MULTIPLY RESISTANT NONTYPHOIDAL SALMONELLA GASTROENTERITIS IN CHILDREN

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 mug/ml), cephalothin (>128 mug/ml), cefuroxime (>128 mug/ml), nalidixic acid (>256 mug/ml), rifampin (>256 mug/ml), gentamicin (>256 mug/ml) and tobramycin (256 mug/ml); 77.3% of strains were resistant to ceftazidime (32 mug/ml), 97.6% to netilmicin (>256 mug/ml), 92.8% to amikacin (256 mug/ml), 24.4% to isepamicin (32 mug/ml), 5.3% to chloramphenicol (4 mug/ml) and 2.7% to cefoxitin (2 mug/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.