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. 2021 May 17;105(1):37-46.
doi: 10.4269/ajtmh.20-1453.

Salmonella Bloodstream Infections in Hospitalized Children with Acute Febrile Illness-Uganda, 2016-2019

Grace D Appiah  1 , Arthur Mpimbaza  2   3 , Mohammed Lamorde  4 , Molly Freeman  1 , Henry Kajumbula  5 , Zainab Salah  1 , Kiersten Kugeler  6 , Matthew Mikoleit  7 , Porscha Bumpus White  1 , James Kapisi  2 , Jeff Borchert  6 , Asadu Sserwanga  2 , Susan Van Dyne  1 , Paul Mead  6 , Sunkyung Kim  1 , Ana C Lauer  1 , Alison Winstead  8 , Yukari C Manabe  9 , Robert J Flick  9 , Eric Mintz  1
Affiliations

Salmonella Bloodstream Infections in Hospitalized Children with Acute Febrile Illness-Uganda, 2016-2019

Grace D Appiah et al. Am J Trop Med Hyg. .

Abstract

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.

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Conflict of interest statement

Disclaimer: The opinions expressed by authors contributing to this manuscript do not necessarily reflect the opinions of the CDC or the institutions with which the authors are affiliated.

Figures

Figure 1.
Figure 1.
Acute febrile illness (AFI) surveillance sites— Uganda, 2016–2019. This figure appears in color at www.ajtmh.org.This figure appears in color at www.ajtmh.org.
Figure 2.
Figure 2.
Flow diagram of blood culture results.
See this image and copyright information in PMC

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