The risk of vascular infection in adult patients with nontyphi Salmonella bacteremia

Benenson, Shmuel; Raveh, David; Schlesinger, Yechiel; Alberton, Joseph; Rudensky, Bernard; Hadas-Halpern, Irit; Yinnon, Amos M.

doi:10.1016/s0002-9343(00)00638-0

Cited by 88 publications

(51 citation statements)

References 15 publications

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“…Salmonella is a well-recognized cause of endovascular infection in different anatomic sites, of which mycotic aneurysm of the aorta is considered to be the most frequent (13). Among patients above 50 years of age with non-serovar Typhi Salmonella bacteremia, 7 to 10% have been reported to develop arterial infection (2,5,12). In our patient, the muscular abscess most probably originated from an atherosclerotic plaque that had become infected during a transient bacteremic episode.…”

Section: Case Reportmentioning

confidence: 60%

A Pilot with Pain in His Leg: Thigh Abscess Caused by Salmonella enterica Serotype Brandenburg

Björkman¹,

Nilsson²,

Riesbeck

2002

J Clin Microbiol

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Salmonella enterica serotype Brandenburg is one of the more uncommon serotypes isolated from patients with gastroenteritis. Few cases of extraintestinal infections with serotype Brandenburg have been documented. The first case of a serotype Brandenburg-dependent thigh abscess originating from an atherosclerotic pseudoaneurysm of the femoral artery is reported. CASE REPORTDuring a medium-distance flight, a 57-year-old male Caucasian pilot suddenly experienced sharp pain in his right thigh followed by fever. The patient had hypercholesterolemia and non-insulin-dependent diabetes mellitus regulated by diet. In addition, he had previously experienced mild claudicatio intermittens in his right leg and had thus been prescribed acetylsalicylic acid. On the following day, he was seen by his general physician, who found no signs of deep venous thrombosis and prescribed diclofenac for symptomatic relief. During the subsequent week, the thigh swelling increased and the fever persisted. Five days after the initial symptoms, a tender nonfluctuating mass measuring 10 by 15 cm was found in the right thigh adjacent to the groin. A fine-needle puncture of the mass yielded blood only. A week later, magnetic resonance tomography of the thigh showed an extensive swelling surrounded by soft-tissue edema ( Fig. 1A and B). A pseudoaneurysm of the right femoral artery with extensive collateral circulation was identified by intravenous angiography (Fig. 1C). Empirical antibiotic therapy with difloxacillin (750 mg three times orally) was initiated. However, the patient's condition deteriorated with expansion of the soft tissue mass and persistent fever. The patient was admitted to the hospital. On admission, the leukocyte count was 16.6 ϫ 10 9 /liter with a predominance of neutrophils, the erythrocyte sedimentation rate and C-reactive protein level were 84 mm/h and 160 mg/liter, respectively, and the hemoglobin level was 124 g/liter. Liver and renal function tests were normal. Therapy with intravenously administered cefuroxime was initiated, after which the fever disappeared; however, the soft tissue mass remained unchanged. Three weeks after onset of symptoms, an abscess in the thigh muscles with close connection to the femur was incised and drained of pus. The patient's condition improved rapidly after the surgical intervention. Culture of pus from the abscess revealed growth of Salmonella species strain O4. Bone scintigraphy showed no pathological uptake in the femur or elsewhere in the skeleton. The patient was treated with oral levofloxacin for 3 months with no signs of recurrent infection. Interestingly, 2 weeks prior to the onset of disease, our patient had been to Tunisia, where he had experienced transient gastrointestinal discomfort without diarrhea or fever.The bacterial organism was isolated from the abscess fluid after 4 days of incubation using aerobic flasks with liquid medium (BacT/Alert; Organon Teknika). The isolate was subcultured onto supplemented human blood agar plates containing Columbia II agar, L-cysteine, hemin,...

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Section: Case Reportmentioning

confidence: 60%

A Pilot with Pain in His Leg: Thigh Abscess Caused by Salmonella enterica Serotype Brandenburg

Björkman¹,

Nilsson²,

Riesbeck

2002

J Clin Microbiol

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“…125,190,[197][198][199] Previously, gram-negative bacilli, especially nontyphoidal Salmonella, were more common than staphylococci, but now they account for at least 30% to 40% of cases. 125,[200][201][202] Salmonella enteritidis, Salmonella choleraesuis, and other nontyphoidal strains are more common causes of abdominal aortic MA in Asia. Salmonella nontyphoidal strains have a special predilection to infect vascular tissue.…”

Section: Microbiologymentioning

confidence: 99%

“…Salmonella nontyphoidal strains have a special predilection to infect vascular tissue. [200][201][202][203] The mechanism for this is poorly understood. The presumed portal of entry is the gastrointestinal tract.…”

Section: Microbiologymentioning

confidence: 99%

“…Approximately 25% of patients aged ≥50 years with Salmonella species bacteremia have an endovascular focus of infection. [200][201][202][203] Other gram-negative bacilli can also cause aortic MA. Arizona species, especially A hinshawii, cause gastroenteritis and other infectious diseases similar to those of Salmonella species and can infect the abdominal aorta, especially in elderly diabetic men with a history of cigarette smoking and atherosclerotic peripheral vascular disease.…”

Section: Microbiologymentioning

confidence: 99%

“…Sustained Salmonella nontyphoidal bacteremia in a patient with abdominal aortic aneurysm is highly suggestive of arteritis or MA. [200][201][202][203] Sustained Salmonella nontyphoidal bacteremia can cause distal site infection, including vertebral osteomyelitis, septic arthritis, hepatic abscess, or other infection, but these distal infections are usually the result of Salmonella endovascular infection, not the cause of the endovascular infection. In addition to positive blood cultures, stool cultures can also be positive for nontyphoidal Salmonella.…”

Section: Laboratory Findingsmentioning

confidence: 99%

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Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

364

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Management of aortic aneurysm infected with Salmonella

Hsu

Tsay

Wang

et al. 2003

British Journal of Surgery

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The risk of vascular infection in adult patients with nontyphi Salmonella bacteremia

Cited by 88 publications

References 15 publications

A Pilot with Pain in His Leg: Thigh Abscess Caused by Salmonella enterica Serotype Brandenburg

A Pilot with Pain in His Leg: Thigh Abscess Caused by Salmonella enterica Serotype Brandenburg

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Management of aortic aneurysm infected with Salmonella

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