頁籤選單縮合
題 名 | Extraintestinal Focal Infections in Adults with Salmonella Enterica Serotype Choleraesuis Bacteremia |
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作 者 | 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; | 書刊名 | 微免與感染雜誌 |
卷 期 | 40:3 2007.06[民96.06] |
頁 次 | 頁240-247 |
分類號 | 414.83 |
關鍵詞 | Bacteremia; Drug resistance; Bacterial; Microbial sensitivity tests; Mortality; Salmonella enterica; |
語 文 | 英文(English) |
英文摘要 | 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: 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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