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Volume 45, Number 5, October 2012

Non-typhoidal Salmonella bacteremia among adults: An adverse prognosis in patients with malignancy


Chia-Wen Li, Po-Lin Chen, Nan-Yao Lee, Hsin-Chun Lee, Chia-Ming Chang, Ching-Chi Lee, Wen-Chien Ko


Received: April 30, 2011    Revised: August 22, 2011    Accepted: August 25, 2011   

 

Corresponding author:

Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan. E-mail address: winston@mail.ncku.edu.tw (W.-C. Ko).



 

Background and purpose: 

Clinical information about non-typhoidal Salmonella (NTS) bacteremia in patients with malignancy has rarely been described. This study investigated clinical characteristics and prognostic variables of patients with malignancy while complicated with NTS bacteremia.



 

Methods:

The study included demographic data, clinical information, and outcome in adults (≥18 years old) with and without malignancy complicated with NTS bacteremia at a medical center from 2000 to 2009.



 

Results:

There were 206 patients with NTS bacteremia. The serogroups of NTS isolates included group B (40.2%), group D (30.9%), group C (26.5%), and group E (1.5%). Extraintestinal infections were noted in 66 (32.4%) patients and were mainly endovascular (26/206, 12.7%) or pleuropulmonary (17/206, 8.3%) infections. On multivariate analysis, independent factors for in-hospital mortality included shock (odds ratio [OR] 9.13; 95% confidence interval [CI] 3.81–21.83; p < 0.001), malignancy (OR 8.42; 95% CI 3.12–22.71; p < 0.001), and acute renal failure (OR 2.63; 95% CI 1.11–6.22; p = 0.028). Different clinical presentations and outcome were noted in 74 (36.2%) patients with malignancy and 130 without malignancy. The former had more leucopenia and thrombocytopenia at initial presentation and fewer extraintestinal infections (20.2% vs. 39.2%,p = 0.005), endovascular infections (2.7% vs. 18.5%; p = 0.002), and serovar Choleraesuis (10.8% vs. 27.7%; p = 0.005). An elevated in-hospital mortality rate was noted in patients with malignancy compared to those without malignancy (40.5% vs.17.7%, p < 0.001). Among patients with malignancy, multivariate analysis revealed that shock was the only independent factor associated with in-hospital mortality (OR 7.52; 95% CI, 2.38–23.80; p = 0.001).

 


 

Conclusion:

Malignancy is an adverse prognostic factor in patients with NTS bacteremia. Food safety in patients with malignancy should be emphasized to prevent salmonellosis.



 

Key words:

MalignancyMortalityNon-typhoidal Salmonella bacteremia