Campylobacter enteritis in adult patients with acute diarrhea from 2005 to 2009 in Beijing, China

BACKGROUND

There has been a marked global increase in the incidence of human Campylobacter enteritis in recent years. This study investigated the epidemiological and clinical features of Campylobacter enteritis in adult patients suffering from acute diarrhea.

METHODS

This was a retrospective review of Campylobacter enteritis in adult patients with acute diarrhea presenting at Beijing University First Hospital, Beijing, China, in the summer and autumn (April to October) of 2005 to 2009. The data collected included the species of campylobacter identified, and the age, gender, clinical manifestations and results of laboratory test on stool samples collected from the patients. Campylobacter sensitivity tests to various antimicrobial agents were conducted on 80 specimens. Chi-square tests were applied using SPSS13.0 software and a two-sided P value of < 0.05 was considered statistically significant.

RESULTS

Campylobacter spp. isolated from the stool specimens of 142 patients with diarrhea represented 14.9% of all the cases examined. C. jejuni was identified in 127 patients (89.4%) and C. coli in 15 others (10.6%). The infection incidence was highest in the age range of 21 - 30 years which comprised 21.7% of the total cases examined. Most cases of diarrhea (46 patients) occurred in June. Watery diarrhea (97.2%), abdominal pain (72.5%) and fever (64.8%) were the most common manifestations of enteric campylobacteriosis. Only four patients (2.8%) had bloody diarrhea. The antimicrobial resistance rates were: cefoperazone (100%), levofloxacin (61.3%), gentamicin (12.5%), erythromycin (6.3%), and azithromycin (2.5%).

CONCLUSIONS

Campylobacter was prevalent among adults with acute diarrhea from 2005 to 2009 in Beijing, China. The large number of those afflicted by the disease warrants the commission of a large multicenter study to determine the extent of enteric campylobacteriosis in this region.

Longitudinal on-farm study of the development of antimicrobial resistance in Campylobacter coli from pigs before and after danofloxacin and tylosin treatments

Effects of danofloxacin or consecutive fluoroquinolone and macrolide treatments on resistance development in Campylobacter have remained uncharacterised. Therefore we analysed the development of resistance in porcine Campylobacter coli before and after danofloxacin and tylosin treatments at a farrowing farm. Danofloxacin-treated (n=12, group A) and control pigs (n=15, group B) were subsequently treated with tylosin and sampled longitudinally. C. coli were isolated and susceptibilities to ciprofloxacin and erythromycin were assessed, isolates were genotyped with PFGE and resistance-related mutations were identified. Isolates from the danofloxacin-treated pigs had more frequently non-wild type MICs (above the epidemiological cut-off value (ECOFF)) for ciprofloxacin (P<0.001) and erythromycin (P<0.05) than those isolated before danofloxacin or those from the controls. Subsequent tylosin treatment increased proportion of isolates with non-wild type MICs for erythromycin in both groups A and B (P<0.01) and, interestingly, proportion of isolates with non-wild type MICs for ciprofloxacin in group B (P<0.001) with high MICs (128 μg/ml). PFGE analysis revealed treatments selecting predominant genotypes with variable resistance patterns and decreasing initial diversity of genotypes. The most common genotype had mainly high MICs for ciprofloxacin among danofloxacin-treated pigs but wild type MICs (below the ECOFF) among the controls housed in the same pens. This suggests that the non-wild type isolate was rarely transmitted or outcompeting wild type genotype in the control pigs without selection pressure. Isolates exhibiting non-wild type MICs for ciprofloxacin harboured the C257T (Thr-86-Ile) mutation in the gyrA gene. In conclusion, a high dose of danofloxacin used at the farm did not prevent emergence of isolates with high MICs for ciprofloxacin. After subsequent tylosin treatment isolates had even higher MICs for ciprofloxacin and erythromycin than before the treatment. Therefore, controlled use of antimicrobials in food animal production is essential.

Campylobacter fetus as cause of prosthetic valve endocarditis

A 65-year-old woman who had previously undergone aortic root replacement with a bioprosthetic valve (Bentall operation) in treatment of annuloaortic ectasia became feverish after developing dental caries and was admitted to our hospital. Transesophageal echocardiography showed an 18 × 4-mm vegetation on her prosthetic valve. Campylobacter fetus was isolated on blood cultures, and she was diagnosed with infectious endocarditis. Aggressive combined antibiotic treatment was effective for her recovery. C. fetus infection is a rarely reported cause of prosthetic valve endocarditis.

[Salmonella and campylobacter infections in 2008]

INTRODUCTION

Information about whether Salmonella and Campylobacter infections are acquired during foreign travel has previously been incomplete. We collected such information systematically for 2008.

METHODS

Information from all laboratory-confirmed cases of Salmonella and Campylobacter-cases from three laboratory catchment areas were prospectively collected by telephone interviews.

RESULTS

Of the overall 3,675 cases of Salmonella infection in 2008, information about recent travel was obtained in 3,152 (86%). Among these, 61% of S. Enteritidis, 6% of S. Typhimurium, and 34% of individuals infected with other serotypes were acquired abroad. Among the isolates that were tested for antimicrobial drug sensitivity, 21% of the isolates acquired during foreign travel were resistant and 9% were multidrug-resistant compared with 7% and 2%, respectively, of the indigenous strains. Nearly a quarter of the 3,455 registered Campylobacter cases were included in the survey, and information about recent travel was obtained from 82%. Among these, 33% were acquired abroad.

DISCUSSION

The proportion of Salmonella infections acquired abroad varies by serotype. S. Enteritidis used to be the most frequent serotype, predominantly acquired from contaminated Danish egg, but S. Enteritidis is today primarily an imported infection. By contrast, S. Typhimurium is predominately acquired in Denmark. The latter observation should be interpreted on the background of the unprecedented large outbreaks of S. Typhimurium in 2008. There was a clear association between a history of foreign travel and the risk of acquiring an infection with a drug-resistant strain.

[Antibiotic resistance of bacteria Campylobacter sp]

Campylobacter is recognized as a major cause of human acute bacterial enteritis. The incidence of human Campylobacter infection has increased markedly in both developed and developing countries and, more significantly, so has rapid emergence of antibiotic-resistant Campylobacter strains. It is caused by improper applying antibiotics in treating people and too frequent applying these substances in the animal husbandry. In this review, the patterns of emerging resistance to the antimicrobial agents useful in treatment of the disease are presented and the mechanisms of resistance to these drugs in Campylobacter spp. are discussed.

Campylobacter spp among children with acute diarrhea attending Mulago hospital in Kampala--Uganda

BACKGROUND

Campylobacter infections occur worldwide. A recent study in Kampala, Uganda, found that 87% of broiler chickens had Campylobacter jejuni; these are potential source of human infection. Isolation rate in developing countries is between 5-35%. This study aimed at finding prevalence of children with campylobacter infection among children with acute diarrhea attending Mulago hospital.

OBJECTIVE

The objective was to establish the proportion of children infected with Campylobacter spp among children with acute diarrhea at Mulago hospital.

METHODS

A crossectional study from July to October 2005 was conducted involved 226 children with acute diarrhea. Serial sampling was done a total of 226 stool specimens were obtained and cultured on selective media. Identification was done using biochemical test and susceptibility using standard discs diffusion method.

RESULTS

Campylobacter spp were isolated in 21 (9.3%) of 226 stool specimens analyzed. Campylobacter jejuni 17 (80.9%), Campylobacter lari 2 (9.5%), Campylobacter coli 1 (4.5%) and Campylobacter jejuni/coli 1(4.5%). All Campylobacter isolates were sensitive to erythromycin, and 20% had intermediate resistance to Ampicillin.

CONCLUSION

Campylobacter spp are prevalent among children with acute diarrhea in Kampala- Uganda. A large multicenter study should be undertaken so that the extent of campylobacter infection in our setting can be established.

Antibiotic Resistance Among Campylobacter jejuni/coli Strains Acquired in Sweden and Abroad: A Longitudinal Study

Antibiotic resistance was compared in 844 Campylobacter jejuni/coli strains acquired outside Sweden and 575 acquired in Sweden during 1990-2002. There was a clear gradual increase in ciprofloxacin and tetracycline resistance among C. jejuni/coli strains acquired outside Sweden during the 13 y period. This trend was not seen for erythromycin or in domestically acquired strains for any of the 3 antibiotics tested.

Campylobacter fetus cellulitis in an immunocompromised patient: case report and review of the literature

Campylobacter fetus is an opportunist Gram-negative bacillus. The most frequent clinical manifestation is bacteriemia but it can also be responsable for soft tissue infections, endovascular infections, meningitis, peritonitis and thrombophlebitis. Campylobacter fetus cellulitis has been described, but rarely identified in subcutaneous puncture samples. We report a case of an immunocompromised patient with Campylobacter fetus bacteriemia associated with a soft tissue infection whose subcutaneous puncture also revealed the bacteria.

Prevalence and antibiotic susceptibility of thermophilic Campylobacter isolates from free range domestic duck (Cairina moschata) in Morogoro municipality, Tanzania

Prevalence and antibiotic susceptibility of thermophilic Campylobacter isolated from free-ranging ducks was determined in Morogoro Municipality, Tanzania. Ninety intestinal contents from ducks were screened for thermophilic Campylobacter using Skirrow's protocol. Of the Campylobacter jejuni isolates, 50 were tested for sensitivity to 12 antibiotics. Overall prevalence of thermophilic Campylobacter was 80%. The prevalence of Campylobacter in adult ducks (91.3%) was significantly (p < 0.05) higher than ducklings (68.2%). The isolation rate of C. jejuni (81.9%) was significantly (P < 0.001) higher than C. coli (18.1%). All C. jejuni isolates were susceptible to streptomycin, nitrofurantoin and amikacin. Forty eight percent, 74% and 82% of isolates were resistant to cefuroxime sodium, tetracycline and ampicillin respectively. Between 20-50% of isolates were resistant to erythromycin, gentamicin, cloxacillin and amoxicillin. Norfloxacin and ciprofloxacin had lower C. jejuni resistance of 10% and 16% respectively. C. jejuni isolates from adult ducks showed significantly higher rates of resistance (p < 0.05) to most antibiotics than did duckling isolates. High prevalence of thermophilic Campylobacter in ducks could be of public health significance in Morogoro municipality. The observed multidrug resistance in this study poses a threat of transfer of antibiotic resistance to human pathogens because of the close contact between ducks and human.

[Campylobacter enteritis and related organisms. Clinical microbiology and antibiotic resistance]

The Authors underline the importance to always and correctly investigate also for Campylobacters and related organisms (Clo's) in faeces of humans with enteritis, because prevalent like Salmonella and for surveillance antibiotic resistances; in fact for campylobacteriosis specific therapy is often necessary. Between 2001 and 2005 248 strains of Campylobacter and Clo's were isolated: 225 were C. jejuni (90.7%) and 16 C. coli (6.5%). The recommended antibiotics to use for therapy, for preventing secondary effects too, are erythromycin, ciprofloxacin and tetracycline. Among C. jejuni, resistances towards erithromycine were 6.8% during 2001-02, 6.8% during 2003 and 4.8% during 2004-05; the resistances towards ciprofloxacin were 52.9% during 2001-02, 53.8% during 2003 and 42.9% during 2004-05; the resistances towards tetracycline were 39.2% during 2001-02, 46.2% during 2003 and 50.0% during 2004-05. The strains of C. coli showed less resistances, also in respect of previous our data too. No relevant differences were observed in antibacterial resistances among strains isolated from children and strains isolated from adults.

Combined treatment with oral kanamycin and parenteral antibiotics for a case of persistent bacteremia and intestinal carriage with Campylobacter coli

Campylobacter coli (C. coli) is a rare pathogen of bacteremia, but in immunocompromised hosts, C. coli occasionally causes bacteremia which can be refractory to antibiotic treatment. We report a case of C. coli bacteremia in a patient with X-linked agammaglobulinemia. Bacteremia relapsed repeatedly in spite of treatment with combined intravenous antibiotics. C. coli was observed in the biopsy specimens from the intestinal mucosa, suggesting intestinal carriage and reservoir of recurring infection. The addition of oral kamamycin with intravenous antibiotics was successful in eradicating C. coli from the blood and intestine.

Trends in antibiotic sensitivity pattern and molecular detection of tet(O)-mediated tetracycline resistance in campylobacter jejuni isolates from human and poultry sources

This study was conducted to determine the trends in Campylobacter antibiotic resistance occurring in our setting and to assess the differences in the isolates using patterns of plasmid profiles. One hundred Campylobacter jejuni strains of human and poultry origin isolated in 2002-2003 (phase A) and 2005-2006 (phase B) in the Kingdom of Bahrain were evaluated. Susceptibility to erythromycin, ciprofloxacin and tetracycline was determined, and plasmid extraction and polymerase chain reaction detection of the tet(O) gene was carried out. A single erythromycin-resistant isolate was identified, in sharp contrast to the high ciprofloxacin resistance which also showed an increment in phase B. Tetracycline resistance was higher in chicken (80.9%) compared to human (41.3%) isolates (P<0.01). Most isolates harbored two plasmids (23 kb and 35 kb) with significant correlation between tetracycline resistance and plasmid carriage in chicken isolates. The findings show continued effectiveness of erythromycin for campylobacteriosis but an increasing trend of high ciprofloxacin and tetracycline resistance. Tetracycline resistance is most likely due to the transfer of plasmids carrying the tet(O) gene between isolates.

Prevalence, haemolytic and haemagglutination activities and antibiotic susceptibility profiles of Campylobacter spp. isolated from human diarrhoeal stools in Vhembe District, South Africa

Campylobacter species are increasingly being recognized as agents of gastroenteritis worldwide. However, data on the pathogenic characteristics of the organism isolated in rural communities in South Africa are lacking. In this study, the prevalence of Campylobacter spp. from diarrhoeal stools, haemolytic and haemagglutinating activities of the isolates, and antibiotic susceptibility profiles, including minimum inhibitory concentration (MIC) patterns to different antibiotics, were determined using the standard microbiological techniques. Campylobacter spp. were isolated from individuals of all age-groups; however, the infection rate was higher among individuals aged less than two years (30.4%). Of 115 Campylobacter strains isolated, polymerase chain reaction (PCR) analysis indicated that 98 (85%) were C. jejuni, while 17 (15%) were C. coli. Seventy-one (62%) of the strains showed haemolysis on human blood, and 80% agglutinated human blood, whereas 22.6% were beta-lactamase-positive. Resistance to antimicrobials, such as erythromycin, ciprofloxacin, vancomycin, and fusidic acid, was high. Increased resistance to macrolide and quinolone antibiotics poses major risks for treatment failure. Haemolytic and haemagglutinating activities may be useful in preliminary characterization of pathogenic strains in settings where Campylobacter-associated infections are common.

Association of antimicrobial resistance in Campylobacter isolated from food-producing animals with antimicrobial use on farms

On 1,374 food-producing animal farms in 2001-2004, we investigated the influence of antimicrobial usage within 6 months before a survey conducted on antimicrobial resistance in Campylobacter. Tetracyclines and fluoroquinolones were used for therapeutic purposes on 107 and 21 farms, respectively. Oxytetracycline-resistant C. jejuni and C. coli were found in 57.1% (8/14) and 92.5% (37/40) of the farms, respectively, when the animals were treated with tetracyclines. However, they were found in 43.2% (112/259) and 74.3% (122/164) of the farms, respectively, when the animals were not treated with tetracyclines. Enrofloxacin-resistant C. jejuni and C. coli were found in 66.7% (2/3) and 16.7% (1/6) of the farms, respectively, when the animals were treated with fluoroquinolones. However, they were found in 15.5% (42/270) and 28.8% (57/198) of the farms, respectively, when the animals were not treated with fluoroquinolones. The percentage of oxytetracycline resistance in C. coli was significantly elevated when the animals were treated with tetracyclines (P < 0.05). The farms on which antimicrobials included by their resistance pattern were used accounted for 9.1% (4/44) and 24.1% (14/58) of the farms where enrofloxacin-resistant C. jejuni and C. coli were isolated, respectively. It is likely that several factors account for the presence of fluoroquinolone-resistant Campylobacter.

Macrolide-resistant Campylobacter: the meat of the matter

The use of macrolide antibiotics in food animals has the potential to select for macrolide-resistant strains of resident bacterial flora. This may include the animal pathogens that are the intended targets of macrolide antibiotic intervention and Campylobacter, common inhabitants of the intestinal tract of food animals that are zoonotic pathogens in man. Such Campylobacter strains are not only resistant to the macrolide antibiotics used in food animals, e.g. tylosin, tilmicosin and tulathromycin, but to the macrolide antibiotics used in human medicine, e.g. erythromycin, azithromycin and clarithromycin, as well. Retail meat is a possible source of Campylobacter and persons consuming the meat derived from macrolide-treated food animals could acquire infections due to macrolide-resistant strains of this organism. Erythromycin is sometimes used to treat human cases of campylobacteriosis and those infected with animal-derived macrolide-resistant Campylobacter may not respond to treatment. The actual risk to human health from the use of macrolide antibiotics in food animals has been difficult to determine because of a lack of information about the macrolide-resistant Campylobacter found on the farm and in the clinic. Recently, however, a plethora of new information has become available on this topic. This review discusses what is currently known about the selection of macrolide-resistant Campylobacter in food animals, the prevalence of macrolide-resistant Campylobacter on retail meat, the prevalence of animal-derived macrolide-resistant Campylobacter in the clinic and the human health consequences associated with macrolide-resistant Campylobacter infection. This work will emphasize the comprehensive body of data generated in Denmark and the US as part of government-sponsored research studies over the last 10 years. These scientific findings may allow informed decisions to be made in the future about how macrolide antibiotics should be used in food animals while still safeguarding human health.

Development of macrolide-resistant Campylobacter in broilers administered subtherapeutic or therapeutic concentrations of tylosin

The use of antimicrobials in food animal production, particularly those commonly used to treat infections in humans, has become a source of debate in recent years. However, limited data are available regarding the development of resistance following the subtherapeutic or therapeutic administration of antimicrobials in animal production. The objective of this study was to evaluate the effect of the administration of therapeutic and subtherapeutic concentrations of tylosin on the erythromycin susceptibility of Campylobacter jejuni and Campylobacter coli isolated from the ceca of treated broilers. In three replicated studies, day-of-hatch chicks were exposed to macrolide-susceptible C. jejuni or C. coli. At 2 weeks of age, tylosin was administered at subtherapeutic (22 ppm, continuously in the diet) or therapeutic concentrations (529 ppm, in the drinking water for 5 days). Broilers were sacrificed weekly. Total and erythromycin-resistant Campylobacter spp. were enumerated from individual ceca plus cecal contents. Overall erythromycin resistance was observed at a higher frequency (P < 0.01) among C. coli isolates (70.8%) than among C. jejuni isolates (36.8%) following tylosin administration. Across Campylobacter species, erythromycin resistance was observed at a higher frequency (P < 0.001) when tylosin was administered at subtherapeutic (62.7%) than at therapeutic (11.4%) concentrations. Subtherapeutic administration resulted in the recovery of 83.3 and 56.1% erythromycin-resistant isolates compared with only 33.3 and 7.9% of the isolates expressing erythromycin resistance following the administration of therapeutic concentrations for C. coli and C. jejuni, respectively. Further studies are needed to determine the factors involved in the apparent difference in the acquisition of macrolide resistance in C. coli compared with C. jejuni.

Prevalence of resistance to 11 antimicrobials among Campylobacter coill isolated from pigs on 80 grower-finisher farms in Ontario

We carried out a cross-sectional study to investigate antimicrobial resistance patterns of Campylobacter coli isolated from Ontario grower-finisher pigs. From January to June 2004, 1200 samples were collected from 80 farms by obtaining a constant number (15) of fecal samples per farm. Susceptibility of the isolates to 11 antimicrobial drugs was determined by the agar-dilution technique. The overall prevalence of resistance to 1 or more antimicrobials among the isolates was 99.2%. High levels of resistance were observed for azithromycin, clindamycin, erythromycin, streptomycin, and tetracycline: 91.7%, 82.5%, 81.4%, 70.7%, and 63.7%, respectively. For sulfamethoxazole, ampicillin, and nalidixic acid, resistance was observed in 40.3%, 26.6%, and 22.7% of the isolates, respectively. Although at very low levels, resistance was observed for ciprofloxacin (a fluoroquinolone), chloramphenicol, and gentamicin: in 2.4%, 1.7%, and 0.2%, respectively. Many of the isolates (29.7%) were resistant to 5 antimicrobials, the most common being azithromycin, clindamycin, erythromycin, streptomycin, and tetracycline. Isolates from the same farm showed at least 5 patterns of resistance. Results from this study indicate high levels of resistance to the antimicrobial drugs most commonly used in the Canadian swine industry (macrolides, lincosamides, and tetracyclines) among C. coli isolated from grower-finisher pigs in Ontario. Macrolides and fluoroquinolones are the drugs most commonly used to treat severe human campylobacteriosis. Fortunately, at present, there is little resistance to fluoroquinolones among C. coli from pigs in Ontario.

Isolation and drug-resistant patterns of Campylobacter strains cultured from diarrheic children in Tehran

To detect campylobacteriosis and determine the drug susceptibility of causative organisms, we acquired 500 diarrheic samples in Cary-Blair transfer medium from two pediatric hospitals in Tehran between October 2004 and October 2005. The samples were also enriched in Preston broth (with supplements) and defibrinated sheep blood (7%). They were plated from both media on Brucella agar containing antibiotics and blood. Isolates were identified through biochemical tests and by the polymerase chain reaction method. Drug susceptibility testing was performed using the disk diffusion method. In total, 40 Campylobacter strains were isolated (8%). C. jejuni was the dominant species (85.8%) followed by C. coli (14.2%). The rates of resistance to antimicrobial agents were as follows: ciprofloxacin (61.7%), ceftazidime (47%), carbenicillin (35%), tetracycline (20.5%), cefotaxime (14.7%), ampicillin (11.7%), neomycin erythromycin and chloramphenicol (2.9%), gentamicin, streptomycin, imipenem and colistin (0.0%). Campylobacter is an important cause of diarrhea among Iranian children. The detection of Campylobacter increases by 25% if samples are treated in enrichment broth prior to plating. The high rate of resistance to ciprofloxacin is alarming, and further investigation into the possible reasons for this is imperative.

Fatal relapse of a purulent pleurisy caused by Campylobacter fetus subsp. fetus

Campylobacter fetus is associated with invasive disease, while other Campylobacter species, such as C. coli and C. jejuni, are a common cause of bacterial diarrhea. Bacteremia has been well described, but pleurisy remains very uncommon. We report the recurrent isolation of a C. fetus subsp. fetus strain during two episodes of pleural effusion with a fatal outcome.