Clinical characteristics and antibiotic susceptibility of non-typhoidal Salmonella in immunocompromised children: a 15-year retrospective study in Thailand.
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We aimed to evaluate the outcomes, antibiotic susceptibility of non-typhoidal Salmonella (NTS), and risk factors of invasive NTS (iNTS) infections in immunocompromised children. This is a retrospective observational study of immunocompromised children under 15 years of age with microbiologically proven NTS infections at Songklanagarind Hospital from January 2007 to December 2021. Among the 96 patients with NTS, 41 were diagnosed with hematologic malignancies, 26 with solid tumors, 6 with primary immunodeficiencies, and 23 with other immunodeficiencies, including nephrotic syndrome, autoimmune disorders treated with steroids, and aplastic anemia. NTS isolates collected during 2007-2012 and 2013-2021 demonstrated comparable susceptibility rates to ceftriaxone (100% and 93%, respectively), whereas susceptibility to ciprofloxacin decreased from 100% to 85.5%. Among the 96 patients, 21 (21.9%) had iNTS infections, including bacteremia (n = 19), urinary tract infections (UTIs; n = 2), and musculoskeletal infection (n = 1). One patient had concurrent UTI and osteomyelitis. The overall mortality rate among iNTS cases was 14.3%. In multivariable analysis, immunocompromised children with a sickly appearance, absence of gastrointestinal symptoms, and/or other immunodeficient conditions were at increased risk for iNTS infection, with predictive scores of 2.5, 2.7, and 2.8, respectively. A score ≥2.7 significantly predicted iNTS infection, with an area under the curve of 0.88. The sensitivity and specificity were 0.80 and 0.77, respectively. Nearly 22% of immunocompromised children had iNTS infection. Ceftriaxone remains an appropriate empirical treatment for suspected iNTS infection.