Yen Yung-Fong, Wang Fu-Der, Chiou Chien-Shun, Chen Yin-Yin, Lin Mei-Lin, Chen Te-Li, Liu Cheng-Yi
Section of Infectious Diseases, Taipei Municipal Yang-Ming Hospital, Taipei, Taiwan, R.O.C.
J Chin Med Assoc. 2009 Aug;72(8):408-13. doi: 10.1016/S1726-4901(09)70397-1.
Infections caused by non-typhoid Salmonella (NTS) have increased, and the increasing incidence of multidrug-resistant NTS bacteremia in adult patients has also been noted. This study aimed to investigate the clinical and microbiological characteristics of NTS bacteremia.
A total of 71 episodes of NTS bacteremia among 65 patients were identified between 2004 and 2006. Clinical characteristics were collected from medical records. The agar dilution method described by the Clinical and Laboratory Standards Institute was used to determine the in vitro activities of each antibiotic. Multiple logistic regression analysis was used to evaluate the relationship between patient characteristics and all other covariates studied for prognosis.
Salmonella enteritidis was isolated in 30 cases (42.3%), Salmonella typhimurium in 22 (31.0%), and Salmonella choleraesuis in 19 (26.7%). Thirty-two (45.1%) isolates of 71 NTS bacteremias were susceptible to chloramphenicol, 37 (52.1%) to ampicillin, 47 (66.2%) to trimethoprim/sulfamethoxazole (TMP/SMX), 56 (78.9%) to moxifloxacin, 57 (80.3%) to ciprofloxacin and levofloxacin, and 71 (100%) to ceftriaxone. The crude 30-day mortality rate was 19.7%. In multiple logistic regression analysis, the following variables were independent and significant predictors of mortality: coma (odds ratio, 12.03) and inadequate antibiotic treatment (odds ratio, 6.63).
S. enteritidis was the most frequently isolated serotype. High resistance rates of NTS to some readily available antimicrobials (ampicillin, chloramphenicol, TMP/SMX, fluoroquinolones) were found. Patients with the factor of coma or inadequate antibiotic treatment had poor prognosis.
非伤寒沙门氏菌（NTS）引起的感染有所增加，并且成人患者中耐多药NTS菌血症的发病率也在上升。本研究旨在调查NTS菌血症的临床和微生物学特征。
2004年至2006年间，在65例患者中确定了71例NTS菌血症发作。从病历中收集临床特征。采用临床和实验室标准协会描述的琼脂稀释法测定每种抗生素体外活性。使用多因素逻辑回归分析评估患者特征与所有其他研究的协变量之间对预后的关系。
肠炎沙门氏菌分离出30例（42.3%），鼠伤寒沙门氏菌22例（31.0%），猪霍乱沙门氏菌19例（26.7%）。71例NTS菌血症中有32株（45.1%）对氯霉素敏感，37株（52.1%）对氨苄西林敏感，47株（66.2%）对甲氧苄啶/磺胺甲恶唑（TMP/SMX）敏感，56株（78.9%）对莫西沙星敏感，57株（80.3%）对环丙沙星和左氧氟沙星敏感，71株（100%）对头孢曲松敏感。30天粗死亡率为19.7%。在多因素逻辑回归分析中，以下变量是死亡率的独立且显著预测因素：昏迷（比值比，12.03）和抗生素治疗不足（比值比，6.63）。
肠炎沙门氏菌是最常分离出的血清型。发现NTS对一些常用抗菌药物（氨苄西林、氯霉素、TMP/SMX、氟喹诺酮类）耐药率较高。有昏迷因素或抗生素治疗不足的患者预后较差。
