Abstract
BackgroundCampylobacter spp. cause mostly self-limiting enterocolitis, although a significant proportion of cases require hospitalisation highlighting potential for severe disease. Among people admitted, blood culture specimens are frequently collected and antibiotic treatment is initiated. We sought to understand clinical and host factors associated with bacteraemia, antibiotic treatment and isolate non-susceptibility among Campylobacter-associated hospitalisations.MethodsUsing linked hospital microbiology and administrative data we identified and reviewed Campylobacter-associated hospitalisations between 2004 and 2013. We calculated population-level incidence for Campylobacter bacteraemia and used logistic regression to examine factors associated with bacteraemia, antibiotic treatment and isolate non-susceptibility among Campylobacter-associated hospitalisations.ResultsAmong 685 Campylobacter-associated hospitalisations, we identified 25 admissions for bacteraemia, an estimated incidence of 0.71 cases per 100,000 population per year. Around half of hospitalisations (333/685) had blood culturing performed. Factors associated with bacteraemia included underlying liver disease (aOR 48.89, 95% CI 7.03–340.22, p < 0.001), Haematology unit admission (aOR 14.67, 95% CI 2.99–72.07, p = 0.001) and age 70–79 years (aOR 4.93, 95% CI 1.57–15.49). Approximately one-third (219/685) of admissions received antibiotics with treatment rates increasing significantly over time (p < 0.05). Factors associated with antibiotic treatment included Gastroenterology unit admission (aOR 3.75, 95% CI 1.95–7.20, p < 0.001), having blood cultures taken (aOR 2.76, 95% CI 1.79–4.26, p < 0.001) and age 40–49 years (aOR 2.34, 95% CI 1.14–4.79, p = 0.02). Non-susceptibility of isolates to standard antimicrobials increased significantly over time (p = 0.01) and was associated with overseas travel (aOR 11.80 95% CI 3.18–43.83, p < 0.001) and negatively associated with tachycardia (aOR 0.48, 95%CI 0.26–0.88, p = 0.02), suggesting a healthy traveller effect.ConclusionsCampylobacter infections result in considerable hospital burden. Among those admitted to hospital, an interplay of factors involving clinical presentation, presence of underlying comorbidities, complications and increasing age influence how a case is investigated and managed.
Highlights
Campylobacter spp. cause mostly self-limiting enterocolitis, a significant proportion of cases require hospitalisation highlighting potential for severe disease
We examined clinical and host factors associated with the diagnosis of blood stream infections (BSI), isolate non-susceptibility and antibiotic treatment of hospitalised cases
We observed no difference in the proportion of admissions with documented comorbidities who had blood specimens collected for culture when compared to admission without comorbidities who had blood taken for culture (χ2 = 1.42, p = 0.23 )
Summary
Campylobacter spp. cause mostly self-limiting enterocolitis, a significant proportion of cases require hospitalisation highlighting potential for severe disease. We sought to understand clinical and host factors associated with bacteraemia, antibiotic treatment and isolate non-susceptibility among Campylobacter-associated hospitalisations. Most cases of infectious diarrhoea, including those caused by Campylobacter spp., are self-limiting, with management focused on maintenance of hydration via fluid repletion [2]. For persons hospitalised with Campylobacter infection, clinical thresholds for exclusion of bacteraemia and the consideration of antimicrobial therapy differ due to symptom severity, risk of complications or the exacerbation of underlying co-morbidities [2]. The likelihood of clinicians commencing antibiotic therapy may increase among hospitalised cases, highlighting the importance of judicial prescribing and understanding of isolate susceptibility patterns to ensure viable treatment options remain [5]
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