Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-08T00:38:09.323Z Has data issue: false hasContentIssue false
  • English
  • Français

Salmonella and Shigella Gastroenteritis at a Public Teaching Hospital in Nairobi, Kenya

Published online by Cambridge University Press:  21 June 2016

S. Paton ,
L. Nicolle ,
M. Mwongera ,
P. Kabiru ,
N. Mirza ,
F. Plummer  and
I. Wamola
S. Paton
Affiliation:
departments of Medical Microbiology, University of Manitoba, Winnepeg, Canada
L. Nicolle*
Affiliation:
departments of Medical Microbiology, University of Manitoba, Winnepeg, Canada Internal Medicine, University of Manitoba, Winnepeg, Canada
M. Mwongera
Affiliation:
Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
P. Kabiru
Affiliation:
Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
N. Mirza
Affiliation:
Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
F. Plummer
Affiliation:
departments of Medical Microbiology, University of Manitoba, Winnepeg, Canada Internal Medicine, University of Manitoba, Winnepeg, Canada Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
I. Wamola
Affiliation:
Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
*
Health Sciences Centre, MS675D-820 Sherbrook St., Winnipeg, Manitoba R3A lR9
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To measure the proportion of nosocomial diarrhea cases associated with Salmonella and Shigella species.

Design:

Prospective 6-month survey.

Setting:

Tertiary care center in a developing country.

Patient:

Pediatric and adult patients admitted within the previous 24 hours and all consenting adult or pediatric medical patients with nosocomial diarrhea.

Outcome Measures:

Prevalence of Salmonella and Shigella species isolated from rectal swabs at admission and among subjects with nosocomial diarrhea.

Results:

Salmonella species and Shigella species were isolated from 3.0% and 2.5%, respectively, of 667 patients screened on admission. All admission Salmonella isolates were identified in children under 13 years of age; Shigella prevalence was similar for children and adults. Children with Salmonella at admission were significantly older and more likely to have diarrhea, fever, and some indicators of malnutrition than those from whom Salmonella was not isolated. Salmonella and Shigella were isolated from rectal cultures in 36 (10%) and 9 (2.5%) of 360 nosocomial gastroenteritis cases, respectively. Nosocomial cases occurred equally in adults and children. In adults, nosocomial Salmonella acquisition was associated with sharing a room with a diarrhea patient and previous institutionalization. In children, it was associated with recent antimicrobial therapy, crowding at home, and age between 6 months and 6 years. Nine (41%) of 22 nosocomial Salmonella cases in adults occurred in patients with human immunodeficiency virus-type 1 (HIV-1) infection, while none of 79 HIV-1-positive patients had Salmonella isolated at admission.

Conclusions:

Salmonella is a frequent cause of nosocomial gastroenteritis in this tertiary care institution in a developing country Risk factors appear to differ for children and adults, and HIV-1-infected subjects may be at increased risk of acquisition. Control measures feasible for the limited resources available to such institutions require evaluation.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 12 , Issue 12 , December 1991 , pp. 710 - 717
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Joseph, CA, Palmer, SR. Outbreaks of Salmonella infection in hospitals in England and Wales, 1978-1987. Br Med J. 1989;298:1161–1164.Google Scholar
2. Weikel, CS, Guerrant, RL. Nosocomial salmonellosis. Infect Control. 1985;6:218–219.Google Scholar
3. Riley, LW, Ceballos, BSD, Trabulsi, LR, de Toledo, MRF, Blake, PA. The significance of hospitals as reservoirs for endemic multiresistant Salmonella typhimurium causing infection in urban Brazilian children.] Infect Dis. 1984;150:236–241.Google Scholar
4. Nesbitt, A, Mirza, NB. Salmonella septicaemias in Kenyan children.] Trop Pediatr. 1989;35:35–39.CrossRefGoogle ScholarPubMed
5. Cohen, ML, Tauxe, RV. Drug-resistant Sulmonella in the United States: an epidemiologic perspective. Science. 1986;234:964–969.Google Scholar
6. Hamill, PV, Drized, TA, Johnson, CL, Reed, RB, Rocte, AF, Moore, WM. Physical growth: National Centre for Health Statistics percentiles. Am J Clin Nutr. 1979;32:607–629.CrossRefGoogle ScholarPubMed
7. Merritt, RJ, Blackburn, Gl. Nutritional assessment and metabolic response to illness of the hospitalized child. In: Susskind, RM, ed. Textbook of Pediatric Nutrition. New York, NY: Raven Press; 1981;110–122.Google Scholar
8. Kelly, MT Brenner, DJ, Farmer, JJ III. Enterobacteriaceae. In: Lennette, EH, ed. Manual of Clinical Microbiology. 4th ed. Washington DC: American Society of Microbiology; 1985:263–277.Google Scholar
9. Barry, AL, Thomsberry, C. Susceptibility tests: diffision test procedures. In: Lennette, EH, Balows, A, Hausler, WJ Jr Sadomy, HJ, eds. Manual of Clinical Microbiology. 4th ed. Washington DC: American Society of Microbiology; 1985:978–987.Google Scholar
10. Gilligan, PH. Diarrheal disease in the hospitalized patient. Infect Control. 1986;7:607–609.CrossRefGoogle ScholarPubMed
11. Goldbert, MB, Rubin, RH. The spectrum of Salmonella infection. Infect Dis Clin North Am. 1988;2:571–598.CrossRefGoogle Scholar
12. DuPont, HL. Shigellu. Infect Dis Clin North Am. 1988;2:599–606.CrossRefGoogle Scholar
13. Sperber, SJ, Schleupner, CJ. Salmonellosis during infection with human immunodeficiency virus. Rev Infect Dis. 1987;9:925–934.Google Scholar
14. Gilks, CF, Brindle, RJ, Otienol, S, et al. Life-threatening bactere mia in HIV-1-seropositive adults admitted to hospital in Nairobi, Kenya. Lancet. 1990;336;545–549.CrossRefGoogle Scholar
15. Buchwald, DS, Blaser, MU. A review of human salmonellosis: II duration of excretion following infection with nontyphi Salmonella . Rev Infect Dis. 1984;6:345–356.Google Scholar
16. McMall, CE, Martin, WT, Boring, JR. Efficiency of cultures of rectal swabs and fecal specimens in detecting Sulmonella carriers: correlations with number of salmonellae excreted. J Hyg (Lond). 1966;64:261–269.Google Scholar
17. Dixon, RE. Costs of nosocomial infections and benefits of infection control programs. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. Baltimore, MD: Williams and Wilkins; 1987:19–25.Google Scholar