1201. Preliminary Clinical and Microbiological Characteristics of Campylobacter Infection at a Military Medical Center in Hawaii
Session: Poster Abstract Session: Clinical Infectious Diseases: Enteric Infections
Friday, October 28, 2016
Room: Poster Hall

Background: Campylobacter species are the leading cause of diarrheal illness in Hawaii, with an incidence of 44-57 cases per 100,000 persons, 4-6 times the national average.  Antimicrobial susceptibility is not routinely available thus necessitating empiric treatment. Given its geographical location halfway between Asia and the continental US, isolates acquired endemically in Hawaii or from foreign travel may more closely resemble the fluoroquinolone resistant strains in Asia than the mainland. This pilot study sought to identify circulating strains of Campylobacter in Hawaii, determine their antimicrobial susceptibilities, and describe associated clinical signs, symptoms and potential risk factors. 

Methods: Campylobacter isolates obtained from routine clinical stool cultures at TAMC from January 2012 to March 2016 were tested for antimicrobial susceptibility and capsular typed by multiplex PCR, pulse-field gel electrophoresis (PFGE) and multi-locus sequence typing. Clinical presentation and risk factors for infection were assessed through chart reviews.

Results: Thirty five (35) isolates have been tested (35/100).  The majority were C. jejuni (34/35). Antimicrobial resistance to ciprofloxacin, tetracycline, and azithromycin are 20%, 20%, and 0%, respectively. The dominant circulating capsular types were HS2 (20% - PFGE-type I) and HS4 8586 HS62 complex (26% - PFGE-type E). The majority of HS2 typed isolates were resistant to ciprofloxacin (6/8) while other serotypes retained sensitivity to ciprofloxacin (25/26). HS2 serotypes predominate in Asia and Oceania while HS4-complex serotypes predominate in North America and Europe. Median patient age was 29 (range 9 months - 75 years). Symptoms included fever (50%), bloody diarrhea (60%), abdominal pain/cramps (80%), and leukocytosis (55%). Empiric treatment was given to 24/35 patients. A fluoroquinolone was the empiric therapy in the majority of adult patients (11/17) while pediatric patients were prescribed azithromycin (7/7). 

Conclusion: Campylobacteriosis in Hawaii presents with fever, bloody diarrhea, and abdominal pain. Preliminary testing suggests a high rate of fluoroquinolone resistance in serotype HS2, the predominant circulating strain in Asia.

Evan Ewers, MD1, Sarah Anisowicz, MD2, Michael Washington, PhD3, Willie Agee, PhD4, Brett Swierczewski, PhD5, Tomas Ferguson, MD, FIDSA1, Mark Burnett, MD2, Scott Seronello, PhD4, Md Nahid, PhD4, Oralak Serichantalergs, PhD5, Woradee Lurchachaiwong, PhD5, Jason Barnhill, PhD4 and Viseth Ngauy, MD, FIDSA1, (1)Department of Medicine, Tripler Army Medical Center, Honolulu, HI, (2)Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI, (3)Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI, (4)Department of Pathology, Tripler Army Medical Center, Honolulu, HI, (5)Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand

Disclosures:

E. Ewers, None

S. Anisowicz, None

M. Washington, None

W. Agee, None

B. Swierczewski, None

T. Ferguson, None

M. Burnett, None

S. Seronello, None

M. Nahid, None

O. Serichantalergs, None

W. Lurchachaiwong, None

J. Barnhill, None

V. Ngauy, None

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