# Antimicrobial resistance, characterization, and knowledge practices of Salmonella spp. infection in under-five children with acute gastroenteritis at Levy Mwanawasa University Teaching Hospital, Lusaka Zambia

## TL;DR

This study examines Salmonella infections in young children in Zambia, finding high antibiotic resistance and risk factors like poor water and feeding practices.

## Contribution

The study provides new insights into antimicrobial resistance patterns and risk factors for Salmonella infections in under-five children in Zambia.

## Key findings

- 9.76% of children had Salmonella infections, with 35% of isolates being multidrug resistant.
- High resistance to trimethoprim-sulfamethoxazole was observed.
- Untreated water and poor feeding practices were identified as risk factors.

## Abstract

Salmonella spp. is a major cause of bacterial gastroenteritis worldwide borne from consuming contaminated food or water. The growing incidence of difficult-to-treat Salmonella infections has been heightened by increased AMR due to increased use of antibiotics posing acritical public health challenge.

This was a cross-sectional study involving 205 children with AGE at Levy Mwanawasa University Teaching Hospital in Lusaka Zambia, between September 2020 and February 2021. Stool samples were collected and subjected to standard microbiological testing, serotyping, antimicrobial susceptibility testing and molecular confirmation for Salmonella spp. In addition, a questionnaire was administered to participants’ guardians to determine the level of knowledge and practices towards Salmonella infections. Data analysis was performed using Microsoft Excel, GraphPad Prism and WHONET.

Twenty Salmonella isolates were recovered from the processed stool samples (n = 205), giving a 9.76% prevalence. Out of 20 Salmonella isolates identified, only four were susceptible to all tested antibiotics. Seven isolates (35%) were classified as multidrug resistant. The highest resistance was observed to trimethoprim-sulfamethoxazole (42.9%). Identified risk factors included use of untreated drinking water and suboptimal feeding practices.

The presence of multidrug-resistant Salmonella among paediatric patients highlights the need for strengthened AMR surveillance, antimicrobial stewardship and targeted public health interventions.