Multidrug-resistant bacteria pose a major challenge to the clinical management of infections in resource-poor settings. Although\nnontyphoidal Salmonella (NTS) bacteria cause predominantly enteric self-limiting illness in developed countries, NTS is responsible\nfor a huge burden of life-threatening bloodstream infections in sub-Saharan Africa. Here, we characterized nine S. Typhimurium\nisolates from an outbreak involving patients who initially failed to respond to ceftriaxone treatment at a referral hospital\nin Kenya. These Salmonella enterica serotype Typhimurium isolates were resistant to ampicillin, chloramphenicol,\ncefuroxime, ceftriaxone, aztreonam, cefepime, sulfamethoxazole-trimethoprim, and cefpodoxime. Resistance to -lactams, including\nto ceftriaxone, was associated with carriage of a combination of blaCTX-M-15, blaOXA-1, and blaTEM-1 genes. The genes encoding\nresistance to heavy-metal ions were borne on the novel IncHI2 plasmid pKST313, which also carried a pair of class 1 integrons.\nAll nine isolates formed a single clade within S. Typhimurium ST313, the major clone of an ongoing invasive NTS\nepidemic in the region. This emerging ceftriaxone-resistant clone may pose a major challenge in the management of invasive\nNTS in sub-Saharan Africa.
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