Infectious Diseases Epidemiological Unit, Public Health School, Université Libre de Bruxelles, Brussels, Belgium.
Pediatr Infect Dis J. 2010 Jun;29(6):504-10. doi: 10.1097/INF.0b013e3181cd615a.
The morbidity of Salmonella bloodstream infections is unacceptably high in Africa. In 2000, the WHO Global Salmonella-Surveillance (GSS) program was founded to reduce the health burden of foodborne diseases. The incorporation, in 2002, of the Democratic Republic of Congo (DRC) in this program allowed the improvement of laboratory capacities. In this retrospective study, we describe the first signs of impact the GSS program has had in DRC in the management of bacteremia.
Between 2002 and 2006, we evaluated, in one pediatric hospital, the microbiologic and clinical features of Salmonella isolated from children suspected of having bacteremia. A random selection of isolates was typed by pulsed field gel electrophoresis (PFGE).
Among the 1528 children included in the study, 26.8% were bacteremic. Salmonella accounted for 59% of all bloodstream infections. Salmonella typhimurium (60.5%) and Salmonella enteritidis (22.3%) were the most common Salmonella serotypes. In total, 92.4% were resistant to at least 3 antimicrobials with the following proportion of strains resistant to: ampicillin (86%), chloramphenicol (92%), trimethoprim/sulfamethoxazole (95%), and tetracycline (34%). In 2002, 32.1% of children received an appropriate empiric antimicrobial treatment. In 2006, with the restoration of the confidence in the results provided by the laboratory, we observed an increase of the proportion of patients appropriately (82.9%) treated with antimicrobials (P < 0.01) without any decrease in the overall mortality rates associated with salmonellae bacteremia.
Our findings indicate the benefit to strengthen laboratory capacities in Africa, allowing the development of management guidelines of bloodstream infection.
在非洲，沙门氏菌血流感染的发病率高得令人无法接受。2000 年，世界卫生组织（WHO）全球沙门氏菌监测（GSS）计划成立，旨在减轻食源性疾病的健康负担。2002 年，刚果民主共和国（DRC）加入该计划，提高了实验室能力。在这项回顾性研究中，我们描述了 GSS 计划在 DRC 对沙门氏菌菌血症管理的首次影响迹象。
在一家儿科医院，我们评估了 2002 年至 2006 年间，疑似菌血症患儿分离的沙门氏菌的微生物学和临床特征。对随机选择的分离株进行脉冲场凝胶电泳（PFGE）分型。
在纳入研究的 1528 名儿童中，有 26.8%为菌血症。沙门氏菌占所有血流感染的 59%。鼠伤寒沙门氏菌（60.5%）和肠炎沙门氏菌（22.3%）是最常见的沙门氏菌血清型。共有 92.4%的菌株至少对 3 种抗生素耐药，以下是耐药菌株的比例：氨苄西林（86%）、氯霉素（92%）、甲氧苄啶/磺胺甲噁唑（95%）和四环素（34%）。2002 年，32.1%的患儿接受了经验性抗菌治疗。2006 年，随着实验室结果的可信度恢复，我们观察到接受抗菌治疗的患者比例增加（82.9%）（P<0.01），而与沙门氏菌菌血症相关的总体死亡率没有下降。
我们的研究结果表明，加强非洲实验室能力的好处是能够制定血流感染管理指南。
