Salmonella: Difference between revisions
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==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 | |||
==Antibiotic Sensitivities<ref>Sanford Guide to Antimicrobial Therapy | ==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== | |||
{{Diarrhea DDX}} | |||
==Evaluation== | |||
*Stool culture | |||
==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) 500mg daily x 7-10 days | |||
***Azithromycin 500mg daily x 7 days | |||
***Duration should be 14 days in immunocompromised | |||
**Children: | |||
***[[Ceftriaxone]] 100mg/kg/day divided into two doses x 7-10 days | |||
***Azithromycin 20mg/kg/day daily x 7 days | |||
===[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>=== | |||
{| class="wikitable" | {| class="wikitable" | ||
| align="center" style="background:#f0f0f0;"|'''Category''' | |||
| align="center" style="background:#f0f0f0;"|'''Antibiotic''' | |||
| align="center" style="background:#f0f0f0;"|'''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=== | ===Key=== |
Revision as of 20:14, 27 January 2017
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
- Viral (e.g. rotavirus)
- Bacterial
- Campylobacter
- Shigella
- Salmonella (non-typhi)
- Escherichia coli
- E. coli 0157:H7
- Yersinia enterocolitica
- Vibrio cholerae
- Clostridium difficile
- Parasitic
- Toxin
Noninfectious
- GI Bleed
- Appendicitis
- Mesenteric Ischemia
- Diverticulitis
- Adrenal Crisis
- Thyroid Storm
- Toxicologic exposures
- Antibiotic or drug-associated
Watery Diarrhea
- Enterotoxigenic E. coli (most common cause of watery diarrhea)[1]
- Norovirus (often has prominent vomiting)
- Campylobacter
- Non-typhoidal Salmonella
- Enteroaggregative E. coli (EAEC)
- Enterotoxigenic Bacteroides fragilis
Traveler's Diarrhea
Evaluation
- 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) 500mg daily x 7-10 days
- Azithromycin 500mg daily x 7 days
- Duration should be 14 days in immunocompromised
- Children:
- Ceftriaxone 100mg/kg/day divided into two doses x 7-10 days
- Azithromycin 20mg/kg/day daily x 7 days
- Adults:
Antibiotic Sensitivities[6]
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
|
See Also
References
- ↑ Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
- ↑ 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.
- ↑ DuPont, H. L. (2014). Acute infectious diarrhea in immunocompetent adults. The New England journal of medicine, 16, 1532–1540.
- ↑ DuPont HL. Bacterial diarrhea. N Engl J Med 2009;361:1560-9.
- ↑ DuPont HL. Bacterial diarrhea. N Engl J Med 2009;361:1560-9.
- ↑ Sanford Guide to Antimicrobial Therapy 2014