Salmonella Blood Stream Infections In a Tertiary care

Salmonella Blood Stream Infections In a Tertiary care setting in Ghana African Conference on Antibiotic Use and Resistance Dr. Appiah-Korang Labi 1

Background • Invasive salmonellosis is a global health problem • Epidemiology varies worldwide • Associated with poor public health and low socioeconomic indices • Affected by seasonal variations • Associated with malaria in Africa 2

Invasive salmonellosis…. • Resistance to commonly used antibiotics is increasing • Indiscriminate use of antibiotics in areas of high endemicity • MDR increases challenge of management by increasing morbidity and mortality 3

Invasive salmonellosis…. • Surveillance data is limited worldwide esp. in Eastern, Central and West Africa • Data is essential for disease prevention and control programmes • There is paucity of epidemiological data on invasive salmonellosis in Ghana 4

Aim • This study looks at the occurrence of invasive salmonellosis in a Ghanaian tertiary care setting over a four year period - Prevalence - Serotypes - resistance patterns - seasonal variations 5

Methods • Retrospective review of all blood cultures from KBTH, 2010 -2013 - Blood cultures performed using BACTEC 9240 - Identification by biochemical tests - salmonellae isolates typed by latex agglutination - Susceptibility by disc diffusion method 6

Results • Total blood cultures: 23, 708 • Blood culture positivity rate: 11. 8% • 181(6. 5%) prevalence of salmonella bloodstream infections • Significant difference in prevalence - Typhoidal salmonellae (TS, 2. 4%) - Non-typhoidal salmonellae (NTS, 4. 1% ) • No sign. increase/decrease in Salmonella BSI over the 4 years 7

4 -year distribution of salmonellae Isolates Number of Salmonella species a (%) Total n=181) Crxres. 2010 Total Crx (n=37) res. 2011 Total Crx res. (n=53) 2012 Total Crx (n=63) res. 2013 Total (n=28) Crx res. P-value b Typhoidal Salmonella 66 (36. 5)a 11 (16. 7)a 14 (37. 8) 4 (28. 5) 12 (22. 4) 4 (30. 7) 27 (44. 8) 2 (7. 4) 13 (22. 4) 1 (7. 6) 0. 1322 S. Typhi 48 (26. 54) 7 (14. 5) 8 (21. 6) 2 (25. 0) 7 (14. 8) 2 (25. 0) 25 (61. 9) 2 (3. 3) 8 (28. 5) 1 (12. 5) 0. 8056 S. Paratyphi A 12 (6. 6) 4 (33. 3) 3 (8. 1) 2 (66. 6) 3 (5. 5) 2 (66. 7) 1 (1. 6) 0 5 (17. 8) 0 0. 0441 S. Paratyphi B 6 (3. 3) 0 3 (8. 1) 0 2 (3. 7) 0 1 (1. 6) 0 0. 1988 115 (63. 5)b 21 (18. 2)a 23 (62. 1) 5 (21. 7) 41 (77. 3) 11 (23. 4) 36 (57. 1) 4 (11. 1) 15 (53. 5) 1 (6. 7) 0. 1322 S. Enteritidis 93 (51. 2) 18 (19. 3) 16 (25. 2) 4 (25. 0) 33 (61. 1) 9 (27. 2) 29 (46. 0) 4 (13. 8) 15 (53. 5) 1 (6. 7) 0. 129 c 2010*2013, P=0. 018; 2011*2013, P = 0. 019 S. Typhumurium 22 (12. 2) 3 (13. 6) 7 (18. 9) 1 (14. 2) 8 (14. 0) 2 (25. 0) 7 (6. 1) 0 0 0 - Non-typhoidal Salmonella 8

Demography…. • 98 males and 83 females • Mean age of 9. 5 years (range, 14 days -70 years) • Burden of disease is higher in children under 5 • Among Children with Salmonella BSI - those ≤ 1 year were less likely infected by TS [Multivariate analysis: AOR, 0. 51; 95%CI, 0. 16 -0. 92; P-value 0. 021]. 9

Age-specific incidence of Salmonella BSI 10

Seasonal variation of Salmonella bloodstream Infections 11

Antibiotic susceptibility pattern of Salmonella isolates… • % resistance NTS and TS >70% for ampicillin, chloramphenicol and tetracycline • Resistance to chloramphenicol appears be getting worse with years • No resistance of TS to ciprofloxacin and cefotaxime • % resistance of NTS to ciprofloxacin( 0. 8% ) and cefotaxime( 6. 1% ) 12

Multidrug resistance (MDR)… • Defined as resistance to ≥ 1 antibiotic from ≥ 3 classes of antibiotics - 81(44. 8%) of all salmonallae were MDR - Significant difference in MDR between NTS and TS - NTS: 59/115 (51. 3%) - TS: 22/66 (33. 3%) 13

Conclusion • 6. 5% prevalence of Salmonella bacteraemia at the KBTH • High prevalence of NTS over TS • Burden of disease is higher in children under 5 • Peak transmission during rainy season • Low level resistance to ciprofloxacin and cefotaxime but high level of multidrug resistance among isolates 14

Acknowledgement To staff of the microbiology unit of the KBTH for their support 15

Thank you 16