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Published on: August 11, 2014
Factors affecting fecal excretion time in pediatric nontyphoid Salmonella infection
Pei-Yu Ho1, Wan-Ling Chen2, Ming-Fang Cheng3
1Department of Pediatrics, Kaohsiung Veterans General Hospital Tainan Branch, Taiwan; Institute of Biotechnology and Chemical Engineering, I-Shou University, Taiwan.
Insights
Inappropriate antibiotic use and low hemoglobin levels prolong Salmonella shedding in children. Appropriate antibiotics do not affect shedding time, highlighting the need for careful antibiotic selection in pediatric cases.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Pharmacology
Background:
- Nontyphoid Salmonella infections are common in children.
- Fecal excretion time varies and can be influenced by treatment.
- Understanding factors prolonging Salmonella shedding is crucial for public health.
Purpose of the Study:
- To determine if appropriate antibiotic therapy impacts fecal excretion time in pediatric salmonellosis.
- To identify factors associated with prolonged fecal excretion of nontyphoid Salmonella in children.
Main Methods:
- A cohort of 126 children with nontyphoid salmonellosis was studied.
- Patients were categorized by disease severity and antibiotic therapy appropriateness.
- Fecal excretion time was monitored via serial stool cultures; regression analysis identified influencing factors.
Main Results:
- Mean fecal excretion time was 12.17 days.
- Appropriate antibiotic therapy showed no significant difference in excretion time compared to no antibiotics.
- Inappropriate antibiotic therapy, age <1 year, elevated white blood cell count, and decreased hemoglobin prolonged fecal excretion.
Conclusions:
- Inappropriate antibiotic therapy and decreased hemoglobin significantly prolong fecal excretion time in pediatric nontyphoid salmonellosis.
- Appropriate antibiotic therapy does not affect fecal excretion duration.
- Judicious antibiotic use and monitoring resistance are essential in managing pediatric Salmonella infections.
Background:
This study investigated whether the appropriate antibiotics therapy affects the fecal excretion time in pediatric salmonellosis of different severities and explored the factors associated with the fecal excretion time of nontyphoid Salmonella.
Methods:
Between 2012 and 2017, admitted children with nontyphoid salmonellosis who consented to receive consecutive stool cultures every 4-7 days until 2 consecutive negative results were obtained were enrolled. Patients were stratified into no, appropriate (bacteremia or severe patients receiving antibiotics active in vitro), and inappropriate antibiotics (patients with mild or moderate severity receiving antibiotics or severe receiving antibiotics resistant in vitro) therapy groups. A previously proposed severity score was used to classify the patients into severe, moderate, and mild severity classes. The demographics, clinical manifestations, laboratory data and severity were compared among the groups. To explore the factors associated with the fecal excretion time of nontyphoid Salmonella, univariate and multivariate analyses were performed using linear regression analysis.
Results:
This study enrolled 126 children with nontyphoid salmonellosis; 58 and 18 in the mild and severe classes, respectively. The no, appropriate and inappropriate antibiotics therapy groups comprised 69, 24 and 33 patients, respectively. The mean fecal excretion time was 12.17 days. The appropriate antibiotics therapy group had comparable fecal excretion time with that of no antibiotics group. Age <1 year, increased white blood cell count, decreased hemoglobin, and inappropriate antibiotics therapy significantly prolonged fecal excretion time in univariate analysis (p < 0.05). The multivariate analysis showed that inappropriate antibiotics therapy and decreased hemoglobin significantly prolonged the fecal excretion time.
Conclusion:
Inappropriate antibiotics therapy and decreased hemoglobin prolong the fecal excretion time of nontyphoid Salmonella, whereas appropriate antibiotics therapy does not. Continuous monitoring of antibiotic resistance and judicious use of antibiotics in children with nontyphoid salmonellosis are necessary.
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