Community-acquired Salmonella bacteraemia in patients with sickle-cell disease 1969-2008: a single centre study

We document the aetiology of community-acquired bacteraemia in sickle-cell disease (SCD) patients and present clinical aspects of 11 cases of Salmonella bacteraemia. Prospective computerized records of all significant bacteraemic episodes presenting to our institution from 1969 to 2008 were analysed. Additional clinical information was drawn from hospital medical records. Six thousand three hundred and sixty-nine community-acquired bacteraemic episodes were documented, with 66 occurring in SCD patients. Salmonella species were the third most frequently isolated organism in SCD patients; 18% of bacteraemias in SCD patients were caused by Salmonella species vs 3% in non-SCD patients (p < 0.0001). Moreover, the proportion of community-acquired Salmonella bacteraemic episodes caused by non-Typhi species was significantly higher in SCD compared to other patients (p = 0.0015). Focal infection was identified in 7 of the 11 cases of Salmonella bacteraemia in SCD patients, with bone and joint accounting for 6 of these. Infection may have been acquired during travel to the tropics in 4 patients. Our study supports the view that SCD patients are particularly susceptible to Salmonella infection. These infections frequently require multiple surgical interventions and prolonged hospital stays. SCD patients should be advised to pay particular attention to food hygiene while travelling to the tropics.