title: Salmonella blood stream infections in a tertiary care setting in Ghana.
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.
authors.forename: Appiah-Korang
authors.initials: AK
authors.lastname: Labi
authors.forename: Noah
authors.initials: N
authors.lastname: Obeng-Nkrumah
authors.forename: Naa Okaikor
authors.initials: NO
authors.lastname: Addison
authors.forename: Eric S
authors.initials: ES
authors.lastname: Donkor
authors.forename: Eric Sampene
authors.initials: ES
authors.lastname: Donkor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002444:Cefuroxime / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D052978:Disk Diffusion Antimicrobial Tests; D024901:Drug Resistance, Multiple, Bacterial / Q000502:physiology*; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012475:Salmonella / Q000187:drug effects / Q000502:physiology*; D012480:Salmonella Infections / Q000453:epidemiology* / Q000382:microbiology; D012477:Salmonella enteritidis / Q000187:drug effects / Q000502:physiology; D012482:Salmonella paratyphi A / Q000187:drug effects / Q000502:physiology; D012485:Salmonella typhi / Q000187:drug effects / Q000502:physiology; D012486:Salmonella typhimurium / Q000187:drug effects / Q000502:physiology; D012621:Seasons; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002444:Cefuroxime