Analysis of factors influencing the outcome and development of septic metastasis or relapse in Salmonella bacteremia.
One-hundred seventy-two consecutive adult patients with salmonella bacteremia documented by at least one positive blood culture were prospectively evaluated over a 10-year period. Salmonella enteritidis was isolated in 121 cases (70.3%), Salmonella typhimurium in 29 (16.9%), and other Salmonella species in 22 (12.8%). Twenty-seven patients (15.7%) developed septic metastasis; 21 patients (12.2%) died of bacteremia, and 24 (16.7%) of the 144 patients who survived had at least one relapse. A logistic regression analysis selected three variables as independently influencing outcome: septic shock (P = .005), coma (P = .029), and immunosuppression (P = .04). By means of the same statistical analysis, leukopenia (a white blood cell count of < 4 x 10(9)/L) was identified as an independent risk factor for relapse (P < .0001). The possibility of salmonella bacteremia must be considered when immunosuppressed patients have fever and no obvious source of infection. Treatment with a drug active against Salmonella species is essential in this population. Patients with leukopenia should be considered as recipients of prophylaxis for relapse.
Galofré
J
J
Infectious Diseases, Hospital Clinic i Provincial, University of Barcelona, Spain.
Moreno
A
A
Mensa
J
J
Miró
J M
JM
Gatell
J M
JM
Almela
M
M
Claramonte
X
X
Lozano
L
L
Trilla
A
A
Mallolas
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012480:Salmonella Infections / Q000175:diagnosis / Q000382:microbiology*; D012477:Salmonella enteritidis