title: A retrospective study of secondary bacteraemia in hospitalised adults with community acquired non-typhoidal Salmonella gastroenteritis.
abstract: BACKGROUND
  The clinical significance of bacteraemia secondary to non-typhoidal Salmonella (NTS) gastroenteritis in hospitalised adults is uncertain.
  
  
  METHODS
  Adults admitted to a hospital in Liverpool, UK, with NTS gastroenteritis were identified using hospital discharge data and laboratory records. Patients with known HIV infection were excluded. Risk factors for a complicated or fatal course were determined.
  
  
  RESULTS
  Between 1982 and 2006 inclusive, 633 adults were identified. Serovars causing infection included Enteritidis (46.6%), Typhimurium (27.6%) and Virchow (4.9%). A blood culture was taken in 364 (57.5%) patients who were generally sicker than those who were not cultured. Bacteraemia was detected in 63 (17.3%) patients who had blood cultures taken (63/633 (10.0%) of all patients). Bacteraemia was more common in those aged ≥ 65 years (p < 0.001) and in those aged < 65 years who had an underlying chronic disease. A complicated course occurred in 91 (25.0%) patients who had had a blood culture taken (148/633 (23.4%) of all patients). Independent factors associated with a complicated or fatal course among the patients investigated with a blood culture were bacteraemia (Adjusted Odds Ratio 5.34, 95% CI 2.86-9.95); new onset confusion or coma (AOR 4.80, 95% CI 1.91-12.07); prolonged symptoms prior to admission (AOR 2.48, 95% CI 1.44-4.27); dehydration (AOR1.90, 95% CI 1.07-3.38); and absence of fever (AOR 0.56, 95% CI 0.32-0.95). The 30 day attributable case fatality for all patients was 1.5%.
  
  
  CONCLUSIONS
  In this study secondary bacteraemia, as well as other clinical factors, was independently associated with a complicated or fatal course in non-HIV infected adults admitted to hospital with NTS gastroenteritis.
authors: Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK. cmparry@liverpool.ac.uk
authors: Christopher M
authors: CM
authors: Parry
authors: Sherine
authors: S
authors: Thomas
authors: Esther J
authors: EJ
authors: Aspinall
authors: Richard P D
authors: RP
authors: Cooke
authors: Stephen J
authors: SJ
authors: Rogerson
authors: Anthony D
authors: AD
authors: Harries
authors: Nicholas J
authors: NJ
authors: Beeching
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology / Q000382:microbiology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012480:Salmonella Infections / Q000453:epidemiology / Q000382:microbiology*; D006113:United Kingdom / Q000453:epidemiology