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Background  The Global Enteric Multicenter Study (GEMS) determined the etiologic agents of moderate-to-severe diarrhea (MSD) in children under 5 years old in Africa and Asia. Here, we describe the prevalence and antimicrobial susceptibility of nontyphoidal  Salmonella  (NTS) serovars in GEMS and examine the phylogenetics of  Salmonella  Typhimurium ST313 isolates.    Methods   Salmonella  isolated from children with MSD or diarrhea-free controls were identified by classical clinical microbiology and serotyped using antisera and/or whole-genome sequence data. We evaluated antimicrobial susceptibility using the Kirby-Bauer disk-diffusion method.  Salmonella  Typhimurium sequence types were determined using multi-locus sequence typing, and whole-genome sequencing was performed to assess the phylogeny of ST313.    Results  Of 370  Salmonella- positive individuals, 190 (51.4%) were MSD cases and 180 (48.6%) were diarrhea-free controls. The most frequent  Salmonella  serovars identified were  Salmonella  Typhimurium, serogroup O:8 (C 2 -C 3 ), serogroup O:6,7 (C 1 ),  Salmonella  Paratyphi B Java, and serogroup O:4 (B). The prevalence of NTS was low but similar across sites, regardless of age, and was similar among both cases and controls except in Kenya, where  Salmonella  Typhimurium was more commonly associated with cases than controls. Phylogenetic analysis showed that these  Salmonella  Typhimurium isolates, all ST313, were highly genetically related to isolates from controls. Generally,  Salmonella  isolates from Asia were resistant to ciprofloxacin and ceftriaxone, but African isolates were susceptible to these antibiotics.    Conclusions  Our data confirm that NTS is prevalent, albeit at low levels, in Africa and South Asia. Our findings provide further evidence that multidrug-resistant  Salmonella  Typhimurium ST313 can be carried asymptomatically by humans in sub-Saharan Africa.

Characteristics ofSalmonellaRecovered From Stools of Children Enrolled in the Global Enteric Multicenter Study