Non-Typhoidal Salmonella Gastroenteritis Outcomes in Immunocompetent Children

Objective: To compare the clinical outcomes in children older than 3 months with non-typhoidal Salmonella (NTS) gastroenteritis treated with or without empirical antibiotics. Material and Methods: Medical records of all patients aged 3 months to 15 years having experienced their first episode of NTS and treated at Songklanagarind Hospital from January 2007 until December 2021 were reviewed. Results: NTS infections occurred in 18 (8.0%) of 224 patients, with NTS gastroenteritis. Antibiotics were empirically prescribed to 159 (70.9%) patients. The antibiotics group included a significantly higher proportion of patients with a general sick appearance (20.1% vs. 6.3%), bloody diarrhea (56.6% vs. 33.3%), and abdominal pain (12.9% vs. 1.9%) than that in the no-antibiotics group. The antibiotics group seemed to have a shorter median (interquartile range [IQR]) duration of bloody diarrhea (3.0 [1.3–4.8] vs. 4.5 (3.0–6.5) days, p-value=0.051), but similar duration for fever (3.0 [1.0–4.0] vs. 3.0 [1.3–5.0] days, p-value=0.566) compared to that for the no-antibiotics group. In multivariate analysis, children with underlying diseases (extravascular hemolytic anemia and/or abnormal kidney and urinary bladder system), fever duration >5 days by the first visit, and white blood cell (WBC) count >15,000 cells/mm3 were at risk of iNTS infections, with an odds ratios (95% confidence intervals) of 7.96 (1.70, 37.30), 7.75 (1.74, 34.46), and 8.69 (2.39, 31.55), respectively. Conclusion: Patients aged 3-36 months with NTS gastroenteritis having an underlying disease, fever duration >5 days, and/or WBC count >15,000 cells/mm3 should be treated with empirical antibiotics while waiting for hemoculture.