Non-typhi Salmonella bacteremia in children

Background. Non-typhi Salmonella (NTS) infections are:a frequent cause of s elf-limited diarrheal illness in healthy children. Bacteremia is a known co mplication of NTS infection, but the management of children with bacteremia has been based on limited data, Objective. To study the outcomes of pediatric patients with NTS bacteremia. Methods. Retrospective review of patients with NTS bacteremia covering a 1 6-year period at an urban pediatric hospital, Clinical data from the initia l visits and any follow-up visits or hospitalizations were abstracted from the medical record. Results, We studied 144 patients. Median age was 10.5 months. Fifty four pa tients were hospitalized at the initial visit including all the patients wi th immunodeficiency (n = 12), Of the 90 patients initially managed as outpa tients, 79 were subsequently admitted; only 1 of these patients developed a focal complication. Persistent bacteremia was found in 51 (41%) patients. Among nonimmunocompromised patients, persistent bacteremia was noted in 34% [95% confidence interval (CI), 20 to 52%] of those initially treated with oral antibiotics, 52% (CI 30 to 74%) of those initially treated with a pare nteral dose of antibiotics and in 31% (CI 22 to 43%) of those who were not initially given antibiotics. No laboratory or clinical factors predicted pe rsistent bacteremia, Twelve patients developed focal infections: 3 of 119 p reviously healthy children (2.5%, CI 0.5 to 7%); and 9 of 25 children with underlying medical conditions (36%, CI 19 to 57%). Focal infections include d meningitis (3), osteomyelitis (4), septic arthritis (2), pneumonia (2) an d cholangitis (1), Conclusions, NTS bacteremia occurs in otherwise healthy children, although the risk of focal infections is small. Patients with NTS bacteremia frequen tly have persistent bacteremia at follow-up regardless of initial antibioti c treatment.