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Pizzuti M, Bailey P, Derrick C, Albrecht B, Carr AL, Covington EW, Deri CR, Green SB, Hayes J, Hobbs ALV, Hornback KM, Keil E, Lukas JG, Seddon M, Taylor AD, Torrisi J, Bookstaver PB. Epidemiology and treatment of invasive Bartonella spp. infections in the United States. Infection 2024:10.1007/s15010-024-02177-1. [PMID: 38300353 DOI: 10.1007/s15010-024-02177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Bartonella spp., renowned for cat-scratch disease, has limited reports of dissemination. Tissue and blood cultures have limitations in detecting this fastidious pathogen. Molecular testing (polymerase chain reaction, PCR) and cell-free DNA have provided an avenue for diagnoses. This retrospective observational multicenter study describes the incidence of disseminated Bartonella spp. and treatment-related outcomes. METHODS Inclusion criteria were diagnosis of bartonellosis via diagnosis code, serology testing of blood, polymerase chain reaction (PCR) of blood, 16/18S tests of blood or tissue, cultures of blood or tissue, or cell-free DNA of blood or tissue from January 1, 2014, through September 1, 2021. Exclusions were patients who did not receive treatment, insufficient data on treatment course, absence of dissemination, or retinitis as dissemination. RESULTS Patients were primarily male (n = 25, 61.0%), white (n = 28, 68.3%), with mean age of 50 years (SD 14.4), and mean Charlson comorbidity index of 3.5 (SD 2.1). Diagnosis was primarily by serology (n = 34, 82.9%), with Bartonella henselae (n = 40, 97.6%) as the causative pathogen. Treatment was principally doxycycline with rifampin (n = 17, 41.5%). Treatment failure occurred in 16 (39.0%) patients, due to escalation of therapy during treatment (n = 5, 31.3%) or discontinuation of therapy due to an adverse event or tolerability (n = 5, 31.3%). CONCLUSIONS In conclusion, this is the largest United States-based cohort of disseminated Bartonella spp. infections to date with a reported 39% treatment failure. This adds to literature supporting obtaining multiple diagnostic tests when Bartonella is suspected and describes treatment options.
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Affiliation(s)
- Morgan Pizzuti
- Prisma Health Richland, 5 Richland Medical Park Drive, Columbia, SC, 29203, USA.
| | - Pamela Bailey
- Prisma Health Richland, 5 Richland Medical Park Drive, Columbia, SC, 29203, USA.
- University of South Carolina School of Medicine, 2 Richland Medical Park Drive, Suite 205, Columbia, SC, 29203, USA.
| | - Caroline Derrick
- Prisma Health Richland, 5 Richland Medical Park Drive, Columbia, SC, 29203, USA
| | | | | | | | - Connor R Deri
- Duke University Hospital, Durham, NC, USA
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
| | | | | | | | | | | | | | - Megan Seddon
- Sarasota Memorial Health Care System, Sarasota, FL, USA
| | - Alex D Taylor
- Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
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McHugh J, Saleh OA. Updates in Culture-Negative Endocarditis. Pathogens 2023; 12:1027. [PMID: 37623987 PMCID: PMC10459830 DOI: 10.3390/pathogens12081027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Blood culture-negative infective endocarditis (BCNE) is a challenging condition associated with significant morbidity and mortality. This review discusses the epidemiology, microbiology, diagnosis, and treatment of BCNE considering advancements in molecular diagnostics and increased access to cardiac surgery. BCNE can be categorized into bacterial endocarditis with sterilized blood cultures due to previous antibiotic treatment, endocarditis caused by fastidious microorganisms, and true BCNE caused by intracellular organisms that cannot be cultured using traditional techniques. Non-infectious causes such as nonbacterial thrombotic endocarditis should also be considered. Diagnostic approaches involve thorough patient history; blood and serum testing, including appropriate handling of blood cultures; serological testing; and molecular techniques such as targeted and shotgun metagenomic sequencing. Where available, evaluation of explanted cardiac tissue through histopathology and molecular techniques is crucial. The therapy for BCNE depends on the likely causative agent and the presence of prosthetic material, with surgical intervention often required.
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Affiliation(s)
- Jack McHugh
- Division of Public Health, Infectious Diseases, Occupational Medicine, Mayo Clinic, Rochester, MN 55901, USA;
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Ordaya EE, Abu Saleh OM, Mahmood M. Reply to Boodman et al. Open Forum Infect Dis 2023; 10:ofad437. [PMID: 37663089 PMCID: PMC10468736 DOI: 10.1093/ofid/ofad437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Eloy E Ordaya
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar M Abu Saleh
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Maryam Mahmood
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Boodman C, Gupta N. Schrödinger's Cat Paradox: Bartonella Serology Cannot Be Used to Speciate Bartonella Endocarditis. Open Forum Infect Dis 2023; 10:ofad436. [PMID: 37663087 PMCID: PMC10468726 DOI: 10.1093/ofid/ofad436] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Carl Boodman
- Department of Internal Medicine, Division of Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Clinical Sciences, Unit of HIV and Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nitin Gupta
- Department of Clinical Sciences, Unit of HIV and Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Infectious Disease, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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