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Volume 40, Number 3, June 2007

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
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan; Department of Internal Medicine, National Cheng Kung University, Tainan; Department of Nursing, National Cheng Kung University Hospital, Tainan; Department of Nursing, National Cheng Kung University, Tainan; and Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan

Received: March 30, 2006    Revised: April 19, 2006    Accepted: May 31, 2006   

 

Corresponding author:

Wen-Chien Ko, M.D., Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Roda, Tainan 704, Taiwan. E-mail: winston@mail.ncku.edu.tw This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Background and purpose: 

Salmonella entericaserotype 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 (p=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:

.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.

 



 

Key words:

Bacteremia; Drug resistance, bacterial; Microbial sensitivity tests; Mortality, Salmonella enterica



 

J Microbiol Immunol Infect. 2007;40:240-247.