Objective The aim of the study was to investigate whether multi-resistant strains of non-typhoid salmonellosis affect clinical manifestations and outcomes in children.
Methods Between 1996 and 2009, children with nontyphoid salmonellosis admitted to Kaohsiung Veterans General Hospital, Taiwan were enrolled. An organism was considered multi-resistant if resistant to ≥2 agents. Fecal excretion time was defined as the timeframe of the first positive stool culture and the first of two consecutive negative results. The demographic, laboratory data and clinical outcomes were compared between the patients infected with non-typhoid Salmonella susceptible to all antibiotics (susceptible group) and those infected with multi-resistant strains (resistant group).
Results 764 patients were enrolled; 318 were characterized as the susceptible group; 329 were the resistant group. Compared with susceptible group, the patients of resistant group were younger (32.36 vs 23.65 months of age); demonstrated significantly more bloody stool; higher white blood cells; longer total fever days and hospital stay (38.4% vs 49.2%; 9,538 vs 10,205/Cumm; 5.75 vs 6.66 days; 8.38 vs 9.49 days, respectively). However, there were no statistically significant differences in C-reactive protein (7.74 vs 7.82 mg/dl), occurrence of bacteremia (15.04% vs 14.57%), rates of antibiotics used (67.30% vs 70.21%), complications (3.77% vs 2.43%) and fecal excretion time [19.25 (N=20) vs 11.69 (N=16) days].
Conclusion The children with multi-resistant non-typhoid salmonellosis had more severe clinical manifestations and worse outcomes in terms of bloody stool, leukocytosis, fever days and hospital stay. Antibiotics use in humans and animals should be weighed against the development of resistance.