成人非伤寒沙门氏菌菌血症：恶性肿瘤患者预后不良。
Non-typhoidal Salmonella bacteremia among adults: an adverse prognosis in patients with malignancy.
机构信息
Division of Infectious Diseases, Department of Internal medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
出版信息
J Microbiol Immunol Infect. 2012 Oct;45(5):343-9. doi: 10.1016/j.jmii.2011.12.015. Epub 2011 Dec 29.
BACKGROUND
Clinical information about non-typhoidal Salmonella (NTS) bacteremia in patients with malignancy has rarely been described. This study investigated clinical characteristics and prognostic variables of patients with malignancy while complicated with NTS bacteremia.
METHODS
The study included demographic data, clinical information, and outcome in adults (≥18 years old) with and without malignancy complicated with NTS bacteremia at a medical center from 2000 to 2009.
RESULTS
There were 206 patients with NTS bacteremia. The serogroups of NTS isolates included group B (40.2%), group D (30.9%), group C (26.5%), and group E (1.5%). Extraintestinal infections were noted in 66 (32.4%) patients and were mainly endovascular (26/206, 12.7%) or pleuropulmonary (17/206, 8.3%) infections. On multivariate analysis, independent factors for in-hospital mortality included shock (odds ratio [OR] 9.13; 95% confidence interval [CI] 3.81-21.83; p < 0.001), malignancy (OR 8.42; 95% CI 3.12-22.71; p < 0.001), and acute renal failure (OR 2.63; 95% CI 1.11-6.22; p = 0.028). Different clinical presentations and outcome were noted in 74 (36.2%) patients with malignancy and 130 without malignancy. The former had more leucopenia and thrombocytopenia at initial presentation and fewer extraintestinal infections (20.2% vs. 39.2%, p = 0.005), endovascular infections (2.7% vs. 18.5%; p = 0.002), and serovar Choleraesuis (10.8% vs. 27.7%; p = 0.005). An elevated in-hospital mortality rate was noted in patients with malignancy compared to those without malignancy (40.5% vs. 17.7%, p < 0.001). Among patients with malignancy, multivariate analysis revealed that shock was the only independent factor associated with in-hospital mortality (OR 7.52; 95% CI, 2.38-23.80; p = 0.001).
CONCLUSION
Malignancy is an adverse prognostic factor in patients with NTS bacteremia. Food safety in patients with malignancy should be emphasized to prevent salmonellosis.
背景
有关恶性肿瘤患者中非伤寒沙门氏菌（NTS）菌血症的临床信息很少有描述。本研究调查了 2000 年至 2009 年期间在一家医疗中心患有恶性肿瘤且并发 NTS 菌血症的成人患者的临床特征和预后变量。
方法
本研究纳入了年龄≥18 岁的恶性肿瘤合并与不合并 NTS 菌血症患者的人口统计学数据、临床信息和结局。
结果
共 206 例 NTS 菌血症患者。NTS 分离株的血清型包括 B 群（40.2%）、D 群（30.9%）、C 群（26.5%）和 E 群（1.5%）。66 例（32.4%）患者存在肠外感染，主要为血管内（26/206，12.7%）或胸膜肺（17/206，8.3%）感染。多变量分析显示，院内死亡的独立危险因素包括休克（比值比[OR]9.13；95%置信区间[CI]3.81-21.83；p<0.001）、恶性肿瘤（OR 8.42；95% CI 3.12-22.71；p<0.001）和急性肾衰竭（OR 2.63；95% CI 1.11-6.22；p=0.028）。74 例（36.2%）恶性肿瘤患者和 130 例无恶性肿瘤患者的临床表现和结局存在差异。前者初诊时白细胞减少和血小板减少更为常见，肠外感染（20.2%比 39.2%，p=0.005）、血管内感染（2.7%比 18.5%，p=0.002）和血清型霍乱弧菌（10.8%比 27.7%，p=0.005）较少。与无恶性肿瘤的患者相比，恶性肿瘤患者的院内死亡率较高（40.5%比 17.7%，p<0.001）。在恶性肿瘤患者中，多变量分析显示，休克是与院内死亡相关的唯一独立因素（OR 7.52；95% CI，2.38-23.80；p=0.001）。
结论
恶性肿瘤是 NTS 菌血症患者不良预后的危险因素。应强调恶性肿瘤患者的食品安全，以预防沙门氏菌病。
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