Galofré J, Moreno A, Mensa J, Miró J M, Gatell J M, Almela M, Claramonte X, Lozano L, Trilla A, Mallolas J
Infectious Diseases, Hospital Clinic i Provincial, University of Barcelona, Spain.
Clin Infect Dis. 1994 Jun;18(6):873-8. doi: 10.1093/clinids/18.6.873.
One-hundred seventy-two consecutive adult patients with salmonella bacteremia documented by at least one positive blood culture were prospectively evaluated over a 10-year period. Salmonella enteritidis was isolated in 121 cases (70.3%), Salmonella typhimurium in 29 (16.9%), and other Salmonella species in 22 (12.8%). Twenty-seven patients (15.7%) developed septic metastasis; 21 patients (12.2%) died of bacteremia, and 24 (16.7%) of the 144 patients who survived had at least one relapse. A logistic regression analysis selected three variables as independently influencing outcome: septic shock (P = .005), coma (P = .029), and immunosuppression (P = .04). By means of the same statistical analysis, leukopenia (a white blood cell count of < 4 x 10(9)/L) was identified as an independent risk factor for relapse (P < .0001). The possibility of salmonella bacteremia must be considered when immunosuppressed patients have fever and no obvious source of infection. Treatment with a drug active against Salmonella species is essential in this population. Patients with leukopenia should be considered as recipients of prophylaxis for relapse.
在10年期间，对172例经至少一次血培养证实为沙门菌血症的成年连续患者进行了前瞻性评估。121例（70.3%）分离出肠炎沙门菌，29例（16.9%）鼠伤寒沙门菌，22例（12.8%）其他沙门菌属。27例患者（15.7%）发生了脓毒症转移；21例患者（12.2%）死于菌血症，在存活的144例患者中，24例（16.7%）至少有一次复发。逻辑回归分析选择了三个独立影响预后的变量：感染性休克（P = .005）、昏迷（P = .029）和免疫抑制（P = .04）。通过同样的统计分析，白细胞减少症（白细胞计数<4×10⁹/L）被确定为复发的独立危险因素（P < .0001）。免疫抑制患者发热且无明显感染源时，必须考虑沙门菌血症的可能性。对该人群使用对沙门菌有效的药物进行治疗至关重要。白细胞减少的患者应被视为预防复发的对象。
