Exploration of risk factors for ceftriaxone resistance in invasive non-typhoidal Salmonella infections in western Kenya.
Multidrug-resistant non-typhoidal Salmonella (NTS) infection has emerged as a prominent cause of invasive infections in Africa. We investigated the prevalence of ceftriaxone-resistant invasive NTS infections, conducted exploratory analysis of risk factors for resistance, and described antimicrobial...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2020-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0229581 |
| _version_ | 1818916859666235392 |
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| author | Ulzii-Orshikh Luvsansharav James Wakhungu Julian Grass Martina Oneko Von Nguyen Godfrey Bigogo Eric Ogola Allan Audi Dickens Onyango Mary J Hamel Joel M Montgomery Patricia I Fields Barbara E Mahon |
| author_facet | Ulzii-Orshikh Luvsansharav James Wakhungu Julian Grass Martina Oneko Von Nguyen Godfrey Bigogo Eric Ogola Allan Audi Dickens Onyango Mary J Hamel Joel M Montgomery Patricia I Fields Barbara E Mahon |
| author_sort | Ulzii-Orshikh Luvsansharav |
| collection | DOAJ |
| description | Multidrug-resistant non-typhoidal Salmonella (NTS) infection has emerged as a prominent cause of invasive infections in Africa. We investigated the prevalence of ceftriaxone-resistant invasive NTS infections, conducted exploratory analysis of risk factors for resistance, and described antimicrobial use in western Kenya. We conducted a secondary analysis of existing laboratory, epidemiology, and clinical data from three independent projects, a malaria vaccine trial, a central nervous system (CNS) study, and the International Emerging Infections Program morbidity surveillance (surveillance program) during 2009-2014. We calculated odds ratios (OR) with 95% confidence intervals (CI) for ceftriaxone-resistant NTS infections compared with ceftriaxone-susceptible infections. We surveyed hospitals, pharmacies, and animal drug retailers about the availability and use of antimicrobials. In total, 286 invasive NTS infections were identified in the three projects; 43 NTS isolates were ceftriaxone-resistant. The absolute prevalence of ceftriaxone resistance varied among these methodologically diverse projects, with 18% (16/90) of isolates resistant to ceftriaxone in the vaccine trial, 89% (16/18) in the CNS study, and 6% (11/178) in the surveillance program. Invasive ceftriaxone-resistant infections increased over time. Most ceftriaxone-resistant isolates were co-resistant to multiple other antimicrobials. Having an HIV-positive mother (OR = 3.7; CI = 1.2-11.4) and taking trimethoprim-sulfamethoxazole for the current illness (OR = 9.6, CI = 1.2-78.9) were significantly associated with acquiring ceftriaxone-resistant invasive NTS infection. Ceftriaxone and other antibiotics were widely prescribed; multiple issues related to prescription practices and misuse were identified. In summary, ceftriaxone-resistant invasive NTS infection is increasing and limiting treatment options for serious infections. Efforts are ongoing to address the urgent need for improved microbiologic diagnostic capacity and an antimicrobial surveillance system in Kenya. |
| first_indexed | 2024-12-20T00:24:52Z |
| format | Article |
| id | doaj.art-ca03d7a9aa8348439d8ebf55fd9a0f8a |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-20T00:24:52Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-ca03d7a9aa8348439d8ebf55fd9a0f8a2022-12-21T20:00:06ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01153e022958110.1371/journal.pone.0229581Exploration of risk factors for ceftriaxone resistance in invasive non-typhoidal Salmonella infections in western Kenya.Ulzii-Orshikh LuvsansharavJames WakhunguJulian GrassMartina OnekoVon NguyenGodfrey BigogoEric OgolaAllan AudiDickens OnyangoMary J HamelJoel M MontgomeryPatricia I FieldsBarbara E MahonMultidrug-resistant non-typhoidal Salmonella (NTS) infection has emerged as a prominent cause of invasive infections in Africa. We investigated the prevalence of ceftriaxone-resistant invasive NTS infections, conducted exploratory analysis of risk factors for resistance, and described antimicrobial use in western Kenya. We conducted a secondary analysis of existing laboratory, epidemiology, and clinical data from three independent projects, a malaria vaccine trial, a central nervous system (CNS) study, and the International Emerging Infections Program morbidity surveillance (surveillance program) during 2009-2014. We calculated odds ratios (OR) with 95% confidence intervals (CI) for ceftriaxone-resistant NTS infections compared with ceftriaxone-susceptible infections. We surveyed hospitals, pharmacies, and animal drug retailers about the availability and use of antimicrobials. In total, 286 invasive NTS infections were identified in the three projects; 43 NTS isolates were ceftriaxone-resistant. The absolute prevalence of ceftriaxone resistance varied among these methodologically diverse projects, with 18% (16/90) of isolates resistant to ceftriaxone in the vaccine trial, 89% (16/18) in the CNS study, and 6% (11/178) in the surveillance program. Invasive ceftriaxone-resistant infections increased over time. Most ceftriaxone-resistant isolates were co-resistant to multiple other antimicrobials. Having an HIV-positive mother (OR = 3.7; CI = 1.2-11.4) and taking trimethoprim-sulfamethoxazole for the current illness (OR = 9.6, CI = 1.2-78.9) were significantly associated with acquiring ceftriaxone-resistant invasive NTS infection. Ceftriaxone and other antibiotics were widely prescribed; multiple issues related to prescription practices and misuse were identified. In summary, ceftriaxone-resistant invasive NTS infection is increasing and limiting treatment options for serious infections. Efforts are ongoing to address the urgent need for improved microbiologic diagnostic capacity and an antimicrobial surveillance system in Kenya.https://doi.org/10.1371/journal.pone.0229581 |
| spellingShingle | Ulzii-Orshikh Luvsansharav James Wakhungu Julian Grass Martina Oneko Von Nguyen Godfrey Bigogo Eric Ogola Allan Audi Dickens Onyango Mary J Hamel Joel M Montgomery Patricia I Fields Barbara E Mahon Exploration of risk factors for ceftriaxone resistance in invasive non-typhoidal Salmonella infections in western Kenya. PLoS ONE |
| title | Exploration of risk factors for ceftriaxone resistance in invasive non-typhoidal Salmonella infections in western Kenya. |
| title_full | Exploration of risk factors for ceftriaxone resistance in invasive non-typhoidal Salmonella infections in western Kenya. |
| title_fullStr | Exploration of risk factors for ceftriaxone resistance in invasive non-typhoidal Salmonella infections in western Kenya. |
| title_full_unstemmed | Exploration of risk factors for ceftriaxone resistance in invasive non-typhoidal Salmonella infections in western Kenya. |
| title_short | Exploration of risk factors for ceftriaxone resistance in invasive non-typhoidal Salmonella infections in western Kenya. |
| title_sort | exploration of risk factors for ceftriaxone resistance in invasive non typhoidal salmonella infections in western kenya |
| url | https://doi.org/10.1371/journal.pone.0229581 |
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