Factors affecting fecal excretion time in pediatric nontyphoid Salmonella infection

Abstract

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.

Keywords: Severity; antibiotics; children; fecal excretion time; non-typhoid salmonella.