| dc.description.abstract | Salmonella typhimurium infections at Kenyatta National Hospital (KNH) are being isolated more frequently than Salmonella typhi. There has been a persistent rise in the
isolation of S.typhimurium from blood, stools and cerebrospinal fluids (CSF) since 1970, with reports of minor outbreaks in 1972 and 1974. A major outbreak occurred in 1985 which resulted in closure of the paediatric observation wards (POW) the main admission area for children. Renovation measures in POW improved the situation for only a short time. S.typhimurium reappeared soon after reopening these wards. Overcrowding with resultant poor hygiene is one of the contributory factors to infections with S.typhimurium.
Antibiotic resistance pattern of recent S.typhimurium isolates when compared to those isolated in the early 70' s (Table 20), showed an increase in resistance to most antibitics : ampicillin (95%), Tetracycline (56%), cbtrimoxazo1e (83%), kanamycin (53%), gentamicin (32%), streptomycin (95%), sulphafurazole (100%) and chloramphenicol (88%). Only 2% strains were resistant to amikacin and all were sensitive to cefotaxime, the only third generation cephalosporin tested. This reflected the development
of multiple drug resistance in S.typhimurium strains.
S.typhi as compared to S.typhimurium is still sensitive to most of the antibiotics including chloramphenicol.
While chloramphenicol remains the mainstay therapy for S.typhi infections, it cannot be used for the treatment of S.typhimurium infections. It is recommended that
cefotaxime or other third generation cephalosporins would be the drugs of choice for the treatment of lifethreatening infections with S.typhimurium. There is a need to look into cheaper and more effective drugs.
Thirty five strains of S.typhimurium studied for transfer of resistance, showed that they transferred their resistance to a sensitive strain of E.coli K - 12 in the conjuqtion experiments.· Each strain carried multiple plasmids. Further characterization of these
plasmids was not possible due to restricted resources.
S.typhimurium isolated from clinical material from KNH belonged to several different phage-types. Type 56 (29.4%) was most common, followed by 193 (20.5%) and
208(17.6%). Other phage types isolated included 135 (2 strains), 132 (1 strain, 2 (1 strain), 3 aerogenic (1 strain), untypable (5 strains) and RDNC (1 strain).
These phage types did not conform to any particular pattern.
In a 6 month prospective study for nosocomial and community acquired gaptroenteritis a total of eleven hundred patients were screened. Nosocomial gastroenteritis was acquired by 330 (30%) patients.
From 330 nosocomial gastroenteritis cases Salmonella species were isolated from 29 (8.8%) cases out of which 22 (75.9%) were S.typhimurium.
From 770' patients screened on admission with or without diarrhoea, the prevalen~ of rectal carriage of S.typhimurium in the community was 1.2%. The risk of nosocomial gastroenteritis with S.typhimurium was significantly higher than in patients with community acquired infections. There was no age related significant difference in the incidence of nosocomial or prevalence of community acquired gastroenteritis with S.typhimurium, that is nosocomial and community acquired cases occurred equally in children under 5 years of age and those above 5 years.
Of 112 HIV positive patients, 33 developed nosocomial gastroenteritis. S.typhimurium was isolated from 7 (21.2%) of these, while 79 patients did not have Salmonell§..... isolated from their rectal swabs on admission.
In a case control study, 50 cases with S.typhimurium infection were compared with 100 controls matched for age and sex. The results indicated that with S.typhimurium infections, fever was the most commpn presenting complaint (84%), followed by
diarrhoea (56%), malnutrition~(38%), and cough (36%).
A few case's.presented with borie and joint swellings (6%), jaundice (4%) and eNS involvement (2%). The associated risk factors showing significant odds ratios
for S.typhimurium included: residence outside Nairobi (3.14), drinking of untreated water (12.76),use of pit latrines (19.15), presence of domestic animals in the
compound (5.35), chickens (2.84), chickens + cows (3.16) and drinking of untreated cows milk (10.63). Other associated risk factors included illnesses like measles, malnutrition, bronchopneumonia, malignancies, septic arthritis with sickle cell disease
and cardiac problems, which necessitated prolonged stay of the patient in hospital . .... .
Therefore there is an urgent need to set up a surveillance system for early recognition of
S.typhimurium infections in the hospital. That the laboratory should also remain vigilant and provide information early on the development of multiple drug resistance in the pathogens isolated from KNH | en |
| dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
