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Multiply resistant nontyphoidal Salmonella gastroenteritis in children
E Maiorini1, E L Lopez, A L Morrow
1Infectious Diseases Service, Hospital de Niños Dr. Ricardo Gutierrez, Buenos Aires, Argentina.
Insights
Multiply resistant Salmonella gastroenteritis poses a significant pediatric challenge in Buenos Aires. Aggressive Salmonella strains demonstrate widespread antibiotic resistance, necessitating urgent public health attention.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Antimicrobial Resistance
Background:
- Salmonella gastroenteritis is a common childhood illness.
- Multiply resistant Salmonella strains present a growing public health concern, particularly in urban pediatric populations.
- Understanding the epidemiology and resistance patterns of Salmonella is crucial for effective treatment and control.
Purpose of the Study:
- To investigate the clinical characteristics and antimicrobial resistance patterns of multiply resistant Salmonella gastroenteritis in children.
- To identify the most common Salmonella serovars and their resistance profiles.
- To assess the prevalence of complications and mortality associated with these infections.
Main Methods:
- A retrospective study of 75 children diagnosed with multiply resistant Salmonella gastroenteritis between January 1990 and December 1991.
- Data collection included patient demographics, clinical presentation, infection acquisition source, and outcomes.
- Antimicrobial susceptibility testing was performed using minimum inhibitory concentration (MIC) studies for various antibiotics.
Main Results:
- The majority of infections (66.7%) were nosocomially acquired.
- Bloody stools and prolonged fever were common clinical features.
- High rates of resistance were observed against ampicillin, cephalothin, cefuroxime, nalidixic acid, rifampin, gentamicin, and tobramycin.
- Salmonella typhimurium was the predominant serovar (85.3%).
- Complications included enterocolitis, bowel perforation, pulmonary abscess, and bacteremia, with a mortality rate of 5.3%.
Conclusions:
- Multiply resistant Salmonella strains, particularly Salmonella typhimurium, represent a significant and aggressive pediatric problem in Buenos Aires.
- The high prevalence of antimicrobial resistance necessitates careful antibiotic selection and infection control measures.
- Further research into novel therapeutic strategies and preventative measures is warranted.
Abstract:
From January, 1990, to December 31, 1990, 75 children with multiply resistant Salmonella gastroenteritis were studied at the Children's Hospital "Ricardo Gutierrez" of Buenos Aires. These children ranged from 1 month to 15 years of age. Infection was community-acquired in 20 (26.6%), nosocomially acquired in 50 (66.7%) and undetermined in 5. Thirty-nine (52%) had grossly bloody stools. Fever occurred at some point in the clinical course in 61 children (81.3%) with a duration of 1 to 33 days (mean, 6.7 days). The duration of diarrhea (1 to 69 days) was longer in those who developed complications (P < 0.001). Six (8%) developed enterocolitis (2 with bowel perforation), 1 had a pulmonary abscess and 8 (11.4%) had bacteremia; 4 children died (5.3%). Salmonella typhimurium was the most common serovar (85.3%). Ninety percent minimum inhibitory concentration studies demonstrated that all strains were resistant to ampicillin (> 128 micrograms/ml), cephalothin (> 128 micrograms/ml), cefuroxime (> 128 micrograms/ml), nalidixic acid (> 256 micrograms/ml), rifampin (> 256 micrograms/ml), gentamicin (> 256 micrograms/ml) and tobramycin (256 micrograms/ml); 77.3% of strains were resistant to ceftazidime (32 micrograms/ml), 97.6% to netilmicin (> 256 micrograms/ml), 92.8% to amikacin (256 micrograms/ml), 24.4% to isepamicin (32 micrograms/ml), 5.3% to chloramphenicol (4 micrograms/ml) and 2.7% to cefoxitin (2 micrograms/ml). The 90% minimum inhibitory concentration of cefotaxime and ceftazidime was reduced by the addition of clavulanate. Aggressive multiply resistant Salmonella strains are a major pediatric problem in Buenos Aires.