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A Multicountry Molecular Analysis of Salmonella enterica Serovar Typhi With Reduced Susceptibility to Ciprofloxacin in Sub-Saharan Africa.

dc.contributor.author Al-Emran, HM
dc.contributor.author Ali, M
dc.contributor.author Baker, S
dc.contributor.author Biggs, HM
dc.contributor.author Bjerregaard-Andersen, M
dc.contributor.author Breiman, RF
dc.contributor.author Clemens, JD
dc.contributor.author Crump, John Andrew
dc.contributor.author Cruz Espinoza, LM
dc.contributor.author Deerin, J
dc.contributor.author Dekker, Denise Myriam
dc.contributor.author Eibach, D
dc.contributor.author Gassama Sow, A
dc.contributor.author Hertz, JT
dc.contributor.author Ibrango, S
dc.contributor.author Im, J
dc.contributor.author Kabore, LP
dc.contributor.author Konings, F
dc.contributor.author Krumkamp, R
dc.contributor.author Løfberg, Sandra Valborg
dc.contributor.author Marks, Florian
dc.contributor.author May, J
dc.contributor.author Meyer, CG
dc.contributor.author Mintz, ED
dc.contributor.author Montgomery, JM
dc.contributor.author Olack, B
dc.contributor.author Pak, GD
dc.contributor.author Panzner, U
dc.contributor.author Park, SE
dc.contributor.author Rabezanahary, H
dc.contributor.author Rakotondrainiarivelo, JP
dc.contributor.author Rakotozandrindrainy, R
dc.contributor.author Raminosoa, TM
dc.contributor.author Razafindrabe, JLT
dc.contributor.author Sampo, E
dc.contributor.author Schütt-Gerowitt, H
dc.contributor.author Soura, Abdramane Bassiahi
dc.contributor.author Tall, A
dc.contributor.author von Kalckreuth, V
dc.contributor.author Warren, M
dc.contributor.author Wierzba, TF
dc.coverage.spatial United States
dc.date.accessioned 2017-03-02T18:57:26Z
dc.date.available 2017-03-02T18:57:26Z
dc.date.issued 2016-03-15
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/26933020
dc.identifier civ788
dc.identifier.uri https://hdl.handle.net/10161/13761
dc.description.abstract BACKGROUND: Salmonella enterica serovar Typhi is a predominant cause of bloodstream infections in sub-Saharan Africa (SSA). Increasing numbers of S. Typhi with resistance to ciprofloxacin have been reported from different parts of the world. However, data from SSA are limited. In this study, we aimed to measure the ciprofloxacin susceptibility of S. Typhi isolated from patients with febrile illness in SSA. METHODS: Febrile patients from 9 sites within 6 countries in SSA with a body temperature of ≥38.0°C were enrolled in this study. Blood samples were obtained for bacterial culture, and Salmonella isolates were identified biochemically and confirmed by multiplex polymerase chain reaction (PCR). Antimicrobial susceptibility of all Salmonella isolates was performed by disk diffusion test, and minimum inhibitory concentrations (MICs) against ciprofloxacin were measured by Etest. All Salmonella isolates with reduced susceptibility to ciprofloxacin (MIC > 0.06 µg/mL) were screened for mutations in quinolone resistance-determining regions in target genes, and the presence of plasmid-mediated quinolone resistance (PMQR) genes was assessed by PCR. RESULTS: A total of 8161 blood cultures were performed, and 100 (1.2%) S. Typhi, 2 (<0.1%) Salmonella enterica serovar Paratyphi A, and 27 (0.3%) nontyphoid Salmonella (NTS) were isolated. Multidrug-resistant S. Typhi were isolated in Kenya (79% [n = 38]) and Tanzania (89% [n = 8]) only. Reduced ciprofloxacin-susceptible (22% [n = 11]) S. Typhi were isolated only in Kenya. Among those 11 isolates, all had a Glu133Gly mutation in the gyrA gene combined with either a gyrA (Ser83Phe) or gyrB mutation (Ser464Phe). One Salmonella Paratyphi A isolate with reduced susceptibility to ciprofloxacin was found in Senegal, with 1 mutation in gyrA (Ser83Phe) and a second mutation in parC (Ser57Phe). Mutations in the parE gene and PMQR genes were not detected in any isolate. CONCLUSIONS: Salmonella Typhi with reduced susceptibility to ciprofloxacin was not distributed homogenously throughout SSA. Its prevalence was very high in Kenya, and was not observed in other study countries. Continuous monitoring of antimicrobial susceptibility is required to follow the potential spread of antimicrobial-resistant isolates throughout SSA.
dc.language eng
dc.relation.ispartof Clin Infect Dis
dc.relation.isversionof 10.1093/cid/civ788
dc.subject S. Typhi
dc.subject ciprofloxacin
dc.subject sub-Saharan Africa
dc.subject susceptible
dc.subject Adolescent
dc.subject Adult
dc.subject Africa South of the Sahara
dc.subject Anti-Bacterial Agents
dc.subject Child
dc.subject Child, Preschool
dc.subject Ciprofloxacin
dc.subject Drug Resistance, Bacterial
dc.subject Female
dc.subject Humans
dc.subject Infant
dc.subject Male
dc.subject Microbial Sensitivity Tests
dc.subject Molecular Epidemiology
dc.subject Salmonella typhi
dc.subject Typhoid Fever
dc.subject Young Adult
dc.title A Multicountry Molecular Analysis of Salmonella enterica Serovar Typhi With Reduced Susceptibility to Ciprofloxacin in Sub-Saharan Africa.
dc.type Journal article
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/26933020
pubs.begin-page S42
pubs.end-page S46
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Infectious Diseases
pubs.organisational-group Pathology
pubs.organisational-group School of Medicine
pubs.organisational-group Surgery
pubs.organisational-group Surgery, Emergency Medicine
pubs.publication-status Published
pubs.volume 62 Suppl 1
dc.identifier.eissn 1537-6591


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