Campylobacter bacteremia: clinical features and factors associated with fatal outcome.
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; P = .001) and were more likely to have cellulitis (19% vs. 7%; P = .03), endovascular infection (13% vs. 1%; P = .007), or infection associated with a medical device (7% vs. 0%; P = .02). 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.


CONCLUSIONS
Campylobacter bacteremia occurs mainly in immunocompromised patients. Clinical features and risk factors of death differ by infection species.
Pacanowski
Jérôme
J
Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Paris, France. jerome.pacanowski@sat.aphp.fr
Lalande
Valérie
V
Lacombe
Karine
K
Boudraa
Cherif
C
Lesprit
Philippe
P
Legrand
Patrick
P
Trystram
David
D
Kassis
Najiby
N
Arlet
Guillaume
G
Mainardi
Jean-Luc
JL
Doucet-Populaire
Florence
F
Girard
Pierre-Marie
PM
Meynard
Jean-Luc
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology* / Q000401:mortality*; D002167:Campylobacter; D002169:Campylobacter Infections / Q000401:mortality*; D002168:Campylobacter fetus; D002648:Child; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D010297:Paris; D055815:Young Adult