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Comparison of Musculoskeletal Infections due to Nontyphoidal Salmonella Species and Staphylococcus aureus in Immunocompetent Children

Boguniewicz, Juri MD; Rubiano Landinez, Andrea MD; Kaplan, Sheldon L. MD; Lamb, Gabriella S. MD

The Pediatric Infectious Disease Journal: October 2019 - Volume 38 - Issue 10 - p 1020–1024
doi: 10.1097/INF.0000000000002440
Original Studies

Background: Nontyphoidal Salmonella species (NTS) rarely cause musculoskeletal infections in healthy children. Data on NTS musculoskeletal infections in healthy children are limited. No previous studies have directly compared children with NTS musculoskeletal infections with those with Staphylococcus aureus.

Methods: This was a case-control study of children 30 days–18 years old seen at Texas Children’s Hospital between 2010 and 2017 with NTS musculoskeletal infections. Controls were children with S. aureus musculoskeletal infections matched on date of infection. Patients with known predisposing conditions were excluded. Demographic and clinical risk factors between the 2 groups were compared.

Results: From 2010 to 2017, 27 cases of NTS musculoskeletal infections were identified, 12 (46.0%) of which occurred in healthy children. The control group had 53 patients. Predictors of NTS musculoskeletal infections included exposure to reptiles [odds ratio (OR) 8.50, 95% confidence interval (CI): 11.24–58.23] and preceding gastrointestinal symptoms (OR 5.63, 95% CI: 1.45–21.89). Children with NTS musculoskeletal infections had greater odds of pelvic and/or spinal involvement than S. aureus controls (OR 5.32, 95% CI: 1.42–20.13). Complications occurred in 16.7% of NTS cases versus 32% of S. aureus controls.

Conclusions: Healthy children with NTS musculoskeletal infections more frequently report reptile exposure and preceding gastrointestinal symptoms and have pelvic and spinal involvement compared with children with musculoskeletal infections due to S. aureus. NTS should be considered as a potential cause of musculoskeletal infections in children with these risk factors. In contrast to previous case reports and case series, children with NTS musculoskeletal infections had a low rate of complications.

From the Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas.

Accepted for publication July 5, 2019.

The authors have no conflicts of interest or funding to disclose.

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Address for correspondence: Sheldon L. Kaplan, MD, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 1102 Bates St., Ste 1150, Houston, TX 77030. E-mail:

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