Extraintestinal focal infections in adults with nontyphoid Salmonella bacteraemia: predisposing factors and clinical outcome

• Published in: Journal of internal medicine Vol. 261; no. 1; pp. 91 - 100
• Main Authors: Chen, P.‐L., Chang, C.‐M., Wu, C.‐J., Ko, N.‐Y., Lee, N.‐Y., Lee, H.‐C., Shih, H.‐I., Lee, C.‐C., Wang, R.‐R., Ko, W.‐C.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2007; Blackwell Science
• Subjects: Adult; Aged; Aneurysm, Infected - diagnosis; Aneurysm, Infected - drug therapy; Aneurysm, Infected - mortality; Anti-Bacterial Agents - therapeutic use; bacteraemia; Bacteremia - diagnosis; Bacteremia - drug therapy; Bacteremia - mortality; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Drug Resistance, Bacterial; Epidemiologic Methods; extraintestinal focal infection; Female; Fever - microbiology; Focal Infection - diagnosis; Focal Infection - drug therapy; Focal Infection - mortality; General aspects; Human bacterial diseases; Humans; Infectious diseases; Lung Diseases - diagnosis; Lung Diseases - drug therapy; Lung Diseases - mortality; Male; Medical sciences; Middle Aged; nontyphoid Salmonella; Osteomyelitis - diagnosis; Osteomyelitis - drug therapy; Osteomyelitis - mortality; outcome; Salmonella; Salmonella Infections - diagnosis; Salmonella Infections - drug therapy; Salmonella Infections - mortality; Shock, Septic - diagnosis; Taiwan - epidemiology; Treatment Outcome; Taiwan; Human; Salmonella; Prognosis; bacteraemia; nontyphoid Salmonella; extraintestinal focal infection; Bacteremia; Infection; Medicine; Risk factor; Bacteriosis; Bacteria; Adult; Evolution; Salmonellosis; outcome; Enterobacteriaceae
• ISSN: 0954-6820; 1365-2796
• DOI: 10.1111/j.1365-2796.2006.01748.x

. Background.  Nontyphoid Salmonella (NTS) isolates lead to not only self‐limited, acute gastrointestinal infections, but also bacteraemia with or without extraintestinal focal infections (EFIs). The risk factors associated with EFIs in adults with NTS bacteraemia were not clearly elucidated. Methods.  In a medical center in southern Taiwan, patients aged ≥18 years with NTS bacteraemia between January 1999 and June 2005 were included for analysis. Results.  Of 129 patients, 51 (39.5%) were complicated with EFIs. The most common EFI was mycotic aneurysm, followed by pleuropulmonary infections and spinal osteomyelitis. Compared to patients with primary bacteraemia, those with EFIs had higher leucocyte counts (P = 0.004) and higher serum levels of C‐reactive protein (P < 0.0001). The development of EFIs was associated with a higher mortality, more severe septic manifestations, longer hospital stays and duration of antimicrobial therapy. Univariate analysis revealed that diabetes mellitus (P = 0.02), hypertension (P = 0.02) and chronic lung disease (P = 0.006) were significantly associated with EFIs. However, patients with malignancy (P = 0.01) and immunosuppressive therapy (P = 0.03) were less likely to develop EFIs. On the basis of multivariate analysis, an independent factor for the occurrence of EFIs was age [adjusted odds ratio (aOR) 1.05; 95% confidence interval (CI) 1.02–1.07; P < 0.0001], whilst malignancy was negatively associated with EFIs (aOR 0.16; 95% CI 0.14–0.78; P = 0.01). Conclusion.  Amongst patients with NTS bacteraemia, EFIs often occurred in the aged, and were associated with a higher mortality and morbidity. Recognition of specific host factors is essential for identification of EFIs which often demand early surgical interventions and prolonged antimicrobial therapy.