Salmonella Bloodstream Infections in Hospitalized Children with Acute Febrile Illness—Uganda, 2016–2019
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
The American Journal of Tropical Medicine and Hygiene
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.
Description
Keywords
Salmonella Bloodstream Infections, Hospitalized Children, Febrile Illness, Uganda
Citation
Appiah, G. D., Mpimbaza, A., Lamorde, M., Freeman, M., Kajumbula, H., Salah, Z., ... & Mintz, E. (2021). Salmonella bloodstream infections in hospitalized children with acute febrile illness—Uganda, 2016–2019. The American Journal of Tropical Medicine and Hygiene, 105(1), 37. doi:10.4269/ajtmh.20-1453