Urinary tract infection, bacteremia and Non-Typhoidal Salmonella gastroenteritis in Algeria: First report of Salmonella case isolated from urine in Algeria at Ben badis constantine hospital.

BACKGROUND

Infectious diseases caused by Salmonella are typically associated with gastrointestinal manifestations, such as gastroenteritis. However, there exists a subset of cases wherein Salmonella strains have been identified as the causative agents of rare infections affecting the urinary tract. Urinary tract infections (UTIs) are predominantly attributed to bacterial species like Escherichia coli, but emerging research has documented instances of Salmonella species inciting UTIs, albeit infrequently. The mechanisms underlying Salmonella's ability to breach the urinary tract barriers and cause infections remain a subject of investigation.

OBJECTIVES

Exploring these rare occurrences of Salmonella-induced urinary tract and gastrointestinal infections is imperative for a comprehensive understanding the pathogenic potential of Salmonella beyond its conventional manifestations. This research aims to shed light on the epidemiology, clinical features, and potential mechanisms involved in these infrequent but significant Salmonella-associated infections such insights are vital for enhancing diagnostic accuracy, informing treatment strategies, and enhancing our broader understanding of the diverse clinical impact of Salmonella.

METHODS

In a prospective monocentric cohort study at Benbadis University Teaching Hospital's Bacteriology Laboratory, Constantine, Algeria, conducted from September 2018 to March 2019, non-redundant Salmonella strains were collected from diverse patients, including children and adults across departments and the intensive care unit (ICU). These strains underwent bacterial culture, identification using API 20E and MALDI TOF MS, and serotyping. Antimicrobial susceptibility testing employed various antibiotics, and extended spectrum β-lactamases (ESBL) detection utilized the disk diffusion method with EUCAST guidelines. Molecular investigation via RT-PCR targeted ESBL resistance genes, employing BioRobot EZ1 for extraction and Real-Time PCR. The study unveiled insights into antibiotic resistance patterns and gene prevalence in Salmonella strains within the region.

RESULTS

The study involved the analysis of 35 different Salmonella strains were isolated during the specified period. The sample types comprised 28 (80 %) stool, 4 (11 %) urine and 3 (9 %) blood isolates. This distribution highlights that the majority of the testing focused on stool samples, with a smaller but significant proportion dedicated to urine and blood analysis, Our findings offer a substantial contribution to the understanding of Salmonella infections within Algeria. Notably, our study is the first to report the isolation of Salmonella from a urine sample in the country, highlighting a previously undocumented aspect of Salmonella infections in Algeria. The study identified significant antibiotic resistance patterns in the Salmonella strains, with a high prevalence of extended spectrum β-lactamases (ESBL) genes. Among the isolates, bla, bla, and bla genes were predominant. Notably, ESBL-producing strains accounted for 49.1 % of the isolates, with a co-occurrence of all three genes in 64.4 % of these strains. The molecular analysis revealed substantial resistance, posing a threat to effective treatment options.

CONCLUSION

The findings underscore the critical need for ongoing surveillance and robust infection control measures to combat the rising tide of multidrug-resistant (MDR) Salmonella infections, enhanced diagnostic accuracy and informed treatment strategies are essential to address these emerging challenges in clinical settings.