Management and Outcomes of Salmonella Gastroenteritis in the Era of Rapid Molecular Testing

Author:

O’Boyle Hillary12,Kirpalani Anjali13,Weiss Lindsay13,Hames Nicole13,Li Ruoxing4,Leong Traci4,Gonzalez Mark3,Shane Andi L.13,Charvat Courtney13

Affiliation:

1. aDepartment of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

2. *Affiliation has changed since this research was conducted

3. bChildren’s Healthcare of Atlanta, Atlanta, Georgia

4. cDepartment of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia

Abstract

BACKGROUND AND OBJECTIVES Molecular diagnostics provide a rapid and sensitive diagnosis of gastroenteritis compared with a stool culture. In this study, we seek to describe the changes in medical management and outcomes of children with Salmonella gastroenteritis as our hospital system adopted molecular diagnostics. METHODS This study is a retrospective chart review of children <18 years of age diagnosed with nontyphoidal Salmonella gastroenteritis between 2008 and 2018 at a large pediatric health care system in the southeastern United States. Those with immunocompromising conditions and hemoglobinopathies were excluded. Patients diagnosed via molecular testing were compared with those diagnosed solely by stool culture for aspects of management including admission rates, blood culture obtainment, and antibiotic administration. RESULTS Of 965 eligible patients with Salmonella gastroenteritis, 264 (27%) had a stool molecular test and 701 (73%) only had a stool culture performed. Groups were similar in age and presentation. Those diagnosed by molecular methods had higher hospitalization rates (69% vs 50%, P <.001), more blood cultures obtained (54% vs 44%, P <.01), and received more antibiotics (49% vs 34%, P <.001) despite statistically similar rates of bacteremia (11% vs 19%, P = .05). CONCLUSIONS The rapid diagnosis of Salmonella gastroenteritis by molecular methods was associated with increased hospital admission rates, blood culture obtainment, and antibiotic use. This suggests possible overmedicalization of uncomplicated Salmonella gastroenteritis, and clinicians should remain cognizant of the possibility of providing low-value care for uncomplicated disease.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics,General Medicine,Pediatrics, Perinatology and Child Health

Reference34 articles.

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