Comparative genomic and phenotypic characterization of invasive non-typhoidal Salmonella isolates from Siaya, Kenya

Non-typhoidal Salmonella (NTS) is a major global health concern that often causes bloodstream infections in areas of the world affected by malnutrition and comorbidities such as HIV and malaria. Developing a strategy to control the emergence and spread of highly invasive and antimicrobial resistant NTS isolates requires a comprehensive analysis of epidemiological factors and molecular pathogenesis. Here, we characterize 11 NTS isolates that caused bloodstream infections in pediatric patients in Siaya, Kenya from 2003-2010. Nine isolates were identified as S. Typhimurium sequence type 313 while the other two were S. Enteritidis. Comprehensive genotypic and phenotypic analyses were performed to compare these isolates to those previously identified in sub-Saharan Africa. We identified a S. Typhimurium isolate referred to as UGA14 that displayed novel plasmid, pseudogene and resistance features as compared to other isolates reported from Africa. Notably, UGA14 is able to ferment both lactose and sucrose due to the acquisition of insertion elements on the pKST313 plasmid. These findings show for the first time the co-evolution of plasmid-mediated lactose and sucrose metabolism along with cephalosporin resistance in NTS further elucidating the evolutionary mechanisms of invasive NTS phenotypes. These results further support the use of combined genomic and phenotypic approaches to detect and characterize atypical NTS isolates in order to advance biosurveillance efforts that inform countermeasures aimed at controlling invasive and antimicrobial resistant NTS. Author summary Non-typhoidal Salmonella (NTS) has been associated with life-threatening bacteremia in sub-Saharan Africa where co-morbidities such as HIV and malaria are highly prevalent. Children under the age of 5 are especially vulnerable to invasive NTS infections. The emergence and spread of multi-drug resistant invasive NTS isolates have limited the availability of effective treatment options. Understanding the molecular mechanisms that drive the evolution of invasive and antimicrobial resistant NTS strains is key to mitigating their impact on human health. In this study, we obtained 11 NTS isolates from the bloodstreams of children in Siaya, Kenya and performed both genotypic and phenotypic characterization compared to antimicrobial sensitive NTS strains. One strain, named UGA14, displayed a unique plasmid makeup compared to the other 10 isolates, which encoded for cephalosporin resistance as well as novel metabolic features allowing it to metabolize both lactose and sucrose. Not only was UGA14 multi-drug resistant but its unique metabolic profile made it indistinguishable from Escherichia coli on brilliant green agar indicating the failure of traditional culture-based techniques to inform diagnose and treatment decisions. These findings highlight the importance of comparative genotypic and phenotypic analyses to understand the driving mechanisms of invasive and drug-resistant pathogens and support the development of effective countermeasures.