Extraintestinal focal infections in adults with Salmonella enterica serotype Choleraesuis bacteremia

Po-Lin Chen, Chi Jung Wu, Chia-Ming Chang, Hsin Chun Lee, Nan-Yao Lee, Hsin-I Shih, Ching Chi Lee, Nai-Ying Ko, Li Rong Wang, Wen-Chien Ko

Research output: Contribution to journalArticle

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Abstract

Background and Purpose: Salmonella enterica serotype Choleraesuis, which is associated with severe human infections and multidrug resistance, poses a serious problem in Taiwan. The aim of the study was to investigate the epidemiology and clinical features of S. Choleraesuis bacteremia. Methods: Medical records and antimicrobial susceptibility of blood isolates were investigated for 43 adults (≥18 years old) with S, Choleraesuis bacteremia from 1999 to 2005. Results: The proportion of S. Choleraesuis in non-typhoidal Salmonella bacteremia increased in the latter three years (2003-2005). The elderly with aged-related disorders, and younger patients receiving immunosuppressive therapy for their underlying diseases were two high-risk groups. Twenty cases (47%) had extraintestinal focal infections, including 10 cases of mycotic aneurysm, six of osteomyelitis, and 4 pleuropulmonary infections. Univariate analysis revealed that age ≥50 years was associated with occurrence of endovascular infection (p=0.008), while immunosuppressive therapy was negatively associated with endovascular infection (0=0.043). Significant resistance to first-line antimicrobial agents (i.e., ampicillin, trimethoprim-sulfamethoxazole or chloramphenicol) was noted. All strains were resistant to nalidixic acid, and 56% were resistant to ciprofloxacin. Few (<5%) isolates were resistant to ceftriaxone, and all were susceptible to cefepime, aztreonam, imipenem, meropenem and ertapenem. Multivariate analysis showed that shock (odds ratio [OR], 20.6; 95% confidence interval [CI], 1.8-239.4; p=0.016) and apyrexia (OR, 36.2; 95% CI, 3.7-358.2; p=0.002) were independent risk factors for mortality. Conclusion: S. Choleraesuis bacteremia was usually complicated with extraintestinal focal infections in the elderly. With a high level of resistance among S. Choleraesuis, fluoroquinolones should be avoided for critically ill patients with suspected Salmonella bacteremia.

Original languageEnglish
Pages (from-to)240-247
Number of pages8
JournalJournal of Microbiology, Immunology and Infection
Volume40
Issue number3
Publication statusPublished - 2007 Jun 1

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Focal Infection
Salmonella enterica
Bacteremia
meropenem
Immunosuppressive Agents
Infection
Salmonella
Odds Ratio
Confidence Intervals
Infected Aneurysm
Aztreonam
Nalidixic Acid
Ceftriaxone
Imipenem
Fluoroquinolones
Sulfamethoxazole Drug Combination Trimethoprim
Multiple Drug Resistance
Osteomyelitis
Chloramphenicol
Ampicillin

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{9c2213a7ab794ccc85507cc3fd3c4a02,
title = "Extraintestinal focal infections in adults with Salmonella enterica serotype Choleraesuis bacteremia",
abstract = "Background and Purpose: Salmonella enterica serotype Choleraesuis, which is associated with severe human infections and multidrug resistance, poses a serious problem in Taiwan. The aim of the study was to investigate the epidemiology and clinical features of S. Choleraesuis bacteremia. Methods: Medical records and antimicrobial susceptibility of blood isolates were investigated for 43 adults (≥18 years old) with S, Choleraesuis bacteremia from 1999 to 2005. Results: The proportion of S. Choleraesuis in non-typhoidal Salmonella bacteremia increased in the latter three years (2003-2005). The elderly with aged-related disorders, and younger patients receiving immunosuppressive therapy for their underlying diseases were two high-risk groups. Twenty cases (47{\%}) had extraintestinal focal infections, including 10 cases of mycotic aneurysm, six of osteomyelitis, and 4 pleuropulmonary infections. Univariate analysis revealed that age ≥50 years was associated with occurrence of endovascular infection (p=0.008), while immunosuppressive therapy was negatively associated with endovascular infection (0=0.043). Significant resistance to first-line antimicrobial agents (i.e., ampicillin, trimethoprim-sulfamethoxazole or chloramphenicol) was noted. All strains were resistant to nalidixic acid, and 56{\%} were resistant to ciprofloxacin. Few (<5{\%}) isolates were resistant to ceftriaxone, and all were susceptible to cefepime, aztreonam, imipenem, meropenem and ertapenem. Multivariate analysis showed that shock (odds ratio [OR], 20.6; 95{\%} confidence interval [CI], 1.8-239.4; p=0.016) and apyrexia (OR, 36.2; 95{\%} CI, 3.7-358.2; p=0.002) were independent risk factors for mortality. Conclusion: S. Choleraesuis bacteremia was usually complicated with extraintestinal focal infections in the elderly. With a high level of resistance among S. Choleraesuis, fluoroquinolones should be avoided for critically ill patients with suspected Salmonella bacteremia.",
author = "Po-Lin Chen and Wu, {Chi Jung} and Chia-Ming Chang and Lee, {Hsin Chun} and Nan-Yao Lee and Hsin-I Shih and Lee, {Ching Chi} and Nai-Ying Ko and Wang, {Li Rong} and Wen-Chien Ko",
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Extraintestinal focal infections in adults with Salmonella enterica serotype Choleraesuis bacteremia. / Chen, Po-Lin; Wu, Chi Jung; Chang, Chia-Ming; Lee, Hsin Chun; Lee, Nan-Yao; Shih, Hsin-I; Lee, Ching Chi; Ko, Nai-Ying; Wang, Li Rong; Ko, Wen-Chien.

In: Journal of Microbiology, Immunology and Infection, Vol. 40, No. 3, 01.06.2007, p. 240-247.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Extraintestinal focal infections in adults with Salmonella enterica serotype Choleraesuis bacteremia

AU - Chen, Po-Lin

AU - Wu, Chi Jung

AU - Chang, Chia-Ming

AU - Lee, Hsin Chun

AU - Lee, Nan-Yao

AU - Shih, Hsin-I

AU - Lee, Ching Chi

AU - Ko, Nai-Ying

AU - Wang, Li Rong

AU - Ko, Wen-Chien

PY - 2007/6/1

Y1 - 2007/6/1

N2 - Background and Purpose: Salmonella enterica serotype Choleraesuis, which is associated with severe human infections and multidrug resistance, poses a serious problem in Taiwan. The aim of the study was to investigate the epidemiology and clinical features of S. Choleraesuis bacteremia. Methods: Medical records and antimicrobial susceptibility of blood isolates were investigated for 43 adults (≥18 years old) with S, Choleraesuis bacteremia from 1999 to 2005. Results: The proportion of S. Choleraesuis in non-typhoidal Salmonella bacteremia increased in the latter three years (2003-2005). The elderly with aged-related disorders, and younger patients receiving immunosuppressive therapy for their underlying diseases were two high-risk groups. Twenty cases (47%) had extraintestinal focal infections, including 10 cases of mycotic aneurysm, six of osteomyelitis, and 4 pleuropulmonary infections. Univariate analysis revealed that age ≥50 years was associated with occurrence of endovascular infection (p=0.008), while immunosuppressive therapy was negatively associated with endovascular infection (0=0.043). Significant resistance to first-line antimicrobial agents (i.e., ampicillin, trimethoprim-sulfamethoxazole or chloramphenicol) was noted. All strains were resistant to nalidixic acid, and 56% were resistant to ciprofloxacin. Few (<5%) isolates were resistant to ceftriaxone, and all were susceptible to cefepime, aztreonam, imipenem, meropenem and ertapenem. Multivariate analysis showed that shock (odds ratio [OR], 20.6; 95% confidence interval [CI], 1.8-239.4; p=0.016) and apyrexia (OR, 36.2; 95% CI, 3.7-358.2; p=0.002) were independent risk factors for mortality. Conclusion: S. Choleraesuis bacteremia was usually complicated with extraintestinal focal infections in the elderly. With a high level of resistance among S. Choleraesuis, fluoroquinolones should be avoided for critically ill patients with suspected Salmonella bacteremia.

AB - Background and Purpose: Salmonella enterica serotype Choleraesuis, which is associated with severe human infections and multidrug resistance, poses a serious problem in Taiwan. The aim of the study was to investigate the epidemiology and clinical features of S. Choleraesuis bacteremia. Methods: Medical records and antimicrobial susceptibility of blood isolates were investigated for 43 adults (≥18 years old) with S, Choleraesuis bacteremia from 1999 to 2005. Results: The proportion of S. Choleraesuis in non-typhoidal Salmonella bacteremia increased in the latter three years (2003-2005). The elderly with aged-related disorders, and younger patients receiving immunosuppressive therapy for their underlying diseases were two high-risk groups. Twenty cases (47%) had extraintestinal focal infections, including 10 cases of mycotic aneurysm, six of osteomyelitis, and 4 pleuropulmonary infections. Univariate analysis revealed that age ≥50 years was associated with occurrence of endovascular infection (p=0.008), while immunosuppressive therapy was negatively associated with endovascular infection (0=0.043). Significant resistance to first-line antimicrobial agents (i.e., ampicillin, trimethoprim-sulfamethoxazole or chloramphenicol) was noted. All strains were resistant to nalidixic acid, and 56% were resistant to ciprofloxacin. Few (<5%) isolates were resistant to ceftriaxone, and all were susceptible to cefepime, aztreonam, imipenem, meropenem and ertapenem. Multivariate analysis showed that shock (odds ratio [OR], 20.6; 95% confidence interval [CI], 1.8-239.4; p=0.016) and apyrexia (OR, 36.2; 95% CI, 3.7-358.2; p=0.002) were independent risk factors for mortality. Conclusion: S. Choleraesuis bacteremia was usually complicated with extraintestinal focal infections in the elderly. With a high level of resistance among S. Choleraesuis, fluoroquinolones should be avoided for critically ill patients with suspected Salmonella bacteremia.

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