Search

Background: Non-typhoidal Salmonella (NTS) frequently cause bloodstream infection in children under-five in sub-Saharan Africa, particularly in malaria-endemic areas. Due to increasing drug resistance, NTS are often not covered by standard-of-care empirical antibiotics for severe febrile illness. We developed a clinical prediction model to orient the choice of empirical antibiotics (standard-of-care versus alternative antibiotics) for children admitted to hospital in settings with high proportions of drug-resistant NTS., Methods: Data were collected during a prospective cohort study in children (> 28 days-< 5 years) admitted with severe febrile illness to Kisantu district hospital, DR Congo. The outcome variable was blood culture confirmed NTS bloodstream infection; the comparison group were children without NTS bloodstream infection. Predictors were selected a priori based on systematic literature review. The prediction model was developed with multivariable logistic regression; a simplified scoring system was derived. Internal validation to estimate optimism-corrected performance was performed using bootstrapping and net benefits were calculated to evaluate clinical usefulness., Results: NTS bloodstream infection was diagnosed in 12.7% (295/2327) of enrolled children. The area under the curve was 0.79 (95%CI: 0.76-0.82) for the prediction model, and 0.78 (0.85-0.80) for the scoring system. The estimated calibration slopes were 0.95 (model) and 0.91 (scoring system). At a decision threshold of 20% NTS risk, the prediction model and scoring system had 57% and 53% sensitivity, and 85% specificity. The net benefit for decisions thresholds < 30% ranged from 2.4 to 3.9 per 100 children., Conclusion: The model predicts NTS bloodstream infection and can support the choice of empiric antibiotics to include coverage of drug-resistant NTS, in particular for decision thresholds < 30%. External validation studies are needed to investigate generalizability., Trial Registration: DeNTS study, clinicaltrials.gov: NCT04473768 (registration 16/07/2020) and TreNTS study, clinicaltrials.gov: NCT04850677 (registration 20/04/2021)., Competing Interests: Declarations. Ethics approval and consent to participate: The studies were ethically approved by the Ecole de Santé Public Kinshasa (144/2020, 134/2021), the Institutional Review Board of ITM (1419/20, 1483/21) and the Ethics Committee of Antwerp University (20/37/465, 21/18/236). Written informed consent was given by caretakers of before enrollment. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: As part of the containment of the COVID-19 pandemic, mobile handwashing stations (mHWS) were deployed in healthcare facilities in low-resource settings. We assessed mHWS in hospitals in the Democratic Republic of the Congo for contamination with Gram-negative bacteria., Methods: Water and soap samples of in-use mHWS in hospitals in Kinshasa and Lubumbashi were quantitatively cultured for Gram-negative bacteria which were tested for antibiotic susceptibility. Meropenem resistant isolates were assessed for carbapenemase enzymes using inhibitor-based disk and immunochromatographic tests. Mobile handwashing stations that grew Gram-negative bacteria at counts > 10,000 colony forming units/ml from water or soap were defined as highly contaminated., Results: In 26 hospitals, 281 mHWS were sampled; 92.5% had the "bucket with hand-operated tap" design, 50.5% had soap available. Overall, 70.5% of mHWS grew Gram-negative bacteria; 35.2% (in 21/26 hospitals) were highly contaminated. Isolates from water samples (n = 420) comprised 50.3% Enterobacterales (Klebsiella spp., Citrobacter freundii, Enterobacter cloacae), 14.8% Pseudomonas aeruginosa and 35.0% other non-fermentative Gram-negative bacteria (NFGNB, including Chromobacterium violaceum and Acinetobacter baumannii). Isolates from soap samples (n = 56) comprised Enterobacterales (67.9%, including Pluralibacter gergoviae (n = 13)); P. aeruginosa (n = 12) and other NFGNB (n = 6). Nearly one-third (31.2%, 73/234) of Enterobacterales (water and soap isolates combined) were multi-drug resistant; 13 isolates (5.5%) were meropenem-resistant including 10 New Delhi metallo-beta-lactamase (NDM) producers. Among P. aeruginosa and the other NFGNB, 7/198 (3.5%) isolates were meropenem resistant, 2 were NDM producers. Bacteria listed as critical or high priority on the World Health Organization Bacterial Priority Pathogens List accounted for 20.3% of isolates and were present in 12.0% of all mHWS across 13/26 hospitals. Half (50.5%) of highly contaminated mHWS were used by healthcare workers and patients as well as by caretakers and visitors., Conclusions: More than one third of in-use mobile handwash stations in healthcare facilities in a low resource setting were highly contaminated with clinically relevant bacteria, part of which were multidrug resistant. The findings urge a rethink of the place of mobile handwash stations in healthcare facilities and to consider measures to prevent their contamination., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Institutional Review Board of the Institute of Tropical Medicine, Antwerp, Belgium (1434/20) and the ethics committee of the School of Public Health of the University of Kinshasa, DRC (ESP/CE/208/2020). Written support for the study was granted by the General Health Office of the DRC Ministry of Health. All hospital directors and interviewees provided consent. Results presented were aggregated for all hospitals and no results of individual hospitals were presented. Competing interests: The authors declare no competing interests. Consent for publication: Not Applicable., (© 2024. The Author(s).)