Abstract
Campylobacter jejuni is the leading cause of bacterial gastroenteritis and antibiotic resistant C. jejuni are a serious threat to public health. Herein, we sought to evaluate trends in C. jejuni infections, quantify resistance frequencies, and identify epidemiological factors associated with infection. Campylobacter jejuni isolates (n = 214) were collected from patients via an active surveillance system at four metropolitan hospitals in Michigan between 2011 and 2014. The minimum inhibitory concentration for nine antibiotics was determined using microbroth dilution, while demographic and clinical data were used for the univariate and multivariate analyses. Over the 4-year period, a significant increase in the recovery of C. jejuni was observed (p ≤ 0.0001). Differences in infection rates were observed by hospital and several factors were linked to more severe disease. Patients residing in urban areas, for instance, were significantly more likely to be hospitalized than rural residents as were patients over 40 years of age and those self-identifying as non-White, highlighting potential disparities in disease outcomes. Among the 214 C. jejuni isolates, 135 (63.1%) were resistant to at least one antibiotic. Resistance was observed for all nine antibiotics tested yielding 11 distinct resistance phenotypes. Tetracycline resistance predominated (n = 120; 56.1%) followed by resistance to ciprofloxacin (n = 49; 22.9%), which increased from 15.6% in 2011 to 25.0% in 2014. Resistance to two antibiotic classes was observed in 38 (17.8%) isolates, while multidrug resistance, or resistance to three or more classes, was observed in four (1.9%). Notably, patients with ciprofloxacin resistant infections were more likely to report traveling in the past month (Odds Ratio (OR): 3.0; 95% confidence interval (CI): 1.37, 6.68) and international travel (OR: 9.8; 95% CI: 3.69, 26.09). Relative to patients with only tetracycline resistant infections, those with ciprofloxacin resistance were more likely to travel internationally, be hospitalized and have an infection during the fall or summer. Together, these findings show increasing rates of infection and resistance and highlight specific factors that impact both outcomes. Enhancing understanding of factors linked to C. jejuni resistance and more severe infections is critical for disease prevention, particularly since many clinical laboratories have switched to the use of culture-independent tests for the detection of Campylobacter.
Highlights
Campylobacter spp. are a leading cause of bacterial gastroenteritis infections worldwide [1] and represent the most common cause of foodborne infections in the U.S since 2013 [2]
Since campylobacteriosis was not classified as a notifiable infection until 2015 [25], data about disease frequencies and resistance profiles have been limited, for states like Michigan that are not participating in Foodborne Diseases Active Surveillance Network (FoodNet) or NARMS
It was estimated that 42% of campylobacteriosis cases identified via FoodNet in 2019 were diagnosed by culture-independent tests and among these, culture for Campylobacter was only attempted for 63% of the positive samples [2]
Summary
Campylobacter spp. are a leading cause of bacterial gastroenteritis infections worldwide [1] and represent the most common cause of foodborne infections in the U.S since 2013 [2]. While C. jejuni causes a vast majority of human infections, other species including C. coli, C. upsaliensis, C. lari, C. fetus, C. insulaeingrae, and C. hyointestinalis, are important [3]. These pathogens were estimated to cause 1.5 million infections in the U.S each year, contributing to 13,000 hospitalizations and 120 deaths [4]. The incubation period is typically 1–4 days after exposure, and the severity of symptoms tends to vary by bacterial density and strain [5]. Most infections are self-limiting, antibiotics are often needed for immunocompromised patients or those with more severe or persistent infections [7]
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