PP14 -Patient demographics and the varying clinical presentation of invasive salmonellosis with positive blood cultures: An analysis of a decade-long database

Abstract

Introduction

Salmonella is an enteric pathogen that causes both intestinal and extraintestinal disease, ranging from self-limiting gastroenteritis to invasive disease complicated with empyema, abscess, or other serious illnesses.

Objectives

To assess patient demography and to determine the clinical presentations, risk factors, and laboratory parameters in blood culture (BC) positive salmonellosis.

Design, setting, and methods

Anonymized data from 97 reference laboratory confirmed Salmonella blood culture-positive patients from December 2014 to February 2025 were accessed retrospectively and analyzed. Fisher's exact test was used to determine any statistical association between variables, and a p-value of less than 0.05 was taken as significant.

Results

The majority were females (52, 54%), and 22 (23%) were <5 years, while 30 (31%) were >60 years. Clinical presentation varied from acute gastroenteritis (28) to intra-abdominal infections (22) and severe sepsis requiring inotrops on admission (25). There were 14 enteric fever patients whose blood cultures were positive for S. Typhi (12) or S. Paratyphi (2). Other non-typhoidal entities were pyelonephritis (4), meningitis (2), septic arthritis (2), splenic abscess (2), and pleural effusion (1).

Risk factors like cirrhosis, steroid use, chronic kidney disease, or chemotherapy were found in 50 (51%), but no statistical significance was found with any.

Most BCs became positive within 18 hours (65), and 7 took more than 48 hours. All salmonellae were sensitive to ceftriaxone, while 25% were resistant to ciprofloxacin (58% Typhi, 100% Paratyphi A, and 18% non-typhoidal). 

The majority of patients had leukocytosis (49%), with neutrophil predominance (73%), while 39% had counts within the normal range, and 17% had counts below normal. Additionally, 36% had normal or marginally elevated CRP levels. No statistically significant association was found between intestinal or extraintestinal disease and ciprofloxacin resistance.

Mortality within 24 hours was recorded in 6/97 (6%), all of which were by non-typhoidal species.

Conclusions

Invasive salmonellosis can occur in any age group, but it predominantly affects extremes, with varying clinical presentations. Patients can have normal or near-normal leukocyte counts and CRP levels even with a positive BC. Patients with risk factors may be more prone to get invasive disease.