Friday, August 15, 2008
Campylobacter Bacteremia: Clinical Features and Factors Associated with Fatal Outcome
Clin Infect Dis. 2008 Aug
Pacanowski J, Lalande V, Lacombe K, Boudraa C, Lesprit P, Legrand P, Trystram D, Kassis N, Arlet G, Mainardi JL, Doucet-Populaire F, Girard PM, Meynard JL; CAMPYL Study Group.
1Service des Maladies Infectieuses et Tropicales and 2Laboratoire de Microbiologie, Hôpital Saint-Antoine, 3Laboratoire de Bactériologie, Hôpital La Pitié-Salpétrière, 4Laboratoire de Bactériologie, Hôpital Tenon, 5Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Hôpital Européen Georges Pompidou, 6Université Paris VI Pierre et Marie Curie, 7Université Paris V René Descartes, 8INSERM UMR-S707, and 9Unité EA 4065, Paris, 10Unité Contrôle Epidémiologie et Prévention de l'Infection and 11Laboratoire de Microbiologie, Hôpital Henri Mondor, Créteil, 12Laboratoire de Microbiologie, Hôpital Paul Brousse, Villejuif, and 13Laboratoire de Microbiologie, Hôpital de Versailles, Le Chesnay, France.
Background. Campylobacter bacteremia is uncommon. The influence of underlying conditions and of the impact of antibiotics on infection outcome are not known.
Methods. From January 2000 through December 2004, 183 episodes of Campylobacter bacteremia were identified in 23 hospitals in the Paris, France, area.
The medical records were reviewed. Characteristics of bacteremia due to Campylobacter fetus and to other Campylobacter species were compared. Logistic regression analysis was performed to identify risk factors for fatal outcome within 30 days.
Results. Most affected patients were elderly or immunocompromised. C. fetus was the most commonly identified species (in 53% of patients). The main underlying conditions were liver disease (39%) and cancer (38%). The main clinical manifestations were diarrhea (33%) and skin infection (16%). Twenty-seven patients (15%) died within 30 days. Compared with patients with bacteremia due to other Campylobacter species, patients with C. fetus bacteremia were older (mean age, 69.5 years vs. 55.6 years; [Formula: see text]) and were more likely to have cellulitis (19% vs. 7%; [Formula: see text]), endovascular infection (13% vs. 1%; [Formula: see text]), or infection associated with a medical device (7% vs. 0%; [Formula: see text]). Independent risk factors for death were cancer (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.2-20.8) and asymptomatic infection (OR, 6.7; 95% CI, 1.5-29.4) for C. fetus bacteremia, the absence of prescription of appropriate antibiotics (OR, 12.2; 95% CI, 0.9-157.5), and prescription of third-generation cephalosporins (OR, 10.2; 95% CI, 1.9-53.7) for bacteremia caused by other species.
Conclusion. Campylobacter bacteremia occurs mainly in immunocompromised patients. Clinical features and risk factors of death differ by infection species.