Extraintestinal salmonellosis in a children's hospital

An increase in the number of patients presenting with extraintestinal salmonellosis has occurred at our institution. The purpose of this study was to review the extraintestinal salmonellosis cases in our institution and to investigate the possible reasons for this increase.

A retrospective review of patients from 1985 through 1996 was carried out to identify patients with extraintestinal infections with Salmonella. Demographic data were gathered and statistical evaluations comparing differences among groups (1985 to 1989, 1989 to 1992, 1993 to 1996) was done using the G statistic, adjusted (maximum likelihood) chi square or the Fisher's exact test.

Thirty-nine patients were identified with extraintestinal salmonellosis and although the number of cases had increased from 8 in 1985 to 1988 to 18 in 1989 to 1992 and 13 from 1993 to 1996, the percentage of cases that were extraintestinal were similar (3.3%, 6%, 4.9%; P > 0.1). Seventy-two percent of patients had underlying risk factors with the most common being age < 3 months (44%), sickle cell anemia (13%) and gastrointestinal surgery (10%). Fever and diarrhea were more common presenting symptoms in patients < 3 months of age than in older patients (P < 0.05). Salmonella typhimurium and Salmonella heidelberg were the most common serotypes isolated and an increasing trend of ampicillin resistance was noted from 0% in 1985 to 1988 to 39% from 1989 to 1992 and 23% from 1993 to 1996.

The reasons for an increasing trend in extraintestinal cases of human salmonellosis at our institution were not identified. This illness continues to occur in infants and children with well-recognized risk factors.