# Clinical Experience With the Nontyphoidal Salmonella Vascular Infection (NTSVI) Score in a Resource-Limited Malaysian Tertiary Center

## TL;DR

This paper reports the first use of the NTSVI Score in Malaysia to assess vascular risk in Nontyphoidal Salmonella infections, showing it can help avoid unnecessary imaging in low-risk patients.

## Contribution

First clinical application of the NTSVI Score in a resource-limited Malaysian setting, demonstrating its potential utility in Southeast Asia.

## Key findings

- The NTSVI Score showed excellent negative predictive value in identifying low-risk patients without vascular complications.
- Two of four high-risk patients had radiological evidence of infectious aortitis.
- The score was useful for early risk stratification and guiding further investigation.

## Abstract

Nontyphoidal Salmonella (NTS) bacteremia is an uncommon but potentially fatal infection that predisposes patients to vascular complications, including infectious aortitis. The Nontyphoidal Salmonella Vascular Infection (NTSVI) Score was developed to estimate this risk, with scores ≥ 1 indicating high risk. We describe the first clinical application of the NTSVI Score in a resource-limited Malaysian tertiary care center. Five patients with confirmed NTS bacteremia were assessed using the score and subsequently underwent imaging to evaluate for vascular involvement. Four patients were classified as high risk (scores 3, 2, 1, and 1); two had radiological evidence of infectious aortitis, while two showed no vascular changes. The remaining patient, classified as low risk (score 0), also demonstrated no vascular abnormalities. In this series, the NTSVI Score showed excellent negative predictive value, supporting its potential role as a rule-out tool to avoid unnecessary imaging in low-risk patients, particularly in resource-constrained settings. Although the positive predictive value was modest, the score appeared useful in early risk stratification and guiding further investigation. While limited by small sample size and lack of contemporary validation, this report highlights the potential clinical utility of the NTSVI Score in managing NTS vascular infections in resource-limited settings. To our knowledge, this represents the first reported application of the NTSVI Score in Malaysia, underscoring the need for further evaluation in Southeast Asian populations.