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Abstract
Clinical relevance of nontyphoid Salmonella bacteremia in HIV and other immunosuppressed Mexican patients from 1992 to 2003
Y.A. Vargas-Infante1, A. Cravioto2, C. Del Río3, A. Navarro2, J.G. Sierra-Madero1, J. Sifuentes-Osornio1, L.E. Soto-Ramírez1, F. Tuz-Dzib1, A. Villasís-Keever1, G.M. Ruiz-Palacios1
Background: Our objective was to evaluate the frequency and morbimortality of nontyphoid Salmonella bacteremia and the prevalence of multidrug-resistant strains (MDR-NTSb) in Mexican HIV and non-HIV immunosuppressed patients.
Methods: Retrospective study of all patients with NTSb diagnosed at the INCMNSZ in Mexico City between 1992-2003. Strain identification and antimicrobial susceptibility were determined by antigenic profile and broth microdilution tests, respectively [CLSI 2005 guidelines]. Demographic, clinical and microbiological data were analyzed. Statistical analysis included Pearson’s chi square, Fisher’s tests; Wilcoxon and ANOVA. We asses the risk of MDR-NTSb in both univariate and multivariate models as a function of serotype, MDR, recurrence and death.
Results: We identified 103 patients with NTSb. Thirty seven (36%) were HIV+, 30 (29%) had systemic lupus erythematosus (SLE) and 36 (35%) other illness. Fifty six (54%) were men, median age of 35 yrs (range 17-84). Among HIV patients the median CD4+ count was 43/uL (range 4-253; 49% had <50/uL). Serotype was determined in 83 (80%) strains (Enteritidis 44, Choleraesuis 21, Typhimurium 12 and other 6). S. Choleraesuis was more frequent among HIV+ than HIV- patients [RR 3.7 [95%CI 1.5-9.1). MDR was identified in 16/37 (43%) strains of HIV+ and 12/30 (40%) of SLE patients (p=NS). Prevalence of MDR increased after the year 2000 [RR 5.8 (95%CI 2.2-14.9)], and it was associated with serotype Choleraesuis [RR 2.0 (95%CI 1.0-4.0)]. Time on CoTp did not correlate with MDR among the HIV-infected. Recurrent bacteremia occurred in 13.5% (n=14), and was independently associated with Choleraesuis serotype [RR 3.5 (95% 1.2-10.1)], but not with HIV serostatus nor MDR. Absolute mortality was 34% (n=35), and attributable mortality was 17% (n=18). There was no increased risk in mortality due to MDR.
Conclusions: In the last decade we have observed a 1.7-fold increase in MDR-NTSb. The risk of MDR, recurrence and death were similar among HIV and other immunosuppressed patients.
AIDS 2006 - XVI International AIDS Conference
Abstract no.
CDB0198
Suggested Citation
"Y.A.Vargas-Infante, et al.
Clinical relevance of nontyphoid Salmonella bacteremia in HIV and other immunosuppressed Mexican patients from 1992 to 2003.
:
AIDS 2006 - XVI International AIDS Conference:
Abstract no.
CDB0198"
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