Abstract: Background:Invasive bloodstream infections with nontyphoid salmonella (NTS) can result in septicemia, and untimely diagnosis and treatment can lead to severe complications and death. Objective:To summarize and analyze the clinical features and treatment experience of NTS septicemia in children. Design:Case series report. Methods:Children diagnosed with NTS septicemia by blood culture at the Sichuan University West China Second University Hospital from November 2017 to October 2022 were enrolled. Data on general information, clinical manifestations, laboratory examinations, treatments, and prognosis of the children were collected through the hospital medical record system. Main outcome measures:Discharge with improvement or death. Results:A total of 13 children with NTS septicemia were enrolled, and the age of onset was 1 year (0.9, 6 years), of which 10 were <5 years. Five were males and 7 had comorbidities. The source of infection was unknown except for one patient who had eaten infected food. The time of onset was from July to September（76.9%）. All patients had a high fever, and 10 (76.9%) had a fever as their first symptom; 6 had diarrhea and 6 had cough. The rest symptoms included shortness of breath, depression, convulsions, vomiting, bloody stools, rash, bone and joint pain, wheezing, cyanosis, and jaundice. There were 6 cases of gastroenteritis, 5 cases of pneumonia, and 1 case of meningitis and 1 case of osteomyelitis. Laboratory result showed increased WBC in 3 cases, increased PLT in 3 cases, increased CRP in 8 cases, increased PCT in 6 cases, decreased Hb in 6 cases, and increased ALT/AST in 6 cases. Blood cultures obtained 3 cases of Salmonella Enteritidis and Salmonella Typhimurium respectively, and 1 case of Salmonella Derby, Salmonella Dublin and Salmonella Newlands respectively, and 4 untyped cases. The blood culture turned negative at 5 (4.5, 13.5) days. Twelve were drugresistant and 7 were multidrugresistant. High resistance rates were observed for amikacin (92.3%), tobramycin (92.3%), and gentamicin (92.3%), followed by ampicillin (69.2%) and sulfamethoxazole/trimethoprim (30.8%). No carbapenems were resistant. Most were sensitive to third and fourthgeneration cephalosporins and aztreonam. The duration of the antibiotic therapy was 17 (14, 21.5) days. All of 13 children recovered and were discharged. Conclusions:NTS septicemia occurs mostly in children under 5 years old with a high fever as the common clinical manifestation and is likely to be accompanied by gastrointestinal symptoms. The diagnosis depends on pathogenetic testing. Thirdgeneration cephalosporins are recommended for empirical treatment, and most patients can obtain a good clinical outcome. Carbapenems are recommended for patients with ineffective firstline therapy and severe infections.

Key words: Non-typhoid salmonella, Septicemia, Children, Clinical features, Antibiotic resistance