Clinical Manifestation And Risk Factors For Bacteremia Of Nontyphoidal Salmonslla Infections In Children

Objective:To characterize the clinical and laboratory manifestations of Nontyphoidal Salmonella infection in children and identify the risk factors for Salmonella bacteremia in children with Nontyphoidal Salmonella gastroenteritis.Enhance the recognition of the disease,so as to improve the diagnostic and therapeutic ability.Methods:Retrospectively analyze the clinical data of 483 non-underlying disease children with community Acquired NTS infection from Children's Hospital of Chongqing Medical University from January 2009 to December 2018,and identify the risk factors for Salmonella bacteremia in children with Nontyphoidal Salmonella gastroenteritis.Results:1.Clinical manifestations of Nontyphoidal Salmonella infection in children:There were 483 non-underlying disease children with community Acquired NTS infection in the research,297 were boy?61.5%?,186 were girl?38.5%?,with a slight male predominance?M/F=1.6/1?.The age of patients ranged from 19 days to 13 years,the median age was 12 months,57 children younger than or equal to 6 months?11.8%?,182 older than 6 months and younger than or equal to 12 months?37.7%?,155 older than 12 months and younger than or equal to 24 months?32.1%?,66 older than 24 months and younger than or equal to 60 months?13.6%?,and 23 older than 60 months?4.8%?.The largest number of patients in summer and autumn.The number of patients with fever was 410?84.9%?,469?97.1%?patients with diarrhea,and most have watery or mushy stool,only 29?6.1%?have typical mucopurulent bloody stool.The other symptoms were vomiting?135,28.0%?,convulsion?31,6.4%?,tenesmus?24,5.0%?,abdominal pain?11,2.3%?,abdominal distention?5,1%?.38.7%of patients had high white blood cell?WBC?count>12*10^{^9}/L.27.1%of patients was anemia.1.7%of patients had PLT<100*10^9/L,29.4%of patients had PLT>400*10^9/L.55.8%of patient's C-reactive protein levels was high?>8mg/dl?,83.8%of patient's level of procalcitonin was more than 0.05ng/ml.IN fecal routine,75.0%patient's leucocytes,50.5%patient's erythrocytes and 46.7%patient's reducing sugar were positive.Salmonella group B was the most prevalent serotype?373,77.7%?,the followed was group D?54,11.38.1%?,group C?39,8.1%?,and group E?13,2.7%?.13 serotypes were found,among them,there are 231Salmonella Typhimurium?80.2%?,25 Salmonella Enteritidis?8.7%?,7Salmonella derby?2.4%?,7 Salmonella Stanley?2.4%?,6 Salmonella dubiln?2%?,3 Salmonella London?1%?,2 Salmonella agona?0.6%?,2 Salmonella newport?0.6%?,1 Salmonella Bovismorbificans?0.3%?,1 Salmonella Saintpaul?0.3%?,1 Salmonella weltevreden?0.3%?,1 Salmonella anatum?0.3%?,1 Salmonella infantis?0.3%?,and only one was multivalent serotype.In 42 abdominal plain films,17 were intestinal dynamic changes,13 were intestinal inflation,9 were intestinal dilatation,5 were incomplete intestinal obstruction,4 were gas-liquid level,1 intussusception,1 peritoneal effusion,and 5 were normal.Among 199 abdominal ultrasonography,increase of intestinal contents,15 were pyoperitoneum,10 were intestinal gas,6 were intestinal wall thickening,2 were intussusceptions,the rest of them were normal.The hospital stay was 1-84 days,with a median of 8 days.94.4%patients have used antibiotics,most of them lasted for 7-14 days,97.8%patients were cured,2.0%patients were hospitalized twice or more for the same disease,and 1 died.5.6%patients did not use antibiotics,all of them were cured.2.Risk factors of Salmonella bacteremia in children with Nontyphoidal Salmonella gastroenteritis:217 patients were included in our risk factors study,34 belonged to Group I?Group I:bacteremia?and 217 belonged to Group??non-bacteremia?.In Group I vs.group?,the proportion of patient aged?3 months?11.8%vs.2.8%p=0.043 0R=4.68995%CI=1.250-17.582?,the proportion of patient aged?6 months?17.6%vs.6%p=0.041 0R=3.363 95%CI=1.183-9.560?,the frequency of diarrhea?10 times/day vs.7times/day p=0.042?,the duration of fever?7 day vs.4day P=0.005?,the proportion of patients with Salmonella group D?40.6%vs.10.2%P<0.001 OR=6.033 95%CI=2.626-13.863?,group I was significantly more than that in group?.There was no significant difference in sex,season,duration of diarrhea,fever degree,positive proportion of rotavirus antigen in feces,basic diseases,CRP,anemia,platelet,WBC and PCT between both groups.Binary logistic regression analysis shows that the duration of fever?P=0.002 OR=1.122 95%CI=1.045-1.206?,Salmonella group D?P=0.000 OR=8.549 95%CI=3.497-28.958?are the risk factors of Salmonella bacteremia in children with Nontyphoidal Salmonella gastroenteritis.Conclusions:NTS infection mainly occurs to children aged 6-24months,with the highest proportion among children aged 6-12 months.It normally causes acute enteritis.Stool and blood examination is typical bacterial infection.There is no characteristic change in imaging tests.In Chongqing,Salmonella group B was the most prevalent serum group serotype,and Salmonella Typhimurium was the most prevalent serotype.duration of fever,Salmonella group,are the risk factors of Salmonella bacteremia in children with Nontyphoidal Salmonella gastroenteritis.