Wittler R R, Bass J W
Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI.
Pediatr Infect Dis J. 1989 Jun;8(6):364-7. doi: 10.1097/00006454-198906000-00008.
Antimicrobial treatment of nontyphoidal Salmonella gastroenteritis is usually advocated for infants younger than 3 months of age based on published data showing that infants in this age group are more prone to have bacteremia and develop extraintestinal focal infections. A review of nontyphoidal Salmonella isolates from our institution from January, 1981, through March, 1988, was undertaken to assess the role of age and specific serovar on the incidence of bacteremia. Two hundred twenty isolates were identified: one cerebrospinal fluid, 14 blood and 205 stool. The mean age of patients with bacteremia was 182 months, not significantly different from the mean age of 142 months for patients with stool isolates. Salmonella weltevreden was the most frequent isolate accounting for 23% of all isolates and all isolates of this organism were from stool cultures. Patients with S. weltevreden infections had mean and median ages of 50 and 2.5 months and were younger than patients with stool isolates from other serovars who had mean and median ages of 174 and 38 months. Infants younger than 3 or 6 months of age with positive stool cultures in whom blood cultures were obtained did not demonstrate a higher incidence of bacteremia than did older patients. We conclude that the incidence of bacteremia in patients with nontyphoidal Salmonella gastroenteritis is highly related to the invasiveness of the infecting specific Salmonella serovar.
根据已发表的数据显示，3个月以下的婴儿更容易发生菌血症并发展为肠外局灶性感染，因此通常主张对非伤寒沙门氏菌胃肠炎的婴儿进行抗菌治疗。对我们机构1981年1月至1988年3月期间分离出的非伤寒沙门氏菌进行了回顾，以评估年龄和特定血清型对菌血症发生率的作用。共鉴定出220株分离菌：1株来自脑脊液，14株来自血液，205株来自粪便。菌血症患者的平均年龄为182个月，与粪便分离菌患者的平均年龄142个月无显著差异。韦太夫雷登沙门氏菌是最常见的分离菌，占所有分离菌的23%，该菌的所有分离菌均来自粪便培养物。韦太夫雷登沙门氏菌感染患者的平均年龄和中位数年龄分别为50个月和2.5个月，比其他血清型粪便分离菌患者的平均年龄和中位数年龄（分别为174个月和38个月）要小。粪便培养阳性且进行了血培养的3个月或6个月以下婴儿，其菌血症发生率并不高于年龄较大的患者。我们得出结论，非伤寒沙门氏菌胃肠炎患者的菌血症发生率与感染特定沙门氏菌血清型的侵袭性高度相关。
