title: Microbiologic and clinical features of Salmonella species isolated from bacteremic children in eastern Democratic Republic of Congo.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Our findings indicate the benefit to strengthen laboratory capacities in Africa, allowing the development of management guidelines of bloodstream infection.
authors.affiliation: Infectious Diseases Epidemiological Unit, Public Health School, Université Libre de Bruxelles, Brussels, Belgium. olivier.vandenberg@ulb.ac.be
authors.forename: Olivier
authors.initials: O
authors.lastname: Vandenberg
authors.forename: Deo Z
authors.initials: DZ
authors.lastname: Nyarukweba
authors.forename: Prudence M
authors.initials: PM
authors.lastname: Ndeba
authors.forename: Rene S
authors.initials: RS
authors.lastname: Hendriksen
authors.forename: Ezra J
authors.initials: EJ
authors.lastname: Barzilay
authors.forename: Carole
authors.initials: C
authors.lastname: Schirvel
authors.forename: Balaluka B
authors.initials: BB
authors.lastname: Bisimwa
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Collard
authors.forename: Awa
authors.initials: A
authors.lastname: Aidara Kane
authors.forename: Frank M
authors.initials: FM
authors.lastname: Aarestrup
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D012475:Salmonella / Q000187:drug effects / Q000302:isolation & purification*; D012480:Salmonella Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents