title: Multiply resistant nontyphoidal Salmonella gastroenteritis in children.
abstract: From January, 1990, to December 31, 1990, 75 children with multiply resistant Salmonella gastroenteritis were studied at the Children's Hospital "Ricardo Gutierrez" of Buenos Aires. These children ranged from 1 month to 15 years of age. Infection was community-acquired in 20 (26.6%), nosocomially acquired in 50 (66.7%) and undetermined in 5. Thirty-nine (52%) had grossly bloody stools. Fever occurred at some point in the clinical course in 61 children (81.3%) with a duration of 1 to 33 days (mean, 6.7 days). The duration of diarrhea (1 to 69 days) was longer in those who developed complications (P < 0.001). Six (8%) developed enterocolitis (2 with bowel perforation), 1 had a pulmonary abscess and 8 (11.4%) had bacteremia; 4 children died (5.3%). Salmonella typhimurium was the most common serovar (85.3%). Ninety percent minimum inhibitory concentration studies demonstrated that all strains were resistant to ampicillin (> 128 micrograms/ml), cephalothin (> 128 micrograms/ml), cefuroxime (> 128 micrograms/ml), nalidixic acid (> 256 micrograms/ml), rifampin (> 256 micrograms/ml), gentamicin (> 256 micrograms/ml) and tobramycin (256 micrograms/ml); 77.3% of strains were resistant to ceftazidime (32 micrograms/ml), 97.6% to netilmicin (> 256 micrograms/ml), 92.8% to amikacin (256 micrograms/ml), 24.4% to isepamicin (32 micrograms/ml), 5.3% to chloramphenicol (4 micrograms/ml) and 2.7% to cefoxitin (2 micrograms/ml). The 90% minimum inhibitory concentration of cefotaxime and ceftazidime was reduced by the addition of clavulanate. Aggressive multiply resistant Salmonella strains are a major pediatric problem in Buenos Aires.
authors.affiliation: Infectious Diseases Service, Hospital de Niños Dr. Ricardo Gutierrez, Buenos Aires, Argentina.
authors.forename: E
authors.initials: E
authors.lastname: Maiorini
authors.forename: E L
authors.initials: EL
authors.lastname: Lopez
authors.forename: A L
authors.initials: AL
authors.lastname: Morrow
authors.forename: F
authors.initials: F
authors.lastname: Ramirez
authors.forename: A
authors.initials: A
authors.lastname: Procopio
authors.forename: S
authors.initials: S
authors.lastname: Furmanski
authors.forename: G M
authors.initials: GM
authors.lastname: Woloj
authors.forename: G
authors.initials: G
authors.lastname: Miller
authors.forename: T G
authors.initials: TG
authors.lastname: Cleary
mesh_terms: D000293:Adolescent; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D001118:Argentina; D002511:Cephalosporins; D002648:Child; D002675:Child, Preschool; D004352:Drug Resistance, Microbial; D005260:Female; D005759:Gastroenteritis / Q000150:complications / Q000382:microbiology*; D006801:Humans; D007223:Infant; D008297:Male; D012475:Salmonella / Q000187:drug effects* / Q000302:isolation & purification; D012480:Salmonella Infections / Q000150:complications / Q000382:microbiology*
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins