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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
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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

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