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Salmonella infections in infants in Hawaii
1Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu.
Insights
Salmonella infections in infants rarely lead to serious complications. Clinical risk factors for sepsis, not the infection itself, should guide antibiotic treatment decisions in infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Salmonella gastroenteritis is a common infant infection.
- Concerns exist regarding potential complications like bacteremia and sepsis.
- The necessity of antibiotic treatment for infant Salmonella infections is debated.
Purpose of the Study:
- To evaluate the incidence of bacteremia and serious complications in infants hospitalized with Salmonella infections.
- To determine if antibiotic treatment impacts complication rates.
- To assess the applicability of general sepsis risk factors to Salmonella cases in infants.
Main Methods:
- Retrospective cohort study of 117 infants hospitalized with Salmonella infections over 10 years.
- Analysis of clinical data, including presence of bacteremia, concurrent infections, and serious complications.
- Review of antibiotic usage and its correlation with outcomes.
Main Results:
- Only 12 out of 117 infants experienced bacteremia or complications.
- Serious complications were infrequent and primarily occurred in infants with pre-existing chronic illnesses or obvious extraintestinal infections.
- Antibiotics did not demonstrate a clear benefit in reducing complication frequency, though the study was limited by sample size.
Conclusions:
- Infants with Salmonella gastroenteritis are not at an inherently increased risk of complications.
- Clinical risk factors for sepsis in general infant populations are also relevant for Salmonella cases.
- Antibiotic treatment decisions should be based on individual clinical presentation and risk factors, not solely on the diagnosis of Salmonella gastroenteritis.
Abstract:
In a 10-year cohort of 117 infants hospitalized in Honolulu with Salmonella infections, there were 12 infants with bacteremia or complications (simple bacteremia, 7; bacteremia with probably unrelated concurrent infection, 2; serious complications, 3). The rate of serious complications in this cohort was low and occurred only in infants with previous chronic illness or clinically obvious extraintestinal infection at the time of presentation. Antibiotics were not shown to be of benefit in reducing the frequency of complications; however, the sample size was too small to make definitive conclusions. These data do not support the contention that infants with Salmonella gastroenteritis are at increased risk of complications and should therefore be treated with antibiotics. Rather, the same clinical risk factors for sepsis that apply to all infants also apply to infants with Salmonella gastroenteritis and the decision to begin antibiotic treatment should be based on similar clinical information.