU - Mpimbaza, Arthur
AU - Lamorde, Mohammed
AU - Freeman, Molly
AU - Kajumbula, Henry
AU - Salah, Zainab
AU - Kugeler, Kiersten
AU - Mikoleit, Matthew
AU - White, Porscha Bumpus
AU - Kapisi, James
AU - Borchert, Jeff
AU - Sserwanga, Asadu
AU - van Dyne, Susan
AU - Mead, Paul
AU - Kim, Sunkyung
AU - Lauer, Ana C.
AU - Winstead, Alison
AU - Manabe, Yukari C.
AU - Flick, Robert J.
AU - Mintz, Eric
N1 - Funding Information:
We thank the following individuals and institutions for their contributions to project management, coordination, and/or surveillance: hospital staff and surveillance officers at Arua, Jinja, Kabale, and Mubende RRHs and Tororo and Apac District hospitals; Vance Brown and Jaco Homsy from CDC Uganda; Hannington Tasimwa from the Department of Medical Microbiology at Makerere University; Ray Ransom and George Odongo from the CDC Division of Global Health Protection; Moses Kamaya from Makerere University; Richard Walwema from the Infectious Disease Institute; Ruth Kigozi from the Infectious Disease Research Collaboration; Prosper Behumbiize from Health Information Systems Program Uganda; the Uganda Ministry of Health; and the Uganda National Health Laboratories. We also thank Graeme Prentice-Mott from the CDC Division of Foodborne, Waterborne, and Environmental Diseases for assistance in data replication, and Jeff Higgins from the CDC Geospatial Research, Analysis, and Services Program for mapping support.
Funding Information:
Financial support: The funding for this work was supported through a CDC cooperative agreement (no. 5NU2GGH001744-02-00).
Publisher Copyright:
Copyright © 2021 by The American Society of Tropical Medicine and Hygiene
PY - 2021/7
Y1 - 2021/7
N2 - Invasive Salmonella infection is a common cause of acute febrile illness (AFI) among children in sub-Saharan Africa; however, diagnosing Salmonella bacteremia is challenging in settings without blood culture. The Uganda AFI surveillance system includes blood culture-based surveillance for etiologies of bloodstream infection (BSIs) in hospitalized febrile children in Uganda. We analyzed demographic, clinical, blood culture, and antimicrobial resistance data from hospitalized children at six sentinel AFI sites from July 2016 to January 2019. A total of 47,261 children were hospitalized. Median age was 2 years (interquartile range, 1-4) and 26,695 (57%) were male. Of 7,203 blood cultures, 242 (3%) yielded bacterial pathogens including Salmonella (N = 67, 28%), Staphylococcus aureus (N = 40, 17%), Escherichia spp. (N = 25, 10%), Enterococcus spp. (N = 18, 7%), and Klebsiella pneumoniae (N = 17, 7%). Children with BSIs had longer median length of hospitalization (5 days versus 4 days), and a higher case-fatality ratio (13% versus 2%) than children without BSI (all P < 0.001). Children with Salmonella BSIs did not differ significantly in length of hospitalization or mortality from children with BSI resulting from other organisms. Serotype and antimicrobial susceptibility results were available for 49 Salmonella isolates, including 35 (71%) non-typhoidal serotypes and 14 Salmonella serotype Typhi (Typhi). Among Typhi isolates, 10 (71%) were multi-drug resistant and 13 (93%) had decreased ciprofloxacin susceptibility. Salmonella strains, particularly non-typhoidal serotypes and drug-resistant Typhi, were the most common cause of BSI. These data can inform regional Salmonella surveillance in East Africa and guide empiric therapy and prevention in Uganda.
AB - Invasive Salmonella infection is a common cause of acute febrile illness (AFI) among children in sub-Saharan Africa; however, diagnosing Salmonella bacteremia is challenging in settings without blood culture. The Uganda AFI surveillance system includes blood culture-based surveillance for etiologies of bloodstream infection (BSIs) in hospitalized febrile children in Uganda. We analyzed demographic, clinical, blood culture, and antimicrobial resistance data from hospitalized children at six sentinel AFI sites from July 2016 to January 2019. A total of 47,261 children were hospitalized. Median age was 2 years (interquartile range, 1-4) and 26,695 (57%) were male. Of 7,203 blood cultures, 242 (3%) yielded bacterial pathogens including Salmonella (N = 67, 28%), Staphylococcus aureus (N = 40, 17%), Escherichia spp. (N = 25, 10%), Enterococcus spp. (N = 18, 7%), and Klebsiella pneumoniae (N = 17, 7%). Children with BSIs had longer median length of hospitalization (5 days versus 4 days), and a higher case-fatality ratio (13% versus 2%) than children without BSI (all P < 0.001). Children with Salmonella BSIs did not differ significantly in length of hospitalization or mortality from children with BSI resulting from other organisms. Serotype and antimicrobial susceptibility results were available for 49 Salmonella isolates, including 35 (71%) non-typhoidal serotypes and 14 Salmonella serotype Typhi (Typhi). Among Typhi isolates, 10 (71%) were multi-drug resistant and 13 (93%) had decreased ciprofloxacin susceptibility. Salmonella strains, particularly non-typhoidal serotypes and drug-resistant Typhi, were the most common cause of BSI. These data can inform regional Salmonella surveillance in East Africa and guide empiric therapy and prevention in Uganda.
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U2 - 10.4269/ajtmh.20-1453
DO - 10.4269/ajtmh.20-1453
M3 - Article
C2 - 33999850
AN - SCOPUS:85109642855
SN - 0002-9637
VL - 105
SP - 37
EP - 46
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 1
ER -