title: Emergence of Community-Acquired, Multidrug-Resistant Invasive Nontyphoidal Salmonella Disease in Rural Western Kenya, 2009-2013.
abstract: BACKGROUND
  Nontyphoidal Salmonella (NTS), mainly serotypes Typhimurium and Enteritidis, cause invasive infections with high mortality in children in sub-Saharan Africa. Multidrug resistance is common, and resistance to third-generation cephalosporins has emerged.
  
  
  METHODS
  We reviewed clinical features, outcomes, and antimicrobial resistance patterns in invasive NTS infections among children aged 6 weeks to 5 years participating in malaria vaccine studies in an area of high malaria and human immunodeficiency virus (HIV) transmission in Siaya, western Kenya. Blood culture was performed in hospitalized children and pediatric outpatients with prolonged fever.
  
  
  RESULTS
  From July 2009 to December 2013, 1696 children aged 6 weeks to 17 months were enrolled into vaccine trials and followed for up to 53 months. We obtained 1692 blood cultures from 847 children. Of 134 bacterial pathogens isolated, 102 (76.1%) were Salmonella serogroup B or D. Invasive NTS disease occurred in 94 (5.5%) children, with an incidence of 1870, 4134, and 6510 episodes per 100 000 person-years overall, in infants, and in HIV-infected children, respectively. Malaria infection within the past 2 weeks occurred in 18.8% (3/16) of invasive NTS episodes in HIV-infected and 66.2% (53/80) in HIV-uninfected children. Case fatality rate was 3.1%. Salmonella group B resistant to ceftriaxone emerged in 2009 and 2010 (6.2% [2/32 isolates]), rising to 56.5% (13/23 isolates) in 2012 and 2013.
  
  
  CONCLUSIONS
  Incidence of invasive NTS disease was high in this area of high malaria and HIV transmission, especially in HIV-infected children. Rapidly emerging resistance against ceftriaxone requires urgent reevaluation of antibiotic recommendations and primary prevention of exposure to Salmonella.
authors.affiliation: Kenya Medical Research Institute/Centre for Global Health Research, Kisumu.
authors.forename: Martina
authors.initials: M
authors.lastname: Oneko
authors.affiliation: Kenya Medical Research Institute/Centre for Global Health Research, Kisumu.
authors.forename: Simon
authors.initials: S
authors.lastname: Kariuki
authors.affiliation: Kenya Medical Research Institute/Centre for Global Health Research, Kisumu.
authors.forename: Vincent
authors.initials: V
authors.lastname: Muturi-Kioi
authors.affiliation: Kenya Medical Research Institute/Centre for Global Health Research, Kisumu.
authors.forename: Kephas
authors.initials: K
authors.lastname: Otieno
authors.affiliation: Kenya Medical Research Institute/Centre for Global Health Research, Kisumu.
authors.forename: Vincent O
authors.initials: VO
authors.lastname: Otieno
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: John M
authors.initials: JM
authors.lastname: Williamson
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jason
authors.initials: J
authors.lastname: Folster
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Michele B
authors.initials: MB
authors.lastname: Parsons
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Laurence
authors.initials: L
authors.lastname: Slutsker
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Mahon
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Hamel
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D002443:Ceftriaxone / Q000494:pharmacology; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000382:microbiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008288:Malaria; D008297:Male; D010045:Outpatients / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D012480:Salmonella Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D019779:Salmonella enterica / Q000187:drug effects*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone
keywords: HIV; invasive; malaria; multidrug resistant; nontyphoidal Salmonella