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Multiresistant Salmonella typhimurium systemic infection in Rwanda. Clinical features and treatment with cefotaxime
P Lepage1, J Bogaerts, C Van Goethem
1Department of Paediatrics, Centre Hospitalier de Kigali, Rwanda.
Abstract:
Children with multiresistant Salmonella typhimurium (MRST) systemic infections, in total 246, were diagnosed during the study period. Of these, 220 had MRST without metastatic focal infections and 26 had metastatic focal infections (including 12 patients with meningitis). The median age of the children was 10 months. Diarrhoeal disease, measles and severe malnutrition were the most frequent causes of admission. Fever was found in 99% and diarrhoea in 72% of the patients, with respiratory symptoms in 72%. In 199 (81%) of the patients, the MRST infection was considered to be hospital-acquired. Of the 246 children, 159 were treated with cefotaxime. In this group, 16 of 152 patients died (10.5%). However, of the 87 children who did not receive cefotaxime, 64 died (74%). Relapses occurred in 4% of the patients with bacteraemia treated with cefotaxime. Our study confirms the high efficiency of cefotaxime in treating severe systemic infections with MRST.
Insights
Cefotaxime significantly reduces mortality in children with multiresistant Salmonella typhimurium (MRST) systemic infections. This antibiotic proved highly effective, lowering death rates from 74% to 10.5% in a hospital-acquired infection study.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Resistance
- Hospital-Acquired Infections
Background:
- Multiresistant Salmonella typhimurium (MRST) poses a significant threat to pediatric populations, particularly in hospital settings.
- Systemic MRST infections, including metastatic focal infections like meningitis, are associated with high morbidity and mortality.
- Commonly observed comorbidities include diarrheal disease, measles, and severe malnutrition, complicating treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of cefotaxime in treating severe systemic infections caused by multiresistant Salmonella typhimurium (MRST) in children.
- To compare mortality rates between children treated with and without cefotaxime.
- To assess the incidence of relapses in patients receiving cefotaxime.
Main Methods:
- A retrospective analysis of 246 children diagnosed with systemic MRST infections.
- Categorization of patients based on the presence of metastatic focal infections.
- Comparison of outcomes (mortality, relapse rates) between children treated with cefotaxime and those who did not receive the antibiotic.
Main Results:
- Of 246 children with MRST infections, 199 (81%) acquired the infection in the hospital.
- Children treated with cefotaxime had a significantly lower mortality rate (10.5%) compared to those not treated (74%).
- Relapse rates were low (4%) in patients with bacteremia treated with cefotaxime.
Conclusions:
- Cefotaxime demonstrates high efficacy in treating severe systemic MRST infections in children.
- Early administration of cefotaxime is crucial for reducing mortality associated with these infections.
- The study underscores the importance of effective antibiotic stewardship in managing hospital-acquired MRST infections.