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Non-Typhi, non-Paratyphi Salmonella-related hospitalisations in Spain: trends, clinical aspects, risk factors for worse prognosis and hospital costs

  • Macarena Garrido-EstepaEmail author
  • P. Latasa
  • G. Y. Ordóñez-León
  • M. Martínez-Avilés
  • A. de la Torre
  • L. García-Comas
Original Article
  • 38 Downloads

Abstract

This study reviews non-typhoid Salmonella (NTS)-related hospitalisations at National level in Spain between 2010 and 2015. NTS hospitalisations were obtained from the National Registry of Hospitalisations. A descriptive analysis of the hospitalisations was performed, including hospitalisation rates (HR) and case-fatality rates (CFR%) calculation. For those with NTS as Main Diagnosis logistic regression were used to estimate the relationship between the different factors and death outcome. 21,660 registered NTS-related hospitalisations were described (88.8% with Salmonella coded as Main Diagnosis). Average HR2010–2015 was 7.7 (range, 7.3 to 8.1) hospitalisations/100,000 population. Those with NTS infections as Secondary Diagnosis were on average (p < 0.001) older (47.9 vs. 36.5 years), presented worse Charlson Comorbidity Index (2.1 vs. 1.2), higher CFR% (4.8% vs. 0.7%), spent more days hospitalised (15.1 vs. 5.8 days), and generated more costs (6173 vs. 4272 euros/per hospitalisation) than those with NTS as Main Diagnosis. For those with NTS as Main Diagnosis increased risk of death was related to being > 64 years old (OR = 20.99; p < 0.001); presenting septicaemia (OR = 15.82; p < 0.001) or localised infections (OR = 3.98; p = 0.061); Charlson Comorbidity Index > 3 (OR = 4.57; p < 0.001); a non-HIV co-infection (OR = 1.80; p = 0.013); other risk factors (OR = 5.70; p < 0.001); bowel perforation (OR = 70.30; p < 0.001); or acute renal failure (OR = 1.95; p = 0.001). In those with Salmonella as Main Diagnosis, among all complications, bowel perforation presented the strongest association with death outcome. Clinical practice guidelines can help to identify patients at risk of bowel perforation to reduce the fatality of the disease.

Keywords

Salmonella Salmonellosis Outcomes Costs Rates Comorbidities Hospitalisations Epidemiology 

Notes

Acknowledgements

This article is a complementary study to support the research program JRP06-FBZ-1-NOVA and S2013/ABI-2747.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Eng S-K, Pusparajah P, Ab Mutalib N-S, Ser H-L, Chan K-G, Lee L-H (2015) Salmonella: a review on pathogenesis, epidemiology and antibiotic resistance. Front Life Sci 8:284–293CrossRefGoogle Scholar
  2. 2.
    Spanish National Center for Epidemiology. Carlos III Health Institute (2017) Resultados de la Vigilancia Epidemiológica de las enfermedades transmisibles. 2015 [Results of the Epidemiological Surveillance of infectious diseases. 2015]. http://gesdoc.isciii.es/gesdoccontroller?action=download&id=12/12/2017-05863fc4dd. Accessed 9 Oct 2018
  3. 3.
    European Food Safety Authority, European Centre for Disease Prevention and Control (2017) The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2016. EFSA J. http://doi.wiley.com/10.2903/j.efsa.2017.5077. Accessed 9 Oct 2018
  4. 4.
    Interterritorial Spanish Council for the Spanish National Health System (2015) Orden SSI/445/2015, de 9 de marzo, por la que se modifican los anexos I, II y III del Real Decreto 2210/1995, de 28 de diciembre, por el que se crea la Red Nacional de Vigilancia Epidemiológica, relativos a la lista de enfermedades de declaración obligatoria, modalidades de declaración y enfermedades endémicas de ámbito regional. [Order SSI/445/2015, of March 9, which modified the annexes I, II and III of Royal Decree 2210/1995, of December 28, which created the National Network of Epidemiological Surveillance, relating to the list of diseases of mandatory notification, modalities of declaration and endemic diseases of regional scope]. Spanish Official Bulletin (BOE) http://www.boe.es/boe/dias/2015/03/17/pdfs/BOE-A-2015-2837.pdf. Accessed 9 Oct 2018
  5. 5.
    Ministry of Health, Social Services and Equity. Registro de Actividad de Atención Especializada. RAE-CMBD [Hospital Discharge Records in the National Health System. CMBD]. http://www.mscbs.gob.es/en/estadEstudios/estadisticas/cmbdhome.htm Accessed 9 Oct 2018
  6. 6.
    Gil Prieto R, Alejandre CG, Meca AÁ, Barrera VH, de Miguel ÁG (2009) Epidemiology of hospital-treated Salmonella infection; data from a national cohort over a ten-year period. J Inf Secur 58:175–181Google Scholar
  7. 7.
    Mor SM, DeMaria A Jr, Naumova EN (2014) Hospitalization records as a tool for evaluating performance of food- and water-borne disease surveillance systems: a Massachusetts case study. PLoS One 9:e93744CrossRefGoogle Scholar
  8. 8.
    Huang I-F, Kao C-H, Lee W-Y, Chang M-F, Chen Y-S, Wu K-S et al (2012) Clinical Manifestations of nontyphoid salmonellosis in children younger than 2 years old—experiences of a tertiary hospital in Southern Taiwan. Pediatr Neonatol 53:193–198CrossRefGoogle Scholar
  9. 9.
    Li C-W, Chen P-L, Lee N-Y, Lee H-C, Chang C-M, Lee C-C et al (2012) Non-typhoidal Salmonella bacteremia among adults: an adverse prognosis in patients with malignancy. J Microbiol Immunol Infect 45:343–349CrossRefGoogle Scholar
  10. 10.
    Chiu CH, Su LH, He CC, Jaing TH, Luo CC, Lin TY (2002) Perforation of toxic megacolon in non-typhoid Salmonella enterocolitis spares young infants and is immune-mediated. Pediatr Surg Int 18:410–412CrossRefGoogle Scholar
  11. 11.
    Shibusawa N, Arai T, Hashimoto K, Hashimoto Y, Yahagi K, Matsumoto J et al (1997) Fatality due to severe salmonella enteritis associated with acute renal failure and septicemia. Intern Med 36:750–753CrossRefGoogle Scholar
  12. 12.
    Dhooria G, Bains H, Bhat D (2013) Proliferative glomerulonephritis causing acute renal failure in a child with Salmonella septicemia. Indian J Nephrol 23:240CrossRefGoogle Scholar
  13. 13.
    Janssen van Doorn K, Pierard D, Spapen H (2006) Acute renal dysfunction in salmonella gastroenteritis. J Clin Gastroenterol 40:910–912CrossRefGoogle Scholar
  14. 14.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
  15. 15.
    Spanish National Center for Epidemiology. Carlos III Health Institute (2016) Resultados de la Vigilancia Epidemiológica de las enfermedades transmisibles. 2014 [Results of the Epidemiological Surveillance of infectious diseases. 2014] http://gesdoc.isciii.es/gesdoccontroller?action=download&id=14/10/2016-3a996e69f2. Accessed 9 Oct 2018
  16. 16.
    Cores-Calvo O, Valero-Juan LF, García-Sánchez E, García-Sánchez JE, García-García MI (2016) Changes in the epidemiology of gastroenteritis caused by Salmonella during 2005-2014 in Salamanca, Spain. Rev Esp Quimioter 29:91–98Google Scholar
  17. 17.
    Mandal BK, Brennand J (1988) Bacteraemia in salmonellosis: a 15 year retrospective study from a regional infectious diseases unit. BMJ 297:1242–1243CrossRefGoogle Scholar
  18. 18.
    Rodríguez M, de Diego I, Mendoza MC (1998) Extraintestinal salmonellosis in a general hospital (1991 to 1996): relationships between Salmonella genomic groups and clinical presentations. J Clin Microbiol 36:3291–3296Google Scholar
  19. 19.
    Ordóñez-León GY, Martínez EV, Herruzo R, Garrido-Estepa M (2016) Updating information about the burden of meningococcal disease hospitalisations in Spain. Vaccines Res Vaccin 2:1–7Google Scholar
  20. 20.
    Cruickshank JG, Humphrey TJ (1987) The carrier food-handler and non-typhoid salmonellosis. Epidemiol Infect 98:223–230CrossRefGoogle Scholar
  21. 21.
    Shimoni Z, Pitlik S, Leibovici L, Samra Z, Konigsberger H, Drucker M et al (1999) Nontyphoid Salmonella bacteremia: age-related differences in clinical presentation, bacteriology, and outcome. Clin Infect Dis 28:822–827CrossRefGoogle Scholar
  22. 22.
    Chao HC, Chiu CH, Kong MS, Chang LY, Huang YC, Lin TY et al (2000) Factors associated with intestinal perforation in children’s non-typhi Salmonella toxic megacolon. Pediatr Infect Dis J 19:1158–1162CrossRefGoogle Scholar
  23. 23.
    Sartor RB (2008) Microbial influences in inflammatory bowel diseases. Gastroenterology 134:577–594CrossRefGoogle Scholar
  24. 24.
    Schultz BM, Paduro CA, Salazar GA, Salazar-Echegarai FJ, Sebastián VP, Riedel CA et al (2017) A potential role of salmonella infection in the onset of inflammatory bowel diseases. Front Immunol 8:191CrossRefGoogle Scholar
  25. 25.
    Qiu H, Sun X, Sun M, He C, Li Z, Liu Z (2014) Serum bacterial toxins are related to the progression of inflammatory bowel disease. Scand J Gastroenterol 49:826–833CrossRefGoogle Scholar
  26. 26.
    Jess T, Simonsen J, Nielsen NM, Jorgensen KT, Bager P, Ethelberg S et al (2011) Enteric Salmonella or Campylobacter infections and the risk of inflammatory bowel disease. Gut 60:318–324CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Ministry of Science, Innovation and UniversitiesMadridSpain
  2. 2.Animal Health Research Center. INIA. CISA. ValdeolmosMadridSpain
  3. 3.Subdirectorate of Epidemiology, Health Department of the Community of MadridMadridSpain
  4. 4.Campo de Gibraltar Health Management AreaPreventive Medicine Service. Hospital de La LíneaCádizSpain

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