Tuesday, December 5, 2023
| Characteristics | All patients, n = 33 | Patients without documented C. fetus bacteremia, n = 12† | Patients with |
p value |
|---|---|---|---|---|
| Baseline | ||||
| Sex | 0.7 | |||
| M | 18/33 (54) | 6/12 (50) | 12/21 (57) | |
| F | 15/33 (45) | 6/12 (50) | 9/21 (43) | |
| Age, y (SD) | 73 (±18) | 66 (±19) | 77 (±16) | 0.12 |
| Underlying comorbidities | 27/33 (82) | 8/12 (67) | 19/21 (90) | 0.2 |
| Immunosuppression | 13/33 (39) | 2/12 (16) | 11/21 (52) | 0.06 |
| Malignancy/cancers | 8/33 (24) | 1/12 (8.3) | 7/21 (33) | 0.2 |
| Transplantation | 0/33 | 0/12 | 0/21 | |
| Cirrhosis | 1/33 (3.0) | 0/12 | 1/21 (4.8) | >0.9 |
| HIV infection | 0/33 | 0/12 | 0/21 | |
| Connective tissue disease‡ | 3/33 (9.0) | 1/12 (8.3) | 2/21 (9.5) | >0.9 |
| Other§ | 1/33 (3.0) | 0/12 (8.3) | 1/21 (29) | >0.9 |
| Prosthetic heart valves | 8/33 (24) | 4/12 (33) | 4/21 (19) | 0.4 |
| Renal failure | 7/33 (21) | 1/12 (8.3) | 6/21 (29) | 0.2 |
| Diabetes mellitus | 12/33 (36) | 5/12 (42) | 7/21 (33) | 0.7 |
| Cardiovascular disease¶ | 20/33 (61) | 5/12 (42) | 15/21 (71) | 0.14 |
| Recent abdominal surgery | 1/33 (3.0) | 0/12 | 1/21 (4.8) | >0.9 |
| Pregnancy | 0/33 | 0/12 | 0/21 | |
| Contact with livestock/cattle | 0/31 | 0/11 | 0/20 | |
| Poultry consumption | 0/31 | 0/11 | 0/20 | |
| Recent travel# | 1/31 (3.2) | 1/11 (9.1) | 0/20 | 0.4 |
| Similar cases in household/entourage | 0/31 | 0/11 | 0/20 | |
| Recent abdominal trauma injury | 4/31 (13) | 2/11 (18) | 2/20 (10) | 0.6 |
| Transmission or contamination, food or pet | 2/31 (6.5) | 0/11 | 2/20 (10) | 0.5 |
| Clinical features | ||||
| Fever | 21/32 (66) | 8/11 (73) | 13/21 (62) | 0.7 |
| Headache | 1/32 (3.1) | 0/11 | 1/21 (4.8) | >0.9 |
| Asthenia/anorexia | 16/33 (48) | 4/12 (33) | 12/21 (57) | 0.3 |
| Abdominal pain | 11/33 (33) | 7/12 (58) | 4/21 (19) | 0.052 |
| Confusion | 8/31 (26) | 2/10 (20) | 6/21 (29) | >0.9 |
| Dyspnea, respiratory rate >22 cycles/min | 8/31 (26) | 1/10 (10) | 7/21 (33) | 0.2 |
| Hypotension, systolic pressure <100 mm Hg | 7/31 (23) | 1/10 (10) | 6/21 (29) | 0.4 |
| qSOFA score | 0.4 | |||
| 0 | 20/31 (65) | 8/10 (80) | 12/21 (57) | |
| 1 | 3/31 (10) | 1/10 (10) | 2/21 (10) | |
| 2 | 6/31 (19) | 0/10 | 6/21 (29) | |
| 3 | 2/31 (6.5) | 1/10 (10) | 1/21 (4.8) | |
| Sepsis: qSOFA ≥2 | 8/31 (26) | 1/10 (10) | 7/21 (33) | 0.22 |
| Diarrhea, n = 33 | ||||
| Total | 16/33 (48) | 10/12 (83) | 6/21 (29) | 0.004 |
| Liquid | 14/33 (42) | 9/12 (75) | 5/21 (24) | 0.009 |
| Bloody | 2/33 (6.1) | 1/12 (8.3) | 1/21 (4.8) | >0.9 |
| Laboratory and imaging findings | ||||
| Leukocyte count, cells/mm3 (SD); reference range 4,000–10,000 cells/mm3 | 12,387 (6,665) | 9,949 (3,307) | 13,548 (7,571) | 0.076 |
| CRP, mg/L (SD), reference range <5 mg/L | 118 (79) | 120 (52) | 116 (93) | 0.9 |
| Peripheral blood culture | ||||
| No. (SD) | NA | NA | 2.52 (1.63) | NA |
| Negativation, d (SD) | NA | NA | 2.89 (3.14) | NA |
| Transthoracic echocardiography** | 4/32 (12) | 1/11 (9.1) | 3/21 (14) | >0.9 |
| 18F-FDG PET/CT | 3/32 (9.4) | 0/11 (0) | 3/21 (14) | 0.5 |
Table 1. Baseline characteristics, clinical features, and laboratory, and imaging findings for patients with Campylobacter fetus infections, Nord Franche-Comté Hospital, Trévenans, France, 2000–2021*
*Values are no./total (%) except as indicated. Boldface indicates p<0.05 or a significant trend defined by p≤0.06. Blank cells for p values indicate no p value was calculated. 18F-FDG PET/CT, 18F-fluoro-deoxyglucose-positron emission tomography/computed tomography; CRP, C-reactive protein; qSOFA, quick sequential organ failure assessment; NA, not applicable.
†Campylobacter fetus was isolated from 11 fecal cultures and from 1 bile fluid culture; only 1 patient had simultaneous positive peripheral blood and fecal cultures in which C. fetus was isolated with the same antimicrobial testing susceptibility pattern.
‡All patients with connective tissue diseases (bacteremia; n = 2) had multiple sclerosis.
§Defined by hematologic diseases, long-term steroid therapy, or immunomodulatory treatment.
¶Defined by cardiac failure, arrhythmia, coronary heart disease, stroke, peripheral arterial obstructive disease and thromboembolic disease.
#28-y-old patient sought care for bloody diarrhea without fever 8 d after a travel in Spain.
**The 3 patients who underwent transthoracic echocardiography were different patients than those who underwent 18F-FDG PET/CT. No patient had both endocarditis and mycotic aneurysm.
| Characteristics | All patients, n = 33 | Patients with no C. fetus bacteremia, n = 12 | Patients with C. fetus bacteremia, n = 21 | p value | |
|---|---|---|---|---|---|
| Secondary localizations† | |||||
| Site infection | |||||
| Total | 7/33 (21) | 0/12 | 7/21 (33) | 0.03 | |
| Mycotic aneurysm | 3/33 (9.0) | 0/12 | 3/21 (14.3) | 0.28 | |
| Endocarditis | 1/33 (3.0) | 0/12 | 1/21 (4.8) | >0.9 | |
| Infection associated with a medical device | 1/33 (3.0) | 0/12 | 1/21 (4.8) | >0.9 | |
| Thrombophlebitis | 1/33 (3.0) | 0/12 | 1/21 (4.8) | >0.9 | |
| Bone or joint infection | 1/33 (3.0) | 0/12 | 1/21 (4.8) | >0.9 | |
| Skin or soft tissue/abscesses | 0/33 (0) | 0/12 | 0/21 (0) | NA | |
| Meningitis | 0/33 (0) | 0/12 | 0/21 (0) | NA | |
| Antimicrobial therapy | 0.6 | ||||
| Amoxicillin | 0/29 (0) | 0/9 | 0/20 (0) | ||
| Amoxicillin–clavulanic acid | 12/29 | 2/9 | 10/20 (50) | ||
| Imipenem | 2/29 (6.9) | 0/9 | 2/20 (10) | ||
| Gentamicin | 3/29 (10) | 0/9) | 3/20 (15) | ||
| Azithromycin | 1/29 (3.4) | 1/9 (11) | 0/20 (0) | ||
| Ciprofloxacin | 3/29 (10) | 2/9 (22) | 1/20 (5.0) | ||
| Other | 11/29 (38) | 3/9 (33) | 8/20 (40) | ||
| No. antimicrobial drugs/patient | 0.065 | ||||
| 0 | 4/29 (17) | 2/9 (22) | 2/20 (10) | ||
| 1 | 11/29 (38) | 5/9 (56) | 6/20 (30) | ||
| 2 | 10/29 (34) | 2/9 (22) | 8/20 (40) | ||
| 3 | 4/29 (14) | 0/9 | 4/20 (20) | ||
| Dual-therapy regimens | |||||
| Amoxicillin/clavulanic acid + gentamicin | 3/10 (30) | 0/2 | 3/8 (38) | ||
| Amoxicillin/clavulanic acid + azithromycin | 1/10 (10) | 0/2 | 1/8 (12) | ||
| Amoxicillin/clavulanic acid + ciprofloxacin | 2/10 (20) | 0/2 | 2/8 (25) | ||
| Amoxicillin/clavulanic acid + doxycycline | 3/10 (30) | 2/2 (100) | 1/8 (12) | ||
| Imipenem + gentamicin | 1/10 (10) | 0/2 | 1/8 (12) | ||
| Treatment duration, d (SD) | 8 (8) | 5 (5) | 9 (8) | 0.2 | |
| Outcomes and mortality rates | |||||
| Long-term complications, n = 33 | |||||
| Total | 1/33 (3.0) | 0/12 | 1/21 (4.8) | >0.9 | |
| Aneurysmal rupture/aortic dissection | 1/33 (3.0) | 0/12 | 1/21 (4.8) | >0.9 | |
| Acute coronary syndrome | 0/33 (0) | 0/12 | 0/21 (0) | NA | |
| Irritable bowel syndrome | 0/33 (0) | 0/12 | 0/21 (0) | NA | |
| GBS (polyradiculoneuritis) | 0/33 (0) | 0/12 | 0/21 (0) | NA | |
| Surgery‡ | 5/31 (16.1) | 1/10 | 4/21 (19) | 0.6 | |
| Relapse§ | 2/33 (6) | 0/12 | 2/21 (9.5) | 0.5 | |
| Transfer to intensive care | 4/33 (12) | 0/12 | 4/21 (19) | 0.3 | |
| Septic shock | 4/33 (12) | 0/11 | 4/21 (19) | 0.3 | |
| Infection-related mortality | 6/29 (21) | 1/8 (12) | 5/21 (24) | 0.6 | |
| 30-day mortality rate¶ | 10/33 (30) | 3/12 (25) | 7/21 (33) | 0.9 | |
Table 2. Secondary localizations, therapeutic management, and outcomes of patients with Campylobacter fetus infections among patients with and without bacteremia, Nord Franche-Comté Hospital, Trévenans, France, 2000–2021*
*Values are no./total (%) except as indicated. Boldface indicates p<0.05 or a significant trend defined by p≤0.06. Blank cells for p values indicate no p value was calculated. GBS, Guillain-Barré syndrome; NA, not applicable.
†Mycotic aneurysm (n = 3) with infectious native aortic aneurysm (n = 2); prosthetic aortic valve and a positive culture of the aneurysm after surgery (n = 1); prosthetic valve endocarditis (n = 1) with typical oscillating vegetation (15 mm) confirmed by transthoracic echocardiography; abdominal aorta thrombophlebitis (n = 1); hematogenous medical device infection with a percutaneous implantable port-related infection (n = 1); osteoarticular (n = 1) with glenohumeral shoulder arthritis and a positive culture of the articular fluid after surgery, suggesting a contiguous infection.
‡Four patients with bacteremia caused by C. fetus underwent surgery: mycotic aneurysm (n = 2), endocarditis (n = 1), and septic arthritis (n = 1).
§Two patients exhibited a relapse with fever after 26 and 50 d; the second patient died of septic shock during the second episode. The first patient received ciprofloxacin orally for 5 d, and the second patient received IV vancomycin for 7 d.
¶Among the 7 bacteremic patients who died, 2 died in the context of evolutive/expanding malignancy (independently of the bacteremia).
| Antimicrobial tested | All patients, no. (%), n = 33 | Patients with no C. fetus bacteremia, no. (%), |
Patients with |
p value |
|---|---|---|---|---|
| Amoxicillin† | 3/28 (10.7) | 1/8 (12) | 2/20 (10) | 0.3 |
| Amoxicillin–clavulanic acid | 0/28 | 0/8 | 0/20 | |
| Imipenem | 0/28 | 0/8 | 0/20 | |
| Gentamicin | 0/27 | 0/8 | 0/19 | |
| Azithromycin | 2/29 (6.9) | 0/9 | 2/20 (10) | >0.9 |
| Fluoroquinolones: ofloxacin and ciprofloxacin‡ | 8/27 (30) | 2/9 (22) | 6/18 (33) | 0.7 |
| Doxycycline | 7/29 (24) | 1/9 (11) | 6/20 (30) | 0.4 |
Table 3. Antimicrobial resistance of Campylobacter fetus strains isolated from patients with and without bacteremia, Nord Franche-Comté Hospital, Trévenans, France, 2000–2021*
*Values are no. resistant/no. tested (%) except as indicated. Blank cells for p values indicate no p value was calculated.
†Susceptibility to amoxicillin was intermediate (susceptible with high doses) for 2 strains.
‡Susceptibility to ofloxacin and ciprofloxacin was the same for all strains.
| Variable | Total, n = 21 | Survival, n = 14 | Death, n = 7 | p value† | OR (95% CI) |
|---|---|---|---|---|---|
| Dyspnea, respiratory rate >22 cycles/min | 7/21 (33) | 2/14 (14) | 5/7 (71) | 0.017 | 15.0 (1.9–186.4) |
| qSOFA score | 0.017 | NA | |||
| 0 | 12/21 (57) | 11/14 (79) | 1/7 (14) | ||
| 1 | 2/21 (10) | 1/14 (7.1) | 1/7 (14) | ||
| 2 | 6/21 (24) | 2/14 (14) | 4/7 (57) | ||
| 3 | 1/21 (4.8) | 0/14 | 1/7 (14) | ||
| qSOFA score | 0.012 | 4.9 (1.6–21.9) | |||
| Sepsis: qSOFA score ≥2 | 7/21 (33) | 2/14 (14) | 5/7 (71) | 0.021 | 13.7 (1.7–171.4) |
| Septic shock | 4/21 (19) | 0/14 | 4/7 (57) | 0.006 | NA |
| Transfer to intensive care | 4/21 (19) | 0/14 | 4/7 (57) | 0.006 | NA |
| Treated with amoxicillin/clavulanic acid | 10/21 (48) | 9/14 (64) | 1/7 (14) | 0.05 | 0.09 (0.0–0.75) |
| Antimicrobial drugs/patient | 0.001 | NA | |||
| 0 | 3/21 (14) | 0/14 | 3/7 (43) | ||
| 1 | 6/21 (29) | 5/14 (36) | 1/7 (14) | ||
| 2 | 8/21 (38) | 8/14 (57) | 0/7 | ||
| 3 | 4/21 (19) | 1/14 (7.1) | 3/7 (43) | ||
| Antimicrobial drugs/patient, median | 1.6 | 1.7 | 1.4 | 0.519 | 0.7 (0.2–1.9) |
| Infection-related mortality | 5/21 (24) | 0/14 | 5/7 (71) | 0.001 | NA |
Table 4. Risk factors for death within 30 d after Campylobacter fetus bacteremia, Nord Franche-Comté Hospital, Trévenans, France, 2000–2021*
*Values are no./total (%) except as indicated. Blank cells for p values indicate no p value was calculated. qSOFA, quick sequential organ failure assessment; NA, not applicable; OR, odds ratio.
†p≤0.05 indicates significance.
Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 1.00 ABIM MOC points
This activity is intended for primary care clinicians, infectious disease specialists, and other healthcare professionals who care for patients with Campylobacter fetus infections.
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Campylobacter fetus accounts for 1% of Campylobacter spp. infections, but prevalence of bacteremia and risk for death are high. To determine clinical features of C. fetus infections and risks for death, we conducted a retrospective observational study of all adult inpatients with a confirmed C. fetus infection in Nord Franche-Comté Hospital, Trevenans, France, during January 2000–December 2021. Among 991 patients with isolated Campylobacter spp. strains, we identified 39 (4%) with culture-positive C. fetus infections, of which 33 had complete records and underwent further analysis; 21 had documented bacteremia and 12 did not. Secondary localizations were reported for 7 (33%) patients with C. fetus bacteremia, of which 5 exhibited a predilection for vascular infections (including 3 with mycotic aneurysm). Another 7 (33%) patients with C. fetus bacteremia died within 30 days. Significant risk factors associated with death within 30 days were dyspnea, quick sequential organ failure assessment score ≥2 at admission, and septic shock.
Campylobacter is a genus of microaerophilic, fastidious, gram-negative, occasionally partially anaerobic, non–spore forming, motile bacteria with a characteristic spiral or corkscrew-like appearance[1]. Such morphology enables the bacteria to colonize the mucosal surfaces of the gastrointestinal tract in humans and other animal species[2]. In France, C. fetus is the most commonly isolated Campylobacter species, after C. jejuni and C. coli, found in fecal samples during diarrheal episodes in humans[3], and the leading species recovered from invasive infections, such as bacteremia and secondary localizations; both C. jejuni and C. coli have been identified in 43% of cases[4].
Earlier reports have revealed the incidence, clinical characteristics, and outcomes of bacteremia caused by C. fetus[4,5]. Disease severity and risk for death from C. fetus systemic infection are of concern for clinicians; fatality rate is ≈15%[4,5]. C. fetus is also known to have a predilection for vascular endothelium, causing mycotic aneurysms, thrombophlebitis, endocarditis (including infections of prosthetic heart valves), and multivisceral complications[4–11]. A bactericidal antimicrobial drug treatment based on use of a β-lactam (such as amoxicillin/clavulanic acid or a carbapenem) should be favored[4].
Using data for January 2000–December 2021, we conducted a retrospective observational and descriptive study in Nord Franche-Comté Hospital, located in eastern France. Our primary objective was to describe clinical and paraclinical features (including antimicrobial susceptibility) in patients with C. fetus infections by comparing patients with and without bacteremia. Our secondary objective was to evaluate the risk factors for 30-day mortality in patients with bacteremia caused by C. fetus.
Patient consent was obtained by sending patients a letter informing them of the use of their medical data for research purposes and receiving no objection by 30 days later. Because of the retrospective nature of the study, with no patient involvement and use of already available data, the local Ethics Committee of Nord-Franche-Comte Hospital determined that patient consent was sufficient. The confidentiality of participant data has been respected in accordance with the Declaration of Helsinki.
