443Non-Typhoidal Salmonella Infections in Cancer Patients

 Retrospectively reviewed charts of patients with NTS clinical isolates at MD Anderson Cancer Center from 01/01/00 to 12/31/13.  We investigated demographics, site of infection, serogroup, susceptibility, management and outcomes.  Wilcoxon ranksum test was used to compare continuous variables and Chi-square or Fisher’s exact tests were used to compare categorical variables, as appropriate. For four-group comparisons, when a significant result (p<0.05) was detected, pairwise comparisons were performed. The α levels of the posthoc pairwise comparisons were adjusted using a sequential Bonferroni method to control type I error. All tests except those in the pairwise comparisons were two-sided tests with a significance level of 0.05. Data analyses were performed using SAS version 9.3 (SAS Institute Inc., Cary, NC). Conclusions/ Discussion  To our knowledge, this study is the largest case series in cancer patients.  Two thirds had hematologic malignancy and most of them had received immunosuppressive agents.  CLSI M100 S23 (2012) revised breakpoint of ciprofloxacin from ≤1.0 to ≤0.06. In our study, 96% was sensitive with old breakpoint, which decreased to 92% with current criteria.  Antibiotic prophylaxis may not prevent salmonellosis since 11 cases developed disease on effective oral antibiotics, presumably due to overwhelming inoculum or lack of adherence.  Compared with previous reports [2, 3], our study showed: 1. Higher proportion of bacteremia (49 vs 1-8%) and lower endovascular disease (1 vs 10-20%). 2. Lower infection-related mortality (2 vs 30-40%), perhaps due to earlier initiation of active antibiotics. 3. An unexpectedly high incidence (17%) of UTI and asymptomatic bacteriuria especially in those with urologic abnormalities. References 1)Mandal BK, et al. Bacteraemia in salmonellosis: a 15 year retrospective study from a regional infectious diseases unit. BMJ. 1988 Nov 12;297(6658):1242-3. 2)Dhanoa A, et al. Non-typhoidal Salmonella bacteraemia: epidemiology, clinical characteristics and its' association with severe immunosuppression. Ann Clin Microbiol Antimicrob. 2009 May 18;8:15. 3)Li CW, et al. Non-typhoidal Salmonella bacteremia among adults: an adverse prognosis in patients with malignancy. J Microbiol Immunol Infect. 2012 Oct;45(5):343-9. Non-typhoidal Salmonella Infections in Cancer Patients Nobuyoshi Mori, MD, Ariel Szvalb, MD, Javier Adachi, MD, Ying Jiang, MS, Victor Mulanovich, MD Department of Infectious Diseases, Infection Control & Employee Health, University of Texas MD Anderson Cancer Center