title: Invasive Salmonella Infections at Multiple Surveillance Sites in the Democratic Republic of the Congo, 2011-2014.
abstract: BACKGROUND
  This study reports the microbiological landscape of Salmonella Typhi and invasive nontyphoidal Salmonella (iNTS) in the Democratic Republic of the Congo (DRC).
  
  
  METHODS
  Blood cultures obtained from hospital-admitted patients suspected of bloodstream infection (BSI) in 4 of 11 provinces in DRC (Kinshasa, Bas-Congo, Equateur, and Orientale) were processed. Sampling had started in 2007; the results for the period 2011-2014 are reported.
  
  
  RESULTS
  Salmonella Typhi and iNTS were cultured from 194 (1.4%) and 840 (5.9%), respectively, of 14,110 BSI episodes and ranked first among BSI pathogens in adults (65/300 [21.7%]) and children (783/1901 [41.2%]), respectively. A total of 948 of 1034 (91.7%) isolates were available for analysis (164 Salmonella Typhi and 784 iNTS). Salmonella Typhimurium and Salmonella Enteritidis represented 386 (49.2%) and 391 (49.9%), respectively, of iNTS isolates, fluctuating over time and geography and increasing during the rainy season. Adults accounted for <5% of iNTS BSI episodes. Children <5 years accounted for 20.3% of Salmonella Typhi BSI episodes. Among Salmonella Typhi, rates of multidrug resistance and decreased ciprofloxacin susceptibility (DCS) were 37.8% and 37.2%, respectively, and 18.3% displayed combined multidrug resistance and DCS; rates of azithromycin and ceftriaxone resistance were 0.6% and absent, respectively. Among NTS isolates, ≥80% (79.7% of Salmonella Enteritidis and 90.2% of Salmonella Typhimurium isolates) showed multidrug resistance, and <2.5% showed DCS. Combined extended-spectrum β-lactamase production (blaTEM-1 gene) and azithromycin resistance was noted in 12.7% of Salmonella Typhimurium isolates, appearing in Bas-Congo from 2013 onward.
  
  
  CONCLUSIONS
  Salmonella Typhi and NTS are major causes of BSI in DRC; their antimicrobial resistance is increasing.
authors.affiliation: Department of Clinical Microbiology, National Institute for Biomedical Research Department of Microbiology, University Hospital of Kinshasa, Democratic Republic of the Congo.
authors.forename: Lisette Mbuyi
authors.initials: LM
authors.lastname: Kalonji
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Annelies
authors.initials: A
authors.lastname: Post
authors.affiliation: Department of Clinical Microbiology, National Institute for Biomedical Research Department of Microbiology, University Hospital of Kinshasa, Democratic Republic of the Congo.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Phoba
authors.affiliation: Department of Pediatrics, University Hospital of Kisangani, Democratic Republic of the Congo.
authors.forename: Dadi
authors.initials: D
authors.lastname: Falay
authors.affiliation: Department of Pediatrics, University Hospital of Kisangani, Democratic Republic of the Congo.
authors.forename: Dauly
authors.initials: D
authors.lastname: Ngbonda
authors.affiliation: Department of Clinical Microbiology, National Institute for Biomedical Research Department of Microbiology, University Hospital of Kinshasa, Democratic Republic of the Congo.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Muyembe
authors.affiliation: Belgian National Centre for Salmonella, Scientific Institute of Public Health, Brussels.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bertrand
authors.affiliation: Belgian National Centre for Salmonella, Scientific Institute of Public Health, Brussels.
authors.forename: Pieter-Jan
authors.initials: PJ
authors.lastname: Ceyssens
authors.affiliation: Belgian National Centre for Salmonella, Scientific Institute of Public Health, Brussels.
authors.forename: Wesley
authors.initials: W
authors.lastname: Mattheus
authors.affiliation: Department of Microbiology and Immunology.
authors.forename: Jan
authors.initials: J
authors.lastname: Verhaegen
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Barbara
authors.initials: B
authors.lastname: Barbé
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Laura
authors.initials: L
authors.lastname: Kuijpers
authors.affiliation: Department of Pediatrics Department of Cardiovascular Sciences, KU Leuven, Belgium.
authors.forename: Chris
authors.initials: C
authors.lastname: Van Geet
authors.affiliation: Department of Clinical Microbiology, National Institute for Biomedical Research Department of Microbiology, University Hospital of Kinshasa, Democratic Republic of the Congo.
authors.forename: Octavie
authors.initials: O
authors.lastname: Lunguya
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium Department of Microbiology and Immunology.
authors.forename: Jan
authors.initials: J
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D017963:Azithromycin / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000494:pharmacology; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012475:Salmonella / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D012480:Salmonella Infections / Q000453:epidemiology* / Q000382:microbiology*; D012477:Salmonella enteritidis / Q000187:drug effects / Q000302:isolation & purification; D012485:Salmonella typhi / Q000187:drug effects / Q000302:isolation & purification; D012486:Salmonella typhimurium / Q000187:drug effects / Q000302:isolation & purification; D012621:Seasons; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D017963:Azithromycin; D001618:beta-Lactamases
keywords: Salmonella Typhi; antibiotic resistance; bloodstream infection; nontyphoidal Salmonella