1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
2Infectious Disease Research Collaboration, Kampala, Uganda.
Am J Trop Med Hyg. 2021 May 17;105(1):37-46. doi: 10.4269/ajtmh.20-1453.
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.
在撒哈拉以南非洲，侵袭性沙门氏菌感染是儿童急性发热性疾病（AFI）的常见病因；然而，在没有血液培养的情况下，诊断沙门氏菌菌血症具有挑战性。乌干达 AFI 监测系统包括对乌干达住院发热儿童的血流感染（BSI）病因进行基于血液培养的监测。我们分析了 2016 年 7 月至 2019 年 1 月期间六个哨点 AFI 地点住院儿童的人口统计学、临床、血液培养和抗微生物药物耐药性数据。共有 47261 名儿童住院。中位年龄为 2 岁（四分位间距，1-4），26695 名（57%）为男性。在 7203 份血培养中，242 份（3%）培养出细菌病原体，包括沙门氏菌（N=67，28%）、金黄色葡萄球菌（N=40，17%）、大肠埃希菌（N=25，10%）、肠球菌（N=18，7%）和肺炎克雷伯菌（N=17，7%）。BSI 患儿的中位住院时间较长（5 天 vs. 4 天），病死率较高（13% vs. 2%）（均 P<0.001）。与由其他病原体引起的 BSI 患儿相比，沙门氏菌 BSI 患儿的住院时间和死亡率无显著差异。对 49 株沙门氏菌分离株的血清型和抗微生物药物敏感性结果进行了分析，包括 35 株（71%）非伤寒血清型和 14 株沙门氏菌血清型伤寒（Typhi）。在伤寒分离株中，10 株（71%）为多药耐药，13 株（93%）对环丙沙星的敏感性降低。沙门氏菌菌株，特别是非伤寒血清型和耐药性伤寒沙门氏菌，是 BSI 的最常见原因。这些数据可以为东非地区的沙门氏菌监测提供信息，并指导乌干达的经验性治疗和预防。
