Three Epidemics of Invasive Multidrug-Resistant Salmonella Bloodstream Infection in Blantyre, Malawi, 1998-2014
Three Epidemics of Invasive Multidrug-Resistant Salmonella Bloodstream Infection in Blantyre, Malawi, 1998-2014
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DOI：
10.1093/cid/civ691
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发表时间：
2015-11-01
影响因子：
11.8
通讯作者：
Gordon, Melita A.
中科院分区：
文献类型：
--
作者：
Feasey, Nicholas A.;Masesa, Clemens;Gordon, Melita A.
背景。马拉维利物浦惠康信托临床研究方案（MLW）自1998年以来定期收集发热患者的血液培养标本和疑似脑膜炎患者的脑脊液标本，并将其送到马拉维布兰太尔伊丽莎白女王中心医院（QECH）。我们提供了1998年至2014年的血液感染（BSI）和脑膜炎监测数据。在MLW进行自动血液培养、人工物种形成、血清分型和抗菌药敏试验。布兰太尔城市最低发病率估计的人口数据来自已发表的估计。1998年至2014年期间，对就诊于QECH的成人和儿科患者进行了167 028例血培养；检出伤寒沙门菌2054例（1.2%），检出非伤寒沙门菌（NTS）血清型10 139例（6.1%），其中检出伤寒沙门菌8017例（79.1%），检出肠炎沙门菌1608例（15.8%）。共有392宗新界南脑膜炎个案及9宗伤寒沙门菌脑膜炎个案。在布兰太尔发生了3次沙门氏菌BSI流行；1999年至2002年的肠炎沙门氏菌，2002年至2008年的鼠伤寒沙门氏菌，以及2011年开始并于2014年持续的伤寒沙门氏菌。在所有3种血清型中均出现了多药耐药，绝大多数分离株均出现了多药耐药，而对第三代头孢菌素和氟喹诺酮类药物的耐药目前并不常见，但已被确定。马拉维的侵袭性沙门氏菌病是动态的，不能明确归因于单一风险因素，尽管所有3次流行都与多药耐药性有关。为了为非疫苗和疫苗干预提供信息，需要进一步调查疾病宿主和传播方式。
Background. The Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW) has routinely collected specimens for blood culture from febrile patients, and cerebrospinal fluid from patients with suspected meningitis, presenting to Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi, since 1998.Methods. We present bloodstream infection (BSI) and meningitis surveillance data from 1998 to 2014. Automated blood culture, manual speciation, serotyping, and antimicrobial susceptibility testing were performed at MLW. Population data for minimum-incidence estimates in urban Blantyre were drawn from published estimates.Results. Between 1998 and 2014, 167 028 blood cultures were taken from adult and pediatric medical patients presenting to QECH; Salmonella Typhi was isolated on 2054 occasions (1.2%) and nontyphoidal Salmonella (NTS) serovars were isolated 10 139 times (6.1%), of which 8017 (79.1%) were Salmonella Typhimurium and 1608 (15.8%) were Salmonella Enteritidis. There were 392 cases of NTS meningitis and 9 cases of Salmonella Typhi meningitis. There have been 3 epidemics of Salmonella BSI in Blantyre; Salmonella Enteritidis from 1999 to 2002, Salmonella Typhimurium from 2002 to 2008, and Salmonella Typhi, which began in 2011 and was ongoing in 2014. Multidrug resistance has emerged in all 3 serovars and is seen in the overwhelming majority of isolates, while resistance to third-generation cephalosporins and fluoroquinolones is currently uncommon but has been identified.Conclusions. Invasive Salmonella disease in Malawi is dynamic and not clearly attributable to a single risk factor, although all 3 epidemics were associated with multidrug resistance. To inform nonvaccine and vaccine interventions, reservoirs of disease and modes of transmission require further investigation.