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Open Access Research article

A retrospective study of secondary bacteraemia in hospitalised adults with community acquired non-typhoidal Salmonella gastroenteritis

Christopher M Parry12345*, Sherine Thomas1, Esther J Aspinall26, Richard PD Cooke5, Stephen J Rogerson17, Anthony D Harries189 and Nicholas J Beeching110

Author Affiliations

1 Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK

2 School of Clinical Infection, Immunology and Medical Microbiology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK

3 Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK

4 Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

5 Department of Medical Microbiology, University Hospital Aintree, Aintree, UK

6 Health Protection Scotland, Glasgow, Scotland, UK

7 Department of Medicine (RMH), University of Melbourne, Parkville, VIC 3010, Australia

8 London School of Hygiene and Tropical Medicine, London, UK

9 International Union Against Tuberculosis and Lung Disease, Paris, France

10 Clinical Group, Liverpool School of Tropical Medicine, Liverpool, UK

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BMC Infectious Diseases 2013, 13:107  doi:10.1186/1471-2334-13-107

Published: 27 February 2013

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.

Keywords:
Salmonella; Bacteraemia; Gastroenteritis; Adults; Complications