EXTRAINTESTINAL SALMONELLOSIS IN A GENERAL-HOSPITAL (1991 TO 1996) - RELATIONSHIPS BETWEEN SALMONELLA GENOMIC GROUPS AND CLINICAL PRESENTATIONS

Episodes of extraintestinal salmonellosis treated at a general hospita l (1,522 beds) over a 6-year period (1991 to 1996) were characterized by the analysis of phenotypic and genotypic traits of Salmonella organ isms and clinical data from medical reports. Extraintestinal salmonell osis accounted for 8% of all salmonellosis episodes. Fifty-two medical reports, dealing with 6 cases of typhoid fever, 32 cases of bacteremi a, and 14 focal infections, were reviewed. All cases of typhoid fever except 1, 7 cases of bacteremia, and 5 focal infections were not relat ed to any underlying disease or predisposing factors, while 25 cases o f bacteremia and 9 focal infections were associated with some of these risk factors. All typhoid isolates and 65.4% of the nontyphoid isolat es were susceptible to antimicrobials, Fifty-one nontyphoid strains we re analyzed and assigned to 21 genomic groups, which were defined by s erotype, combined ribotype, and combined randomly amplified polymorphi c DNA type teach genomic group could include organisms differing in so me phenotypic traits). The relationships between genomic groups and cl inical presentations were traced. Organisms causing 22 episodes (17 ep isodes of bacteremia, 2 of pneumonia, 1 of peritonitis, 1 of pyeloneph ritis, and 1 of cystitis) belonged to a prevalent Salmonella enterica serotype Enteritidis genomic group, which included organisms assigned to four phage types, five biotypes, and four resistance patterns, caus ing infections in patients with and without risk factors. Seven Other genomic groups, 4 Enteritidis groups (associated with both bacteremia and focal infections), 2 Typhimurium groups tone associated with bacte remia and the other with focal infections) and 1 Brandenburg group (as sociated,vith bacteremia) included hive or more strains, and the remai ning 13 genomic groups consisted of only one strain each.