Epidemiology and Antimicrobial Resistance of Non-Typhoidal Salmonella in Children with Diarrhea in Enugu State: A Multicenter Study

Non-typhoidal Salmonella (NTS) is an underappreciated cause of severe invasive and diarrheal illness in African children, with antimicrobial resistance complicating management in clinical settings. This multicenter analytical cross-sectional study investigated the epidemiology and resistance profiles of NTS among children aged 0 to 15 years with acute diarrhea at four referral hospitals in Enugu State, in the South East geopolitical zone of Nigeria. Stool samples from 400 children were cultured on Salmonella-Shigella agar and XLD agar. Presumptive Salmonella isolates were confirmed by biochemical testing and serotyped by slide agglutination using polyvalent antisera. Antibiotic susceptibility was determined by Kirby-Bauer disc diffusion and minimum inhibitory concentration determination by E-test. NTS was isolated from 8.5 percent of stool samples. Salmonella typhimurium and Salmonella enteritidis were the most prevalent serovars. Ceftriaxone resistance was documented in 32.4 percent of NTS isolates, and fluoroquinolone non-susceptibility in 20.6 percent. Risk factor analysis identified malnutrition, lack of breastfeeding, and animal husbandry in the household as independent predictors of NTS infection. Case fatality among NTS bacteremia co-infections was 15 percent. These data highlight an emerging NTS resistance burden in Enugu State and underscore the urgent need for culture-based diagnosis, serovar surveillance, and rational cephalosporin use in childhood diarrhea management. Keywords: non-typhoidal Salmonella, children, diarrhea, antimicrobial resistance, Enugu.