Salmonella blood stream infections in a tertiary care setting in Ghana
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Infectious Diseases
Abstract
Background: Despite the clinical significance of Salmonella infections, surveillance data worldwide remains limited
and is more so exemplified by the lack of reports from Africa especially in eastern, central and western Africa. This
study reports on Salmonella serotypes as significant causes of blood stream infections (BSI) and multidrug antibiotic
resistance at Korle-Bu Teaching Hospital in Accra, Ghana.
Methods: Antibiogram patterns, seasonal variations in disease incidence and predisposing factors for infection with
Salmonella serotypes were analyzed retrospectively over a 4-year period from January 2010 to December 2013.
Blood cultures were processed with BACTEC 9240 blood culture system. Speciation was done with BBL Crystal
Enteric/Nonfermenter identification system®, and with slide agglutination using specific antisera. Antimicrobial
susceptibility testing was carried out by the Kirby-Bauer disc diffusion method according to Clinical and Laboratory
Standard Institute guidelines.
Results: We report a 6.5% (n = 181/2768) prevalence of Salmonella bacteraemia at the Korle-Bu Teaching Hospital;
with a preponderance of non-typhoidal salmonellae (NTS) over typhoidal salmonella (TS) (n = 115/181, 63.5% versus
n = 66/181, 36.5%; P-value <0.002). Children under 5 years bore the brunt of the disease (n = 93/174, 53.4%). Resistance
to ciprofloxacin (n = 1/127, 0.7%), amikacin (n = 3/81, 3.7%), and cefotaxime (n = 6/99, 6.1%) remained low, despite high
levels of multidrug resistant Salmonella phenotypes (n = 81/181, 44.2%). In multivariate analysis, and among patients
with Salmonella BSI, those < 1 year old had reduced risk of non-typhoidal infections [Odds ratio, 0.51; 95% confidence
interval (95% CI), 0.16-0.92, P-value 0.021]. Similarly, patients with cefuroxime resistant strans were at increased risk of
having multidrug resistant Salmonella BSI (OR, 8.97; 95% CI, 3.62-24.15; P-value, 0.001).
Conclusions: Salmonellae, predominantly NTS, account for a reasonable low proportion of positive blood cultures in
our tertiary care setting; but with significant multidrug resistant phenotypes and low ciprofloxacin and cefotaxime
resistance.
Description
Research Article
Keywords
Ghana, Salmonella, Antibiotic, Resistance, Risk factors