title: Burden of laboratory-confirmed Campylobacter infections in Guatemala 2008-2012: results from a facility-based surveillance system.
abstract: BACKGROUND
  Campylobacteriosis is one of the leading causes of gastroenteritis worldwide. This study describes the epidemiology of laboratory-confirmed Campylobacter diarrheal infections in two facility-based surveillance sites in Guatemala.
  
  
  METHODS
  Clinical, epidemiologic, and laboratory data were collected on patients presenting with acute diarrhea from select healthcare facilities in the departments of Santa Rosa and Quetzaltenango, Guatemala, from January 2008 through August 2012. Stool specimens were cultured for Campylobacter and antimicrobial susceptibility testing was performed on a subset of isolates. Multidrug resistance (MDR) was defined as resistance to ≥3 antimicrobial classes.
  
  
  RESULTS
  Campylobacter was isolated from 306 (6.0%) of 5137 stool specimens collected. For children <5 years of age, annual incidence was as high as 1288.8 per 100,000 children in Santa Rosa and 185.5 per 100,000 children in Quetzaltenango. Among 224 ambulatory care patients with Campylobacter, 169 (75.5%) received metronidazole or trimethoprim-sulfamethoxazole, and 152 (66.7%) received or were prescribed oral rehydration therapy. Antimicrobial susceptibilities were tested in 96 isolates; 57 (59.4%) were resistant to ciprofloxacin and 12 (12.5%) were MDR.
  
  
  CONCLUSIONS
  Campylobacter was a major cause of diarrhea in children in two departments in Guatemala; antimicrobial resistance was high, and treatment regimens in the ambulatory setting which included metronidazole and trimethoprim-sulfamethoxazole and lacked oral rehydration were sub-optimal.
authors.affiliation: Global Disease Detection Program, Division of Global Disease Detection and Emergency Response, Center for Global Health, CDC, Atlanta, GA, USA. Electronic address: bvy8@cdc.gov.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Benoit
authors.affiliation: Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Lopez
authors.affiliation: Global Disease Detection Program, Division of Global Disease Detection and Emergency Response, Center for Global Health, CDC, Atlanta, GA, USA.
authors.forename: Wences
authors.initials: W
authors.lastname: Arvelo
authors.affiliation: Division of Foodborne, Waterborne and Environmental Diseases, National Center For Emerging & Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Henao
authors.affiliation: Division of Foodborne, Waterborne and Environmental Diseases, National Center For Emerging & Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA.
authors.forename: Michele B
authors.initials: MB
authors.lastname: Parsons
authors.affiliation: Ministry of Public Health and Welfare, Guatemala City, Guatemala.
authors.forename: Lissette
authors.initials: L
authors.lastname: Reyes
authors.affiliation: Ministry of Public Health and Welfare, Guatemala City, Guatemala.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Moir
authors.affiliation: Global Disease Detection Program, Division of Global Disease Detection and Emergency Response, Center for Global Health, CDC, Atlanta, GA, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Lindblade
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002167:Campylobacter / Q000302:isolation & purification; D002169:Campylobacter Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000627:therapeutic use; D003140:Communicable Disease Control / Q000379:methods; D017281:Cost of Illness; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005243:Feces / Q000382:microbiology; D005260:Female; D005440:Fluid Therapy; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015532:Rehydration Solutions / Q000008:administration & dosage; D018571:Sentinel Surveillance; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015532:Rehydration Solutions; D008795:Metronidazole; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Antimicrobial resistance; Campylobacter; Epidemiology; Guatemala