Skip to main content Accessibility help



  • Access
  • Cited by 1


      • Send article to Kindle

        To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

        Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

        Find out more about the Kindle Personal Document Service.

        Port-Related Nontyphoidal Salmonella Bacteremia
        Available formats

        Send article to Dropbox

        To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

        Port-Related Nontyphoidal Salmonella Bacteremia
        Available formats

        Send article to Google Drive

        To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

        Port-Related Nontyphoidal Salmonella Bacteremia
        Available formats
Export citation

To the Editor—Salmonella species, a genus of the family Enterobacteriaceae, includes Salmonella enterica serovar Typhi and nontyphoidal Salmonella (NTS) spp. 1 , 2 Human infections caused by NTS are often associated with contaminated food products and always develop in an immunocompromised host. 3 The clinical presentations of NTS infection include gastroenteritis, primary bacteremia, mycotic aneurysm, infective endocarditis, urinary tract infection, meningitis, empyema thoracis, and osteomyelitis. 3 7 We performed a study to identify cases of unusual presentation of NTS infection related to subcutaneously implanted port reservoir and to further investigate their associated clinical and microbiological characteristics.

This study was conducted at 1 institution, a 900-bed hospital in southern Taiwan. From the computerized database of the bacteriology laboratory, we identified patients whose cultures yielded NTS. The medical records of all patients with port-related infection caused by NTS included in this study were retrospectively reviewed.

The diagnosis of port-related NTS bacteremia was defined as a primary laboratory-confirmed NTS bacteremia in a patient with a port at the time of (or within 48 hours prior to) the onset of symptoms in whom the infection was not related to another site. Standard definitions for healthcare-associated bacteremia (HAIs) were used. 8 Inappropriate use of antibiotics was defined as use of antimicrobial agents to which the clinical isolates were resistant in vitro.

During the study period, 4 patients were identified to have port-related NTS bacteremia: 3 infections were caused by group D Salmonella, and 1 was caused by group C Salmonella. All of the clinical isolates were susceptible to ampicillin, ceftazidime, ceftriaxone, ciprofloxacin, trimethoprim-sulfamethoxazole, and chloramphenicol. The clinical characteristics of 4 patients with port-related NTS bacteremia are summarized in Table 1. Of these 4 patients, 3 were men, and the age range of this cohort was 44–80 years. All of these patients had various cancers, and 1 patient had received chemotherapy prior to NTS infection. All of these patients had initial presentations of fever; however, none had signs or symptoms of enteritis. In addition, 1 patient had diabetes mellitus. Of these 4 patients, 3 had white blood cell counts >11,000/mm3, and none had neutropenia. In addition, 3 patients had hemoglobin <10 g/dl, and 2 patients had elevated C-reactive protein levels. None of these patients had their port removed. Although all 4 patients received appropriate antibiotics initially, 1 patient died due to NTS sepsis.

TABLE 1 Clinical Manifestations of 4 Patients with Nontyphoidal Salmonella Port-Related Infections

This study describes a rare cluster of NTS bacteremia in hospitalized cancer patients with ports at a single center. The immunocompromised conditions among these patients should be included as major risk factors for NTS bacteremia. Moreover, all of cases in this survey were classified as healthcare-associated, catheter-related bloodstream infections. Although rare, NTS should be considered as a possible pathogen causing intravascular catheter-related bacteremia in cancer patients in healthcare settings.

The clinical outcomes of patients with catheter-associated NTS bacteremia have not been well defined because of the limited number of cases. In the present work, 3 patients had favorable outcomes after appropriate antibiotics treatment without removal of the port. However, 1 patient died due to NTS sepsis, even under treatment with an appropriate antibiotic. Although a firm conclusion cannot be made based on our findings, further study is warranted. Until large-scale studies investigate the clinical impact of catheter removal on the prognosis of NTS-associated, catheter-related bacteremia, clinicians may follow the recommendations by the Infectious Diseases Society of America that all devices be removed in catheter-related infections caused by Gram-negative bacteria. 9

The antibiotic susceptibility patterns of the clinical isolates in this study were susceptible to all tested antibiotics, including third-generation cephalosporins and fluoroquinolones. However, in recent studies, evidence of resistance to fluoroquinolones and third-generation cephalosporins is emerging, despite the overall resistance rate of <5%. 10 Although third-generation cephalosporins or fluoroquinolones may be considered the appropriate antibiotic treatment of choice for patients with NTS bacteremia based on in vitro studies, clinicians still need to keep in mind the emergence of multidrug resistance among NST isolates.

In conclusion, port-related bacteremia caused by NTS can develop in immunocompromised patients, and NTS should be considered as a possible pathogen causing catheter-related bloodstream infections.


Financial support: No financial support was provided relevant to this article.

Potential conflicts of interest: All authors report no conflicts of interest relevant to this article.


1. Crump, JA, Mintz, ED. Global trends in typhoid and paratyphoid fever. Clin Infect Dis 2010;50:241246.
2. Morpeth, SC, Ramadhani, HO, Crump, JA. Invasive non-Typhi Salmonella disease in Africa. Clin Infect Dis 2009;49:606611.
3. Hohmann, EL. Nontyphoidal salmonellosis. Clin Infect Dis 2001;32:263269.
4. Abuhasna, S, Al Jundi, A, Rahman, MU, Said, W. Non-typhoidal Salmonella group D bacteremia and urosepsis in a patient diagnosed with HIV Infection. J Glob Infect Dis 2012;4:218219.
5. Ghais, A, Armano, R, Menten, R, Mathot, M, Zech, F, Nassogne, MC. Meningitis with subdural empyema due to non-typhoid Salmonella in a 9-month-old girl. Eur J Pediatr 2009;168:15371540.
6. Lai, CC, Lee, LN, Hsueh, PR, Yu, CJ, Yang, PC. Empyema thoracic from Salmonella choleraesuis . Emerg Infect Dis 2005;11:14931494.
7. Schulze, T, Lüdtke, A, Rahlff, I, Tunn, PU, Hohenberger, P. Salmonella osteomyelitis in an immunocompromised patient presenting as a primary lymphoma of the bone. Int J Infect Dis 2009;13:e67e70.
8. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection in the acute care setting. Am J Infect Control 2008;36:309332.
9. Mermel, LA, Allon, M, Bouza, E, Craven, E, Flynn, P, O’Grady, NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 updated by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:145.
10. Lunguya, O, Lejon, V, Phoba, MF, Bertrand, S, Vanhoof, R, Glupczynski, Y, Verhaegen, J, Muyembe-Tamfum, JJ, Jacobs, J. Antimicrobial resistance in invasive non-typhoid Salmonella from the Democratic Republic of the Congo: emergence of decreased fluoroquinolone susceptibility and extended-spectrum beta lactamases. PLoS Negl Trop Dis 2013;7:e2103.