Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
BMC Infect Dis. 2011 Oct 19;11:277. doi: 10.1186/1471-2334-11-277.
Information is sparse regarding the association between international travel and hospitalization with non-typhoidal Salmonella bacteremia. The aim of this study was to determine the proportion, risk factors and outcomes of travel-related non-typhoidal Salmonella bacteremia.
We conducted a 10-year population-based cohort study of all patients hospitalized with non-typhoidal Salmonella bacteremia in three Danish counties (population 1.6 million). We used denominator data on Danish travellers to assess the risk per 100,000 travellers according to age and travel destination. We used patients contemporaneously diagnosed with travel-related Salmonella gastroenteritis as reference patients to estimate the relative risk of presenting with travel-related bacteremia as compared with gastroenteritis. To evaluate clinical outcomes, we compared patients with travel-related bacteremia and patients with domestically acquired bacteremia in terms of length of hospital stay, number of extraintestinal focal infections and mortality after 30 and 90 days.
We identified 311 patients hospitalized with non-typhoidal Salmonella bacteremia of whom 76 (24.4%) had a history of international travel. The risk of travel-related bacteremia per traveller was highest in the age groups 15-24 years (0.8/100,000 travellers) and 65 years and above (1.2/100,000 travellers). The sex- and age-adjusted relative risk of presenting with bacteremia was associated with travel to Sub-Saharan Africa (odds ratio 18.4; 95% confidence interval [6.9-49.5]), the Middle East (10.6; [2.1-53.2]) and South East Asia (4.0; [2.2-7.5]). We found high-risk countries in the same three regions when estimating the risk per traveller according to travel destination. Patients hospitalized with travel-related bacteremia had better clinical outcomes than patients with domestically acquired bacteremia, they had a shorter length of hospital stay (8 vs. 11 days), less extraintestinal focal infections (5 vs. 31 patients) and a lower risk of death within both 30 days (relative risk 0.2; [0.1-0.7]) and 90 days (0.3; [0.1-0.7]). A healthy traveller effect was a plausible explanation for the observed differences in outcomes.
International travel is a notable risk factor for being hospitalized with non-typhoidal Salmonella bacteremia and the risk differs between age groups and travel destinations. Healthy travellers hospitalized with bacteremia are less likely to have poor outcomes than patients with domestically acquired bacteremia.
有关国际旅行与非伤寒沙门氏菌菌血症住院之间关联的信息很少。本研究的目的是确定与旅行相关的非伤寒沙门氏菌菌血症的比例、危险因素和结局。
我们对丹麦三个县（人口 160 万）中所有非伤寒沙门氏菌菌血症住院患者进行了一项为期 10 年的基于人群的队列研究。我们使用丹麦旅行者的分母数据，根据年龄和旅行目的地，评估每 100,000 名旅行者的风险。我们使用同时诊断为旅行相关沙门氏菌肠胃炎的患者作为参考患者，以估计与肠胃炎相比，出现旅行相关菌血症的相对风险。为了评估临床结局，我们比较了旅行相关菌血症患者和国内获得性菌血症患者的住院时间、肠外局灶感染数量以及 30 天和 90 天后的死亡率。
我们共确定了 311 名患有非伤寒沙门氏菌菌血症的住院患者，其中 76 名（24.4%）有国际旅行史。旅行者中旅行相关菌血症的风险在 15-24 岁年龄组（0.8/100,000 名旅行者）和 65 岁及以上年龄组（1.2/100,000 名旅行者）最高。经性别和年龄调整后，与前往撒哈拉以南非洲（比值比 18.4；95%置信区间 [6.9-49.5]）、中东（10.6；[2.1-53.2]）和东南亚（4.0；[2.2-7.5]）有关的菌血症发病风险与旅行相关。当根据旅行目的地估计每位旅行者的风险时，我们在相同的三个地区发现了高风险国家。与国内获得性菌血症患者相比，旅行相关菌血症患者的临床结局更好，住院时间更短（8 天 vs. 11 天），肠外局灶感染更少（5 例 vs. 31 例），30 天内（相对风险 0.2；[0.1-0.7]）和 90 天内（0.3；[0.1-0.7]）的死亡率风险也更低。健康旅行者效应是观察到结局差异的一个合理解释。
国际旅行是患非伤寒沙门氏菌菌血症住院的一个显著危险因素，其风险在年龄组和旅行目的地之间存在差异。与国内获得性菌血症患者相比，旅行相关菌血症患者住院期间发生不良结局的可能性较低。
