The morbidity of Salmonella bloodstream infections is unacceptably high in Africa. In 2000, the WHO Global Salmonella-Surveillance (GSS) program was founded to reduce the health burden of foodborne diseases. The incorporation, in 2002, of the Democratic Republic of Congo (DRC) in this program allowed the improvement of laboratory capacities. In this retrospective study, we describe the first signs of impact the GSS program has had in DRC in the management of bacteremia.
Between 2002 and 2006, we evaluated, in one pediatric hospital, the microbiologic and clinical features of Salmonella isolated from children suspected of having bacteremia. A random selection of isolates was typed by pulsed field gel electrophoresis (PFGE).
Among the 1528 children included in the study, 26.8% were bacteremic. Salmonella accounted for 59% of all bloodstream infections. Salmonella typhimurium (60.5%) and Salmonella enteritidis (22.3%) were the most common Salmonella serotypes. In total, 92.4% were resistant to at least 3 antimicrobials with the following proportion of strains resistant to: ampicillin (86%), chloramphenicol (92%), trimethoprim/sulfamethoxazole (95%), and tetracycline (34%). In 2002, 32.1% of children received an appropriate empiric antimicrobial treatment. In 2006, with the restoration of the confidence in the results provided by the laboratory, we observed an increase of the proportion of patients appropriately (82.9%) treated with antimicrobials (P < 0.01) without any decrease in the overall mortality rates associated with salmonellae bacteremia.
Our findings indicate the benefit to strengthen laboratory capacities in Africa, allowing the development of management guidelines of bloodstream infection.
From the *Infectious Diseases Epidemiological Unit, Public Health School, Université Libre de Bruxelles, Brussels, Belgium; †Department of Microbiology, Saint-Peter University Hospital, Brussels, Belgium; ‡Provincial Public Health Reference Laboratory, Centre de Recherche en Sciences Naturelles de Lwiro (CRSN), Democratic Republic of Congo; §Provincial Infectious Disease Epidemiological Unit, South-Kivu Province, Democratic Republic of Congo; ¶WHO Collaborating Centre for Antimicrobial Resistance in Food borne Pathogens and EU Community Reference Laboratory for Antimicrobial Resistance, National Food Institute, Technical University of Denmark, Copenhagen, Denmark; ∥Division of Foodborne, Bacterial and Mycotic Diseases, National Center for Zoonotic, Vectorborne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA; **Centre Scientifique et Médical de l'Université Libre de Bruxelles (CEMUBAC), Université Libre de Bruxelles, Brussels, Belgium; ††Centre de Recherche Médicale et Sanitaire (CERMES), Réseau International des Instituts Pasteur, Niamey, Niger; and ‡‡Department Food Safety, Zoonoses & Foodborne Diseases, World Health Organization, Geneva, Switzerland.
Accepted for publication December 1, 2009.
Supported in part by grants from the Belgium Fund of Scientific and Medical Research to Carole Schirvel and by an internal fund supported by the World Health Organization Global Salm-Surv (http://www.who.int/salmsurv).
O.V. and D.Z.N. contributed equally to this work.
This work is dedicated to the nursing staff of the Children's Hospital of Lwiro and the people living in this study area.Address for correspondence: Olivier Vandenberg, Department of Microbiology, Saint-Peter University Hospital, rue Haute 322, 1000 Brussels, Belgium. E-mail: firstname.lastname@example.org.
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