Chiu et al studied patients with non-typhoidal Salmonella infections who developed extraintestinal infections (EII). A patient with nontyphoidal Salmonella gastroenteritis and risk factors for EII may benefit from prophylactic antibiotics to reduce the probability of invasive disease. The authors are from Chang Gung University in Taoyuan, Taiwan.
Patient selection:
(1) infection with Salmonella species other than S. typhi
(2) not AIDS-related
Gastroenteritis |
Focal Infection |
Bacteremia |
Type EII |
absent |
present |
absent |
localized infection |
absent |
present |
present |
primary bacteremia |
absent |
absent |
present |
primary bacteremia |
present |
present |
present |
secondary bacteremia |
present |
absent |
present |
secondary bacteremia |
present |
present |
absent |
localized infection |
where:
• There are 8 combinations for gastroenteritis, focal infection and bacteremia.
• Gastroenteritis without focal infection or bacteremia (present, absent, absent) was considered intestinal disease.
Risk factors in pediatric patients:
(1) age < 3 years of age
(2) WBC count either < 5,000 per µL or > 15,000 per µL
(3) immature neutrophil forms > 10% of the peripheral blood differential count
(4) C reactive protein > 50 mg/L
Risk factors in adults:
(1) underlying disease, especially immunosuppression, cirrhosis, diabetes mellitus or cancer
(2) age >= 60 years
(3) presence of an invasive serotype (high invasion index) such as choleraesuis, Norwich, or Dublin
Limitations:
• The authors refer to anyone >= 60 years of age as being old.
Specialty: Infectious Diseases, Gastroenterology, Nutrition