Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp.
Department of Microbiology and Immunology, KU Leuven, Belgium.
Clin Infect Dis. 2019 Mar 7;68(Suppl 2):S130-S137. doi: 10.1093/cid/ciy1116.
This study gives an overview of a decade (2007-2017) of hospital-based Salmonella Typhi bloodstream infection (BSI) surveillance in the Democratic Republic of the Congo (DRC), at 4 main sampling sites.
Blood cultures were sampled in hospital-admitted patients with suspected BSI, according to standardized clinical indications. The results of the surveillance period 2015-2017 were compiled with those of previous surveillance periods (2007-2010 and 2011-2014). Whole genome sequencing of isolates with decreased ciprofloxacin susceptibility (DCS) was performed.
Salmonella Typhi was isolated in 1.4% (531/37 388) and 10.3% (531/5177) of suspected and culture-confirmed BSI episodes, respectively. Salmonella Typhi ranked first among the BSI pathogens in adults (n = 220), but was mostly (n = 301 [56.7%]) isolated from children, of which 72.1% (217/301) and 31.6% (95/301) were <10 years and <5 years old, respectively. Multidrug resistance (MDR), DCS, and combined MDR/DCS were found in 38.3% (n = 180), 24.5% (n = 115), and 11.9% (n = 56) of 470 first isolates, respectively. MDR and DCS rates had increased since 2007, but remained stable during 2015-2017 with no geographical clustering at the province level. Most (91/93 [97.8%]) DCS isolates sequenced belonged to Genotyphi genotype 2.5.1, and gyr S83 was the most frequent DCS mutation (76/93 [81.7%]). Infections occurred perennially, but increased during the rainy season.
Salmonella Typhi was a frequent cause of BSI in adults and children in DRC, with high rates of antibiotic resistance. Sustainable surveillance and implementation of vaccination are compelling.
本研究概述了刚果民主共和国（DRC）在四个主要采样点进行的为期十年（2007-2017 年）的医院沙门氏菌 Typhi 血流感染（BSI）监测。
根据标准化临床指征，对疑似 BSI 的住院患者进行血液培养采样。2015-2017 年监测期间的结果与之前的监测期（2007-2010 年和 2011-2014 年）进行了汇编。对具有降低环丙沙星敏感性（DCS）的分离株进行全基因组测序。
疑似和培养确诊的 BSI 病例中，分别分离出沙门氏菌 Typhi 的比例为 1.4%（531/37388）和 10.3%（531/5177）。沙门氏菌 Typhi 在成人（n=220）BSI 病原体中排名第一，但主要（n=301 [56.7%]）从儿童中分离出来，其中 72.1%（217/301）和 31.6%（95/301）<10 岁和<5 岁。470 株首次分离株中，多重耐药（MDR）、DCS 和 MDR/DCS 合并的比例分别为 38.3%（n=180）、24.5%（n=115）和 11.9%（n=56）。自 2007 年以来，MDR 和 DCS 率有所增加，但在 2015-2017 年期间保持稳定，且在省级水平上没有地理聚集。测序的 93 株 DCS 分离株中，91 株（97.8%）属于 Genotyphi 基因型 2.5.1，gyr S83 是最常见的 DCS 突变（76/93 [81.7%]）。感染常年发生，但在雨季增加。
沙门氏菌 Typhi 是 DRC 成人和儿童 BSI 的常见病因，具有较高的抗生素耐药率。需要持续进行监测并实施疫苗接种。
