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 4e7 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 * Corresponding author. No.386, Dazhong 1st Rd.

Non-Typhoidal Salmonella Infection in Children: Influence of Antibiotic Therapy on Postconvalescent Excretion and Clinical Course—A Systematic Review

“…Ho et al also reported a prolongation of fecal shedding, albeit only in children receiving inappropriate antibiotic treatment defined as either not active in vitro or given to patients without severe disease. They did not observe a prolongation of intestinal NTS excretion after adequate antibiotic therapy (active in vitro or given to patients with a high severity score) or in the group receiving no antibiotics [47].…”

“…Furthermore, 39 articles were excluded for the following reasons: insufficient data, no original articles (reviews or case reports), only adult patients, and/or no systematic consideration of antibiotic therapy. A total of 14 scientific articles published between 1954 and 2021 were subsequently assessed for this review [13,23,31,32,37,[41][42][43][44][45][46][47][48][49].…”

“…In one of the prospective controlled trials, patients with severe enterocolitis were assigned to antibiotic treatment, while the rest received supportive treatment only [48]. A recent prospective case series compared children with appropriate, inappropriate, and no antibiotic treatment [47]. The other articles with an observational study design investigated the influence of antibiotics on the duration of NTS excretion without a randomization between antibiotic treatment and a control group.…”

“…In 13 articles, the duration of excretion was investigated [23,31,32,37,[41][42][43][44][45][47][48][49]. Prolongation of NTS shedding after antibiotic therapy was found in four studies (including 127, 117, 70, and 239 patients, respectively) [32,37,41,49].…”

“…In 1965, Dixon et al published an analysis of two similar outbreaks in schools after food poisoning caused by S. typhimurium [32]. Seven weeks after the outbreak, the percentage of positive fecal samples was 44.8% for children with antibiotic treatment versus only 4.7% for untreated In 13 articles, the duration of excretion was investigated [23,31,32,37,[41][42][43][44][45][47][48][49]. Prolongation of NTS shedding after antibiotic therapy was found in four studies (including 127, 117, 70, and 239 patients, respectively) [32,37,41,49].…”