Evolution of Campylobacter bacteraemia before and in the era of highly active anti-retroviral therapy

Abstract number: P1820

Fernández-Cruz A., Muñoz P., Mohedano R., Valerio M., Rodriguez-Creixems M., Bouza E.

Objective:Campylobacter is a very uncommon cause of bloodstream infection (BSI), but was relatively frequent in HIV positive patients. The impact of HAART and new forms of immunocompromise on CB incidence has not been sufficiently assessed. To analyse the evolution of the incidence, microbiological and clinical characteristics of all cases of CB during a 22-year period.

Methods: Review of the clinical records of all patients with Campylobacter bacteraemia (CB) from 1985 to 2007. PreHAART (1985 to 1996) and HAART periods (1997–2007) were compared. Available strains were re-identified with universal PCR.

Results: There were 69 CB in 61 patients (0.25% of all BSI) and the incidence remained stable (mean of 0.06/1000 admissions and 0.49/100,000 inhabitants). Median age was 53 y (IQR 30–74) and 82% were male. Underlying conditions included: liver disease (32.2%), HIV infection (22.7%), neoplasia (12%), solid organ transplantation (SOT)(3.4%) and others (4.7%). CB was community-acquired in 80%. Origin of the BSI was gastrointestinal (34%), unknown (28%) or extra-intestinal (36%:respiratory 15%, intraabdominal 8%, cellulitis 4.5% and urinary 8%). C. jejuni was recovered in 68% of the cases (41% primary CB vs secondary 78%; p 0.013), C. fetus in 18% and C. coli in 10%. Molecular methods reclassified 6 strains: C. fetus (2) and C. jejuni (1) formerly identified as Campylobacter sp and 3 C. fetus formerly identified as C. jejuni. Complications appeared in 25% of the patients. Quinolone-resistance was found in 67% of the isolates and empirical therapy was appropriate in 64%. Mortality rate was 17% and was higher in HIV + pts (33% vs 10%; p 0.04) and in the presence of complications (50% vs 4%; p < 0.0001). Three patients with humoral immunodeficiency recurred (5%).

When preHAART and HAART periods were compared we found that patients with CB were younger in the first period (39 vs 67; p < 0.001) and that C. coli was only detected in the first period. Although forms of immunocompromise have changed between the two periods, differences did not reach statistical significance: immunocompromise (38% vs 46%; p 0.6), HIV+ (28% vs 15%, p = 0.4), solid (7.5% vs 0%) or haematological neoplasia (2.5%vs 12%), SOT (0 vs 8%).

Conclusions:Campylobacter bacteraemia is no longer a disease of HIV+ patients, but often affects immunocompromised patients. CB has an extraintestinal origin in as much as 36% of cases and humoral immunodeficiency must be sought for in patients with recurrent episodes.