Prolonged diarrhea due to ciprofloxacin-resistant campylobacter infection.
BACKGROUND
Campylobacter causes >1 million infections annually in the United States. Fluoroquinolones (e.g., ciprofloxacin) are used to treat Campylobacter infections in adults. Although human infections with ciprofloxacin-resistant Campylobacter have become increasingly common, the human health consequences of such infections are not well described.


METHODS
A case-control study of persons with sporadic Campylobacter infection was conducted within 7 FoodNet sites during 1998-1999. The E-test system (AB Biodisk) was used to test for antimicrobial susceptibility to ciprofloxacin; ciprofloxacin resistance was defined as a ciprofloxacin minimum inhibitory concentration of > or =4 microg/mL. We conducted a case-comparison study of interviewed persons who had an isolate tested.


RESULTS
Of 858 isolates tested, 94 (11%) were ciprofloxacin resistant. Among 290 persons with Campylobacter infection who did not take antidiarrheal medications, persons with ciprofloxacin-resistant infection had a longer mean duration of diarrhea than did persons with ciprofloxacin-susceptible infection (9 vs. 7 days [P=.04]). This difference was even more pronounced among the 63 persons who did not take antidiarrheal medications or antimicrobial agents (12 vs. 6 days [P=.04]). In a multivariable analysis-of-variance model, the persons with ciprofloxacin-resistant infection had a longer mean duration of diarrhea than did the persons with ciprofloxacin-susceptible infection (P=.01); this effect was independent of foreign travel. The association between ciprofloxacin resistance and prolonged diarrhea is consistent across a variety of analytical approaches.


CONCLUSIONS
Persons with ciprofloxacin-resistant Campylobacter infection have a longer duration of diarrhea than do persons with ciprofloxacin-susceptible Campylobacter infection. Additional efforts are needed to preserve the efficacy of fluoroquinolones.
Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
Jennifer M
JM
Nelson
Kirk E
KE
Smith
Duc J
DJ
Vugia
Therese
T
Rabatsky-Ehr
Suzanne D
SD
Segler
Heidi D
HD
Kassenborg
Shelley M
SM
Zansky
Kevin
K
Joyce
Nina
N
Marano
Robert M
RM
Hoekstra
Frederick J
FJ
Angulo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000494:pharmacology*; D002167:Campylobacter / Q000302:isolation & purification*; D002169:Campylobacter Infections / Q000382:microbiology* / Q000473:pathology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000494:pharmacology*; D003967:Diarrhea / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors
D000890:Anti-Infective Agents; D002939:Ciprofloxacin