Non-typhoid Salmonella contributes to gastrointestinal infections in Morogoro: Evidence from patients attending Morogoro regional referral hospital in Tanzania.

Introduction: Salmonella is one of the most common causes of food-borne outbreaks and infection worldwide. Non-typhoid Salmonella (NTS) infections are common and remain a significant public health problem among important bacterial foodborne diseases. The current study aimed to establish the Non typhoid Salmonella infection and antimicrobial resistance status among selected patients at Morogoro Regional Referral Hospital (MRRH), Morogoro Region, Tanzania, to inform clinical care management and public health interventions. Methodology: A cross-sectional study was conducted using medical records and samples were collected from hospitalised and outpatients between October and December 2021. A total of 153 participants were enrolled in the study and 132 consented to being sampled. The collected samples were analysed using standard microbiological techniques. The isolates were subjected to molecular genotyping, where Polymerase Chain Reaction (PCR) was performed targeting the 16S rDNA gene. PCR products were then submitted for sequencing to establish phylogenetic relatedness. Results: The phylogenetic analysis identified two Salmonella serovars; Salmonella Enteritidis and Salmonella Typhimurium. The isolates were from four adults and seven children patients. The isolates were tested against six antimicrobial agents: tetracycline, trimethoprim, gentamycin, ciprofloxacin, ampicillin and cefotaxime. Further antimicrobial assays were performed by screening 10 antimicrobial resistance genes using PCR. Overall, the highest resistance was observed in ampicillin (100%), whereas the lowest resistance was recorded for ciprofloxacin and gentamicin (9.1%). In addition, four (36.4%) of the isolates were resistant to cefotaxime and three (27.3%) to tetracycline and trimethoprim. The isolates also exhibit the presence of resistance genes for sulfamethoxazole 1&2, tetracycline (tet) A&B, Beta-lactamaseCTXM, Beta-lactamaseTEM, Beta-lactamaseSHV, Gentamycine, Acra and acc3-1 in different occurrences. In conclusion, the overall prevalence of Salmonella species in Morogoro region was 8.3% (11/132) with Salmonella Enteritidis and Salmonella Typhimurium being the only serovars detected from adults and children stool samples. Conclusion: Our investigation showed that both children and adults had been exposed to Salmonella spp. However, the occurrence of NTS was higher in children (5.3% (7/132) compared to adults (3.0% (4/132). To stop zoonotic infections and the development of antimicrobial resistance in the community, this calls for Infection Prevention and Control (IPC) and stewardship programmes on rational use of antimicrobials in both health facilities and at the community level. Author summary: Typhoid fever is claimed to prevail in Morogoro region. Most patients with stomach pain and or diarrhoea go for a diagnosis of typhoid despite the existence of other etiological agents causing the same clinical signs. Sample culture and isolation of bacteria have been a gold-standard method for the detection of disease-causing agents. However, this approach is rarely made by most hospitals, with the exception of regional and district hospitals in the public sector and big hospitals in the private sector. They always rely on the widal test, which suffers from significant limitations in its sensitivity and specificity. It is, therefore, difficult to identify appropriate etiological agents and assess their susceptibility to antimicrobials. Because of that, the contribution of non-typhoid salmonellosis is not featured. The authors have assessed the occurrence of non-typhoid Salmonella in hospitalized and outpatients of all age groups at Morogoro Regional Hospital as a modal to establish its contribution to gastrointestinal infections in the region through both conventional and molecular approaches. It was observed that the infection rate was high in children, and the no-typhoid Salmonella serovars had considerable resistance to the commonly used antimicrobial. This calls for further surveillance of these neglected non-typhoid salmonella in clinical settings [ABSTRACT FROM AUTHOR]