Abdulaziz A. Al-Jama

Salmonella as a causative organism of various infections in patients with sickle cell disease.

BACKGROUND Patients with sickle cell disease (SCD) are susceptible to a variety of bacterial infections, including infections caused by Salmonella species. We sought to identify the most common infections caused by Salmonella spp. in SCD patients at our hospital, and to determine their mortality rates and susceptibility to commonly used antimicrobial agents. PATIENTS AND METHODS We conducted a retrospective review of all Salmonella infections in SCD patients admitted to Qatif Central Hospital during the last 11 years. RESULTS During the 11 years of the study, 331 episodes of Salmonella infection occurred in 319 patients. The incidence of Salmonella infection in SCD patients was 11.5% compared to only 0.65% in the general hospital population. The commonest sites of Salmonella infection were blood (42% of isolates), followed by gastrointestinal tract (23.5%) and the skeletal system (22.5%). Salmonella infection was commonly seen in patients less than 15 years of age. The case fatality rate in patients with Salmonella sepsis was 2.2% (3/139), but there were no deaths associated with other types of Salmonella infections. Ampicillin and cotrimoxazole resistance occurred in 29% and 24% of the isolates, respectively, but only 0.6% were resistant to ceftriaxone and 1.8% had intermediate resistance to ciprofloxacin. CONCLUSIONS Salmonella is a common cause of sepsis and osteomyelitis in patients with SCD in our locality. Empirical antimicrobial therapy should cover the likely pathogens, including Salmonella species.