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Abstract：
BACKGROUND: Salmonellosis is a major cause of morbidity and mortality and one of the most frequent etiologies of diarrhea in the world. Mortality due to Salmonellosis in Latin America still poorly understood, and there is a lack of studies that evaluate resistance and clinical manifestations. The aims of this study were to characterize patients infected with Salmonella spp. seen in a university hospital in Colombia between 2012 and 2021, to evaluate trends in antibiotic resistance and to determine the proportion of overall mortality and related factors.
METHODS: Retrospective observational study. All patients with microbiological diagnosis of Salmonella spp. were included. The sociodemographic, clinical and microbiological characteristics were described, and the proportion of antibiotic resistant isolates per year was estimated. The prevalence of mortality according to age groups was calculated. Log binomial regression models were used to establish factors associated with mortality.
RESULTS: Five hundred twenty-two patients were analyzed. Salmonellosis accounted for 0.01% of all medical consultations. The median age was 16 years old. The most common clinical presentation was gastroenteric syndrome (77.1%) and symptoms included diarrhea (79.1%), fever (66.7%), abdominal pain (39.6%) and vomiting (35.2%). Of the Salmonella spp. isolates, 78.2% were not classified, 19.1% corresponded to non-typhoidal Salmonella and 2.7% to Salmonella typhi. Mortality occurs in 4.02% of the patients and was higher in patients with hematologic malignancy (11.6%). When analyzing by age group, the proportion of deaths was 2.8% in patients aged 15 years or younger, while in those older than 15 years it was 5.4%. Factors associated to mortality where bacteremia (aPR = 3.41 CI95%: 1.08-10.76) and to require treatment in the ICU (aPR = 8.13 CI95%: 1.82-37.76). In the last 10 years there has been a steady increase in resistance rates to ciprofloxacin, ampicillin, ampicillin/sulbactam and ceftriaxone, reaching rates above 60% in recent years.
CONCLUSIONS: Despite improved availability of antibiotics for the treatment of salmonellosis in the past decades, mortality due to salmonellosis continues occurring in children and adults, mainly in patients with hematological malignancies and bacteremia. Antibiotic resistance rates have increased significantly over the last 10 years. Public health strategies for the control of this disease should be strengthened, especially in vulnerable populations.
METHODS: Retrospective observational study. All patients with microbiological diagnosis of Salmonella spp. were included. The sociodemographic, clinical and microbiological characteristics were described, and the proportion of antibiotic resistant isolates per year was estimated. The prevalence of mortality according to age groups was calculated. Log binomial regression models were used to establish factors associated with mortality.
RESULTS: Five hundred twenty-two patients were analyzed. Salmonellosis accounted for 0.01% of all medical consultations. The median age was 16 years old. The most common clinical presentation was gastroenteric syndrome (77.1%) and symptoms included diarrhea (79.1%), fever (66.7%), abdominal pain (39.6%) and vomiting (35.2%). Of the Salmonella spp. isolates, 78.2% were not classified, 19.1% corresponded to non-typhoidal Salmonella and 2.7% to Salmonella typhi. Mortality occurs in 4.02% of the patients and was higher in patients with hematologic malignancy (11.6%). When analyzing by age group, the proportion of deaths was 2.8% in patients aged 15 years or younger, while in those older than 15 years it was 5.4%. Factors associated to mortality where bacteremia (aPR = 3.41 CI95%: 1.08-10.76) and to require treatment in the ICU (aPR = 8.13 CI95%: 1.82-37.76). In the last 10 years there has been a steady increase in resistance rates to ciprofloxacin, ampicillin, ampicillin/sulbactam and ceftriaxone, reaching rates above 60% in recent years.
CONCLUSIONS: Despite improved availability of antibiotics for the treatment of salmonellosis in the past decades, mortality due to salmonellosis continues occurring in children and adults, mainly in patients with hematological malignancies and bacteremia. Antibiotic resistance rates have increased significantly over the last 10 years. Public health strategies for the control of this disease should be strengthened, especially in vulnerable populations.
摘要：
背景：沙门氏菌病是发病率和死亡率的主要原因，也是世界上最常见的腹泻病因之一。由于在拉丁美洲沙门氏菌病的死亡率仍然知之甚少，并且缺乏评估耐药性和临床表现的研究。这项研究的目的是表征感染沙门氏菌的患者。2012年至2021年在哥伦比亚的一所大学医院进行观察，以评估抗生素耐药性的趋势，并确定总死亡率和相关因素的比例。
方法：回顾性观察研究。所有患者的微生物诊断为沙门氏菌。包括在内。社会人口统计学，描述了临床和微生物学特征，并估计每年抗生素耐药分离株的比例。计算按年龄组的死亡率。使用对数二项回归模型来建立与死亡率相关的因素。
结果：分析了22例患者。沙门氏菌病占所有医疗咨询的0.01％。中位年龄为16岁。最常见的临床表现是胃肠道综合征（77.1%），症状包括腹泻（79.1%），发烧(66.7%)，腹痛(39.6%)和呕吐(35.2%)。沙门氏菌属。隔离物,78.2%未分类，19.1％对应于非伤寒沙门氏菌，2.7％对应于伤寒沙门氏菌。死亡率发生在4.02％的患者中，在血液系统恶性肿瘤患者中死亡率更高（11.6％）。按年龄组进行分析时，15岁以下患者的死亡比例为2.8%，而在15岁以上的人群中，这一比例为5.4%。与菌血症（aPR=3.41CI95％：1.08-10.76）和ICU需要治疗（aPR=8.13CI95％：1.82-37.76）死亡率相关的因素。在过去的10年中，对环丙沙星的耐药率稳步上升，氨苄青霉素,氨苄西林/舒巴坦和头孢曲松,近年来达到60%以上。
结论：尽管在过去的几十年中，用于治疗沙门氏菌病的抗生素的可用性有所提高，沙门氏菌病导致的死亡率继续发生在儿童和成人中，主要为血液系统恶性肿瘤和菌血症患者。抗生素耐药率在过去10年中显著增加。应加强控制这种疾病的公共卫生策略，特别是在弱势群体中。
方法：回顾性观察研究。所有患者的微生物诊断为沙门氏菌。包括在内。社会人口统计学，描述了临床和微生物学特征，并估计每年抗生素耐药分离株的比例。计算按年龄组的死亡率。使用对数二项回归模型来建立与死亡率相关的因素。
结果：分析了22例患者。沙门氏菌病占所有医疗咨询的0.01％。中位年龄为16岁。最常见的临床表现是胃肠道综合征（77.1%），症状包括腹泻（79.1%），发烧(66.7%)，腹痛(39.6%)和呕吐(35.2%)。沙门氏菌属。隔离物,78.2%未分类，19.1％对应于非伤寒沙门氏菌，2.7％对应于伤寒沙门氏菌。死亡率发生在4.02％的患者中，在血液系统恶性肿瘤患者中死亡率更高（11.6％）。按年龄组进行分析时，15岁以下患者的死亡比例为2.8%，而在15岁以上的人群中，这一比例为5.4%。与菌血症（aPR=3.41CI95％：1.08-10.76）和ICU需要治疗（aPR=8.13CI95％：1.82-37.76）死亡率相关的因素。在过去的10年中，对环丙沙星的耐药率稳步上升，氨苄青霉素,氨苄西林/舒巴坦和头孢曲松,近年来达到60%以上。
结论：尽管在过去的几十年中，用于治疗沙门氏菌病的抗生素的可用性有所提高，沙门氏菌病导致的死亡率继续发生在儿童和成人中，主要为血液系统恶性肿瘤和菌血症患者。抗生素耐药率在过去10年中显著增加。应加强控制这种疾病的公共卫生策略，特别是在弱势群体中。
