Non-typhoidal Salmonella bacteremia among adults: An adverse prognosis in patients with malignancy

Abstract

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. 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. 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). Malignancy is an adverse prognostic factor in patients with NTS bacteremia. Food safety in patients with malignancy should be emphasized to prevent salmonellosis.