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. 2016 Mar 15;62 Suppl 1(Suppl 1):S42-6.
doi: 10.1093/cid/civ788.

A Multicountry Molecular Analysis of Salmonella enterica Serovar Typhi With Reduced Susceptibility to Ciprofloxacin in Sub-Saharan Africa

Hassan M Al-Emran  1 , Daniel Eibach  1 , Ralf Krumkamp  1 , Mohammad Ali  2 , Stephen Baker  3 , Holly M Biggs  4 , Morten Bjerregaard-Andersen  5 , Robert F Breiman  6 , John D Clemens  7 , John A Crump  8 , Ligia Maria Cruz Espinoza  9 , Jessica Deerin  9 , Denise Myriam Dekker  1 , Amy Gassama Sow  10 , Julian T Hertz  4 , Justin Im  9 , Samuel Ibrango  11 , Vera von Kalckreuth  9 , Leon Parfait Kabore  12 , Frank Konings  9 , Sandra Valborg Løfberg  5 , Christian G Meyer  13 , Eric D Mintz  14 , Joel M Montgomery  15 , Beatrice Olack  15 , Gi Deok Pak  9 , Ursula Panzner  9 , Se Eun Park  9 , Jean Luco Tsiriniaina Razafindrabe  16 , Henintsoa Rabezanahary  16 , Jean Philibert Rakotondrainiarivelo  16 , Raphaël Rakotozandrindrainy  16 , Tiana Mirana Raminosoa  16 , Heidi Schütt-Gerowitt  17 , Emmanuel Sampo  18 , Abdramane Bassiahi Soura  19 , Adama Tall  10 , Michelle Warren  9 , Thomas F Wierzba  9 , Jürgen May  1 , Florian Marks  9
Affiliations

A Multicountry Molecular Analysis of Salmonella enterica Serovar Typhi With Reduced Susceptibility to Ciprofloxacin in Sub-Saharan Africa

Hassan M Al-Emran et al. Clin Infect Dis. .

Abstract

Background: Salmonella enterica serovar Typhi is a predominant cause of bloodstream infections in sub-Saharan Africa (SSA). Increasing numbers of S. Typhi with resistance to ciprofloxacin have been reported from different parts of the world. However, data from SSA are limited. In this study, we aimed to measure the ciprofloxacin susceptibility of S. Typhi isolated from patients with febrile illness in SSA.

Methods: Febrile patients from 9 sites within 6 countries in SSA with a body temperature of ≥38.0°C were enrolled in this study. Blood samples were obtained for bacterial culture, and Salmonella isolates were identified biochemically and confirmed by multiplex polymerase chain reaction (PCR). Antimicrobial susceptibility of all Salmonella isolates was performed by disk diffusion test, and minimum inhibitory concentrations (MICs) against ciprofloxacin were measured by Etest. All Salmonella isolates with reduced susceptibility to ciprofloxacin (MIC > 0.06 µg/mL) were screened for mutations in quinolone resistance-determining regions in target genes, and the presence of plasmid-mediated quinolone resistance (PMQR) genes was assessed by PCR.

Results: A total of 8161 blood cultures were performed, and 100 (1.2%) S. Typhi, 2 (<0.1%) Salmonella enterica serovar Paratyphi A, and 27 (0.3%) nontyphoid Salmonella (NTS) were isolated. Multidrug-resistant S. Typhi were isolated in Kenya (79% [n = 38]) and Tanzania (89% [n = 8]) only. Reduced ciprofloxacin-susceptible (22% [n = 11]) S. Typhi were isolated only in Kenya. Among those 11 isolates, all had a Glu133Gly mutation in the gyrA gene combined with either a gyrA (Ser83Phe) or gyrB mutation (Ser464Phe). One Salmonella Paratyphi A isolate with reduced susceptibility to ciprofloxacin was found in Senegal, with 1 mutation in gyrA (Ser83Phe) and a second mutation in parC (Ser57Phe). Mutations in the parE gene and PMQR genes were not detected in any isolate.

Conclusions: Salmonella Typhi with reduced susceptibility to ciprofloxacin was not distributed homogenously throughout SSA. Its prevalence was very high in Kenya, and was not observed in other study countries. Continuous monitoring of antimicrobial susceptibility is required to follow the potential spread of antimicrobial-resistant isolates throughout SSA.

Keywords: S. Typhi; ciprofloxacin; sub-Saharan Africa; susceptible.

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