Choi M, Yoshikawa T T, Bridge J, Schlaifer A, Osterweil D, Reid D, Norman D C
Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, West Los Angeles, California.
J Am Geriatr Soc. 1990 May;38(5):531-4. doi: 10.1111/j.1532-5415.1990.tb02403.x.
We performed a retrospective review of an outbreak of Salmonella gastroenteritis that occurred in a community nursing home in 1987. Forty-four of 199 residents had a diarrheal illness; Salmonella heidelberg was isolated from the stool in 19 cases. Although the distribution of cases suggested a common source for the outbreak, no common source of infection could be demonstrated, despite extensive investigation. The clinical presentation of symptomatic individuals ranged from mild diarrhea to a severe gastrointestinal illness, and 26% of symptomatic, culture-positive patients required hospitalization. The median duration of pathogen excretion during convalescence in untreated residents was six weeks, but six patients who were treated with antibiotics shed S. heidelberg for a median duration of 14.5 weeks. We conclude that (1) the clinical spectrum of Salmonella gastroenteritis in nursing-home patients is variable, ranging from mild to severe illness; and (2) nursing-home Salmonella outbreaks impose a high economic burden because of expense of epidemiologic investigation, prolonged isolation measures, hospitalization for severely ill residents, and potential institutional closure.
我们对1987年发生在一家社区疗养院的沙门氏菌性肠胃炎暴发事件进行了回顾性研究。199名居民中有44人出现腹泻疾病；从19例患者的粪便中分离出了海德堡沙门氏菌。尽管病例分布提示此次暴发有共同来源，但尽管进行了广泛调查，仍未找到感染的共同来源。有症状个体的临床表现从轻度腹泻到严重的胃肠道疾病不等，26%有症状且培养结果呈阳性的患者需要住院治疗。未经治疗的居民在恢复期病原体排泄的中位持续时间为六周，但六名接受抗生素治疗的患者排出海德堡沙门氏菌的中位持续时间为14.5周。我们得出结论：（1）疗养院患者沙门氏菌性肠胃炎的临床谱是可变的，从轻度到严重疾病不等；（2）疗养院沙门氏菌暴发会带来高昂的经济负担，原因包括流行病学调查费用、延长的隔离措施、重病居民的住院治疗以及潜在的机构关闭。
