Research background and purpose
Campylobacter is one of the major pathogens that cause intestinal infections in humans worldwide, usually causing various clinical symptoms such as diarrhea, abdominal cramps, vomiting, and fever. It can also translocate through the digestive barrier and cause invasive infections. Our current understanding of the infectious characteristics and treatment and prognosis of campylobacteremia is still incomplete. These questions were recently explored in a high-scoring study (IF: 20.99) published in Clinical Infectious Diseases.
Research Methods
This is a nationwide multicenter retrospective study in France, including 592 patients with curvature in 37 hospitals between January 1, 2015 and December 31, 2019 bacteremia patients, and collected information on patient demographics, clinical signs, antibiotic treatment, and microbiological data for statistical analysis.
The primary endpoint of the assessment was to analyze the effect of delay in effective antibiotic treatment on 30-day mortality in patients with campylobacteremia. Secondary endpoints were to describe their epidemiology, infection characteristics, and risk factors for the location of secondary infection, and to assess antibiotic resistance.
Study Results
1
Characteristics of infection
A total of 592 patients were included in the study, mainly male and elderly patients, and only 27 patients were younger than 15 years old. Most patients had underlying comorbidities of immune compromised, especially hematological malignancies, solid tumors, diabetes, chronic renal failure, and liver disease (alcoholic, viral, and nonalcoholic steatohepatitis) 62.7%, 13.3% and 12% respectively).
C. jejuni and C. fetus were the most commonly identified species (42.9% and 42.6%, respectively), followed by It was Campylobacter colon (6.8%) and Campylobacter urealyticum (3.7%). Campylobacter jejuni and C. coli are significantly associated with immunodeficiency, especially in patients with hypogammaglobulinemia or in patients receiving rituximab, with fever and gastrointestinal symptoms commonly seen. Gastrointestinal symptoms are less common in older patients with Campylobacter fetus, and secondary localization of cellulitis and infection is more common.
2
Secondary targeting
13.5% (80 patients) had secondary localization of infection, including 38 intravascular infections, 24 bone and joint infections, 12 endocarditis, and 9 ascites, which were mainly Yes fetal Campylobacter infection (91.7%, 81.6%, 79.2% and 66.7%, respectively).
3
Bacterial mixed bloodstream infection
30 patients (5.1%) had mixed bacterial bloodstream infections, often with neutropenia (30%). The main co-infection was Enterobacteriaceae (Escherichia coli, Klebsiella, Enterobacter [56.7%]), followed by Streptococcus (33.3 %), Staphylococcus aureus (10%) and non-fermenting Gram-negative bacilli (6.7%). Bacterial co-infection was more common with the unusual Campylobacter species (22.2%) compared with C. fetus (4%) and C. jejuni (3.5%). In fact, 33.3% of these co-infections were associated with uncommon species, mainly oral commensal bacteria such as Ciliary, Micromonas, Mild Streptococcus, and Streptococcus Miller. . Four patients had fungal co-infections, including invasive aspergillosis (n = 2), fusarium disease (n = 1), and candidemia (n = 1).
4
Microbiological Diagnosis and Antibiotic Resistance
The median time to positive blood samples (IQR) was 54 (6~72) hours. Among the available samples from patients with gastrointestinal symptoms (n = 160), the positive rate of stool culture was 57.8%. Most of the isolates were C. jejuni or C. coli (75.8%). Antimicrobial resistance is shown in Table 1. The resistance of Campylobacter colon to macrolides was higher worldwide (23.7%).
Table 1 Antibiotic resistance
Note: P value,Antibiotic resistance p-value by species (Fisher’s exact test for enumeration data)
5
Clinical Outcomes
84.7% of patients who completed follow-up (n = 483) were alive and well at day 30 without recurrence, with mortality and recurrence rates of approximately 11.7% and 3%. Of the 551 patients with documented antimicrobial therapy, 77.9% received appropriate treatment. After multivariate analysis, Appropriate antimicrobial therapy was significantly associated with lower 30-day mortality [8.9% vs 19.5%, respectively; odds ratio (OR), 0.47 (95% confidence interval (CI), 0] .24~0.93); P = 0.03]
The median delay time (IQR) before effective treatment was very short [2 (0-4) days], was not significantly associated with 30-day mortality OR, 1 [(95% CI .99-1.01); P=0.78]. Ineffective empiric therapy was mainly caused by cephalosporins (141 patients) and piperacillin-tazobactam (46 patients). Only 48 patients (27.6%) were effective in empiric treatment regimens incorporating aminoglycosides.
Study Conclusions
Study results show that campylobacteremia occurs predominantly in the immunocompromised elderly population and that appropriate antibiotic treatment is associated with improved 30-day survival.
References:
1. Li Xuan, Wang Shuying, Xiang Hong. Research progress on the source of human campylobacteriosis infection[J]. Chinese Journal of Zoonoses, 2022,38(03):266-276 .
2. Tinévez C, Velardo F, Campylobacteremia study group., et al. Retrospective Multicentric Study on Campylobacter spp. Bacteremia in France: The Campylobacteremia Study. Clin Infect Dis. 2022 Sep 10;75 (4):702-709.