Salmonella: Difference between revisions

No edit summary
No edit summary
Line 1: Line 1:
==Background==
==Background==
*Salmonella enteritidis is a common cause of food borne disease outbreaks
*Infection commonly from foodborne transmission
*Associated with poultry/hen eggs, peanut butter
*Seen in infants often due to cross-contamination in household


==Clinical Features==
==Clinical Features==
*Severity dependent on dose ingested
*Symptoms within 8-72 hours
**Nausea
**Vomiting
**Fever
**Diarrhea
**Cramping
*Course: Fever resolves within 48-72 hours; diarrhea resolves within 4-10 days
*< 5% of patients develop bacteremia that is rarely complicated by endocarditis, osteomyelitis, or mycotic aneurysm.
*Mortality < 0.5-1%


==Differential Diagnosis==
==Differential Diagnosis==
Line 7: Line 21:


==Diagnosis==
==Diagnosis==
*Stool culture


==Management==
==Management==
'''Supportive care'''
*IVF
'''Antibiotics'''
*Have not been shown to reduce duration of symptoms and not recommended in:<ref>Onwuezobe, I. A., Oshun, P. O., & Odigwe, C. C. (2012). Antimicrobials for treating symptomatic non-typhoidal Salmonella infection. The Cochrane database of systematic reviews, , CD001167.</ref><ref>DuPont, H. L. (2014). Acute infectious diarrhea in immunocompetent adults. The New England journal of medicine, 16, 1532–1540.</ref>
**Mild-moderate infection
**Immunocompetent
**Patients aged 2-50 years old
*Antibiotics may have a role in patients with:<ref>DuPont HL. Bacterial diarrhea. N Engl J Med 2009;361:1560-9.</ref>
**Severe illness
**IBD
**Immunocompromised
**Steroid use
**< 3 months or > 65 years old
**On hemodialysis
**Sickle cell disease
*Recommended regimens:<ref>DuPont HL. Bacterial diarrhea. N Engl J Med 2009;361:1560-9.</ref>
**Adults:
***Levofloxacin (or other fluoroquinolone) 500 mg daily x 7-10 days
***Azithromycin 500 mg daily x 7 days
***Duration should be 14 days in immunocompromised
**Children:
***100 mg/kg/day in two doses x 7-10 days
***20 mg/kg/day daily x 7 days
===[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>===
===[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>===
{| class="wikitable"
{| class="wikitable"

Revision as of 12:21, 6 October 2015

Background

  • Salmonella enteritidis is a common cause of food borne disease outbreaks
  • Infection commonly from foodborne transmission
  • Associated with poultry/hen eggs, peanut butter
  • Seen in infants often due to cross-contamination in household

Clinical Features

  • Severity dependent on dose ingested
  • Symptoms within 8-72 hours
    • Nausea
    • Vomiting
    • Fever
    • Diarrhea
    • Cramping
  • Course: Fever resolves within 48-72 hours; diarrhea resolves within 4-10 days
  • < 5% of patients develop bacteremia that is rarely complicated by endocarditis, osteomyelitis, or mycotic aneurysm.
  • Mortality < 0.5-1%

Differential Diagnosis

Acute diarrhea

Infectious

Noninfectious

Watery Diarrhea

Traveler's Diarrhea

Diagnosis

  • Stool culture

Management

Supportive care

  • IVF

Antibiotics

  • Have not been shown to reduce duration of symptoms and not recommended in:[2][3]
    • Mild-moderate infection
    • Immunocompetent
    • Patients aged 2-50 years old
  • Antibiotics may have a role in patients with:[4]
    • Severe illness
    • IBD
    • Immunocompromised
    • Steroid use
    • < 3 months or > 65 years old
    • On hemodialysis
    • Sickle cell disease
  • Recommended regimens:[5]
    • Adults:
      • Levofloxacin (or other fluoroquinolone) 500 mg daily x 7-10 days
      • Azithromycin 500 mg daily x 7 days
      • Duration should be 14 days in immunocompromised
    • Children:
      • 100 mg/kg/day in two doses x 7-10 days
      • 20 mg/kg/day daily x 7 days

Antibiotic Sensitivities[6]

Category Antibiotic Sensitivity
Penicillins Penicillin G R
Penicillin V R
Anti-Staphylocccal Penicillins Methicillin R
Nafcillin/Oxacillin R
Cloxacillin/Diclox. R
Amino-Penicillins AMP/Amox I
Amox-Clav S
AMP-Sulb S
Anti-Pseudomonal Penicillins Ticarcillin S
Ticar-Clav S
Pip-Tazo S
Piperacillin S
Carbapenems Doripenem S
Ertapenem S
Imipenem S
Meropenem S
Aztreonam X1
Fluroquinolones Ciprofloxacin S
Ofloxacin S
Pefloxacin S
Levofloxacin S
Moxifloxacin S
Gemifloxacin X1
Gatifloxacin S
1st G Cephalo Cefazolin X1
2nd G. Cephalo Cefotetan X1
Cefoxitin X1
Cefuroxime X1
3rd/4th G. Cephalo Cefotaxime S
Cefizoxime S
CefTRIAXone S
Ceftaroline S
CefTAZidime S
Cefepime S
Oral 1st G. Cephalo Cefadroxil R
Cephalexin R
Oral 2nd G. Cephalo Cefaclor/Loracarbef X1
Cefproxil X1
Cefuroxime axetil X1
Oral 3rd G. Cephalo Cefixime S
Ceftibuten S
Cefpodox/Cefdinir/Cefditoren S
Aminoglycosides Gentamicin X1
Tobramycin X1
Amikacin X1
Chloramphenicol S
Clindamycin R
Macrolides Erythromycin R
Azithromycin I
Clarithromycin R
Ketolide Telithromycin R
Tetracyclines Doxycycline I
Minocycline I
Glycylcycline Tigecycline S
Daptomycin R
Glyco/Lipoclycopeptides Vancomycin R
Teicoplanin R
Telavancin R
Fusidic Acid R
Trimethoprim I
TMP-SMX I
Urinary Agents Nitrofurantoin S
Fosfomycin S
Other Rifampin R
Metronidazole R
Quinupristin dalfoppristin R
Linezolid R
Colistimethate X1

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

Table Overview

Gram Positives
Cocci
Clusters
Pairs/Chains
Other
Rods
Gram Negatives
Cocci
Rods
Lactose Fermenters
Lactose Non-Fermenters
Other
Rods/Cocci
Anaerobes

See Also

References

  1. ↑ Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
  2. ↑ Onwuezobe, I. A., Oshun, P. O., & Odigwe, C. C. (2012). Antimicrobials for treating symptomatic non-typhoidal Salmonella infection. The Cochrane database of systematic reviews, , CD001167.
  3. ↑ DuPont, H. L. (2014). Acute infectious diarrhea in immunocompetent adults. The New England journal of medicine, 16, 1532–1540.
  4. ↑ DuPont HL. Bacterial diarrhea. N Engl J Med 2009;361:1560-9.
  5. ↑ DuPont HL. Bacterial diarrhea. N Engl J Med 2009;361:1560-9.
  6. ↑ Sanford Guide to Antimicrobial Therapy 2014
Retrieved from "https://www.wikem.org/w/index.php?title=Salmonella&oldid=47231"