title: Salmonella enterica subspecies arizonae infection of adult patients in Southern Taiwan: a case series in a non-endemic area and literature review.
abstract: BACKGROUND
  The majority of Salmonella arizonae human infections have been reported in southwestern United States, where rattlesnake-based products are commonly used to treat illness; however, little is known in non-endemic areas. We reviewed and analyzed the clinical manifestations and treatment outcomes in adult patients with S. arizonae infection at our institution.
  
  
  METHODS
  A retrospective study was conducted at a regional teaching hospital in southern Taiwan from July 2007 to June 2014. All adult patients diagnosed with S. arizonae infections and treated for at least three days at Chia-Yi Christian Hospital were included. Patients were followed till discharge.
  
  
  RESULTS
  A total of 18 patients with S. arizonae infections (median age: 63.5 years) were enrolled for analysis, of whom two thirds were male. The three leading underlying diseases were diabetes mellitus, peptic ulcer disease and malignancy. Ten patients had bacteraemia and the most common infection focus was the lower respiratory tract. Most of the patients (72.2%) received third-generation cephalosporins as definitive therapy. In contrast, ampicillin-based regimens (accounting for 45.2%) were the major treatment modalities in previous reports. The crude in-hospital mortality was 5.6%, which was much lower than what was previously reported (22.7%).
  
  
  CONCLUSIONS
  Though uncommon, there were cases of S. arizonae infections in Taiwan. Patients receiving third-generation cephalosporins treatment had better prognosis compared with those treated with ampicillin-based regimen.
authors.affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
authors.forename: Yi-Chien
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Miao-Chiu
authors.initials: MC
authors.lastname: Hung
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Sheng-Che
authors.initials: SC
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
authors.forename: Hung-Ping
authors.initials: HP
authors.lastname: Wang
authors.affiliation: Department of Nursing, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Cho
authors.affiliation: Department of Laboratory Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
authors.forename: Mei-Chu
authors.initials: MC
authors.lastname: Lai
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, 10002, Taiwan. 14bcr@yahoo.com.tw.
authors.forename: Jann-Tay
authors.initials: JT
authors.lastname: Wang
mesh_terms: D000368:Aged; D000667:Ampicillin / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D002511:Cephalosporins / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012480:Salmonella Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D012476:Salmonella arizonae / Q000472:pathogenicity*; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D002511:Cephalosporins; D000667:Ampicillin
keywords: Ampicillin; Peptic ulcer disease; Proton pump inhibitors; Salmonella arizonae; Third generation cephalosporins