Extraintestinal focal infections in adults with nontyphoid Salmonella bacteraemia

Predisposing factors and clinical outcome

Po-Lin Chen, Chia-Ming Chang, C. J. Wu, Nai-Ying Ko, Nan-Yao Lee, H. C. Lee, Hsin-I Shih, C. C. Lee, R. R. Wang, Wen-Chien Ko

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)91-100
Number of pages10
JournalJournal of Internal Medicine
Volume261
Issue number1
DOIs
Publication statusPublished - 2007 Jan 1

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Focal Infection
Bacteremia
Salmonella
Causality
Odds Ratio
Confidence Intervals
Infected Aneurysm
Mortality
Osteomyelitis
Immunosuppressive Agents
Infection
Taiwan
Leukocyte Count
C-Reactive Protein
Lung Diseases

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

@article{b92a112aa9a148d19ea3b29c2861f8e7,
title = "Extraintestinal focal infections in adults with nontyphoid Salmonella bacteraemia: Predisposing factors and clinical outcome",
abstract = "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.",
author = "Po-Lin Chen and Chia-Ming Chang and Wu, {C. J.} and Nai-Ying Ko and Nan-Yao Lee and Lee, {H. C.} and Hsin-I Shih and Lee, {C. C.} and Wang, {R. R.} and Wen-Chien Ko",
year = "2007",
month = "1",
day = "1",
doi = "10.1111/j.1365-2796.2006.01748.x",
language = "English",
volume = "261",
pages = "91--100",
journal = "Journal of Internal Medicine",
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TY - JOUR

T1 - Extraintestinal focal infections in adults with nontyphoid Salmonella bacteraemia

T2 - Predisposing factors and clinical outcome

AU - Chen, Po-Lin

AU - Chang, Chia-Ming

AU - Wu, C. J.

AU - Ko, Nai-Ying

AU - Lee, Nan-Yao

AU - Lee, H. C.

AU - Shih, Hsin-I

AU - Lee, C. C.

AU - Wang, R. R.

AU - Ko, Wen-Chien

PY - 2007/1/1

Y1 - 2007/1/1

N2 - 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.

AB - 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.

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