Objective: To investigate the clinical characteristics, serogroups and antimicrobial resistance of invasive non-typhoid Salmonella infection in children at Xiamen. Methods: Retrospective cohort study. The clinical manifestations, treatment, prognosis, serogroups and antimicrobial resistance of 29 hospitalized children with invasive non-typhoid Salmonella infection confirmed by blood, cerebrospinal fluid, bone marrow and other sterile body fluids or deep pus culture at the Department of Infectious Diseases, the Department of Orthopedics and the Department of General Surgery in Xiamen Children's Hospital from January 2016 to December 2021 were analyzed. According to the clinical diagnosis criteria, the patients were divided into sepsis group and non-sepsis group (bacteremia and local suppurative infection). The inflammatory markers, serogroups distribution and drug resistance were compared between the two groups. Comparison between groups using Mann-Whitney U test and χ2 test. Results: Among the 29 cases, there were 17 males and 12 females, with an onset age of 14 (9, 25) months, and 10 cases (34%) of patients were younger than 1 year old, 15 cases (52%) under 1 to 3 years old, and 4 cases (14%) greater than or equal 3 years old. The onset time of 25 cases (86%) was from April to September. The diseases included 19 cases (66%) septicemia (2 of which were combined with suppurative meningitis), 10 cases (34%) non-sepsis group, including 7 cases bacteremia and 3 cases local suppurative infection (2 cases of osteomyelitis, 1 case of appendicitis with peritonitis). The clinical manifestations were fever in 29 cases (100%), diarrhea and abdominal pain in 18 cases (62%), cough and runny nose in 10 cases (34%). Eighteen cases (62%) were cured and 11 cases (38%) were improved by effective antibiotics treatment. C-reactive protein in sepsis group was significantly higher than that in non-sepsis group (25.2 (16.1, 56.4) vs. 3.4 (0.5, 7.5) mg/L, Z=-3.81, P<0.001).The serogroups of C, B and E were the most prevalent among non-typhoid Salmonella isolates, accounting for 10 cases (34%), 9 cases (31%) and 7 cases (24%) respectively. Antibacterial drug sensitivity test showed that the sensitivity rates of imipenem, ertapenem and piperaciratazobactam were all 100% (31/31), those of ceftazidime, ceftriaxone, and cefepime were 94% (29/31), 94% (29/31) and 97% (30/31) respectively. The drug resistance rates of ampicillin, ampicillin-sulbactam and trimethoprim-sulfamethoxazole were 51% (16/31), 48% (15/31) and 48% (15/31) respectively, those of cefazolin, cefotetan, tobramycin, gentamicin and amikacinwere all 100% (31/31). There were no significant differences in the drug resistance rates of ceftazidime, ceftriaxone, aztreonam, ampicillin-sulbactam, ampicillin, trimethoprim-sulfamethoxazole and ciprofloxacin between the sepsis group and the non-sepsis group (χ2=0.31,0.31,0.00,0.02,0.02,0.02,0.26, all P>0.05). Conclusions: Invasive non-typhoid Salmonella infection in children at Xiamen mainly occurred in infants younger than 3 years old.The main clinical manifestations are fever, abdominal pain and diarrhea. C-reactive protein can be served as the laboratory indicators for indicating sepsis. The third generation of cephalosporins is recommended as the first choice for treatment.
目的： 探讨厦门地区儿童侵袭性非伤寒沙门菌感染的临床特征、血清型及抗菌药物耐药性。 方法： 回顾性队列研究。分析厦门市儿童医院感染科、骨科和普外科2016年1月至2021年12月经血液、脑脊液、骨髓等无菌体液或深部脓液培养确诊的29例侵袭性非伤寒沙门菌感染患儿的临床表现、治疗、预后、血清型和抗菌药物耐药性等资料。根据临床疾病诊断标准，比较败血症和非败血症两组患儿的炎症指标、血清型分布及药物耐药性差异。组间比较采用Mann-Whitney U检验和χ2检验。 结果： 29例患儿中男17例、女12例，就诊年龄14（9，25）月龄，<1岁10例（34%），1~<3岁15例（52%），≥3岁4例（14%）。4至9月发病25例（86%）。败血症组19例（66%），其中2例合并化脓性脑膜炎；非败血症组10例（34%），其中菌血症7例、局部化脓感染3例（骨髓炎2例、阑尾炎穿孔伴腹膜炎1例）。发热29例（100%），腹泻、腹痛18例（62%），咳嗽、流涕10例（34%）。经有效抗菌药物治疗，治愈18例（62%）、好转11例（38%）。败血症组C反应蛋白高于非败血症组［25.2（16.1，56.4）比3.4（0.5，7.5）mg/L，Z=-3.81，P<0.001］。非伤寒沙门菌血清型主要为C群10例（34%）、B群9例（31%）、E群7例（24%）。抗菌药物敏感性试验示对亚胺培南、厄他培南和哌拉西拉他唑巴坦的敏感率均为100%（31/31），头孢他啶、头孢曲松、头孢吡肟的敏感率分别为94%（29/31）、94%（29/31）、97%（30/31），氨苄西林、氨苄西林舒巴坦、复方新诺明的耐药率分别为51%（16/31）、48%（15/31）、48%（15/31），头孢唑林、头孢替坦、妥布霉素、庆大霉素、阿米卡星的耐药率均为100%（31/31）。败血症组和非败血症组对头孢他啶、头孢曲松、氨曲南、氨苄西林舒巴坦、氨苄西林、复方新诺明和环丙沙星的耐药率差异均无统计学意义（χ2=0.31、0.31、0.00、0.02、0.02、0.02、0.26，均P>0.05）。 结论： 厦门地区儿童侵袭性非伤寒沙门菌感染主要发生于3岁以下婴幼儿，主要表现为发热、腹痛、腹泻。C反应蛋白可作为提示败血症的实验室指标。推荐三代头孢菌素作为抗感染治疗的首选药物。.