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The Burden and Antibiotic Sensitivity of Salmonella Non-Typhi and Shigella Related Bloody Diarrhea in Children
Abir Rashid Al Sinani1, Tawfiq Taki Al Lawati1, Hajar Musabah Al Saadi1
1Department of Pediatrics, Rustaq Hospital, Rustaq, Oman.
Insights
Non-typhoidal Salmonella (SNT) and Shigella diarrhea are common in children. SNT is sensitive to ceftriaxone and ampicillin, while Shigella shows resistance, necessitating targeted antibiotic treatment based on age and culture results.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Antimicrobial Resistance
Background:
- Diarrheal diseases remain a significant cause of morbidity in children globally.
- Non-typhoidal Salmonella (SNT) and Shigella are common bacterial pathogens causing pediatric diarrhea.
- Understanding local antimicrobial susceptibility patterns is crucial for effective treatment.
Purpose of the Study:
- To determine the frequency of SNT and Shigella diarrhea in children presenting with bloody diarrhea.
- To evaluate the antibiotic sensitivity profiles of SNT and Shigella isolates in this pediatric population.
- To inform empirical treatment guidelines for pediatric bacterial diarrhea.
Main Methods:
- A retrospective study was conducted on children with bloody diarrhea from June 2019 to June 2023.
- Data collected included demographics, symptoms, blood tests, and stool bacterial cultures with antimicrobial sensitivity testing.
- Stool samples were analyzed for Salmonella and Shigella growth.
Main Results:
- Out of 1160 children with diarrhea, 153 (13.2%) had bloody diarrhea. Of these, 92 (60.1%) tested positive for Salmonella or Shigella.
- SNT was identified in 58 children (63.0%) and Shigella in 34 (37.0%). Three children under one year old developed bacteremia.
- SNT showed high sensitivity to ceftriaxone, ampicillin, and ciprofloxacin. Shigella exhibited high resistance to ceftriaxone and ciprofloxacin, with only 46.9% sensitivity to ceftriaxone.
Conclusions:
- Non-typhoidal Salmonella is more prevalent in children under five, while Shigella is more common in older children.
- Salmonella isolates were sensitive to ceftriaxone and ampicillin, whereas Shigella demonstrated significant resistance to ciprofloxacin.
- Empirical treatment with ceftriaxone or ampicillin is recommended for children under one year old; older children require culture-guided therapy due to Shigella's resistance patterns.
Objectives:
We sought to report the frequency of non-typhoidal Salmonella (SNT) and Shigella spp. diarrhea and the antibiotic sensitivity in children.
Methods:
We conducted a retrospective study of children with bloody diarrhea seen at Rustaq Hospital between 1 June 2019 and 31 June 2023. We collected data related to demographic characteristics, symptoms, blood investigations, stool bacterial culture, and antimicrobial sensitivity. Stool samples were tested for Salmonella and Shigella growth.
Results:
Out of 1160 children with diarrhea, 153 (13.2%) had bloody diarrhea of which 129 (84.3%) were under five. Ninety-two (60.1%) children were positive for either Salmonella or Shigella. Among the positive cultures, 58 (63.0%) children had SNT, while 34 (37.0%) had Shigella infection. Three children had bacteremia, all under one year old. SNT demonstrated high sensitivity primarily to ceftriaxone (n = 41; 70.7%), ampicillin (n = 53; 91.4%), and ciprofloxacin (n = 54; 93.1%). In contrast, Shigella showed high resistance to ceftriaxone and only 15 (46.9%) patients showed sensitivity. Additionally, 29 children had Entamoeba histolytica trophozoites co-infection with Salmonella on stool microscopy.
Conclusions:
Salmonella is more prevalent than Shigella in children under five years, while Shigella is more common in children over five. Salmonella is sensitive to both ceftriaxone and ampicillin. Shigella demonstrates resistance to multiple antibiotics, including ciprofloxacin. It is recommended that children under the age of one be admitted and treated empirically with either ceftriaxone or ampicillin. In older children, antibiotic therapy should be guided by stool culture results. Ciprofloxacin is not a good empirical choice for Shigella in our population due to its high resistance and is contraindicated in patients with glucose-6-phosphate dehydrogenase.
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