[CIS PIDD] [cis-pidd] Multi drug resistant Campylobacter jejuni infection in RAG1 SCID

[CIS-PIDD]

Dear Colleagues:
I am seeking advice for a 20 year old female with RAG1 SCID with recurrent and multi drug resistant Campylobacter jejuni infection (in vitro resistance to macrolides, fluoroquinolones,  doxycycline; sensitive to meropenem and aminoglycosides). Patient has had multiple recurrences of campylobacter jejuni bacteremia over the past 5 months, and has responded to meropenem and amikacin.  She was maintained on meropenem and was asymptomatic. CT scans of chest, abdomen were unremarkable;  A central line was placed a day prior to start of conditioning for matched unrelated donor BMT. A surveillance culture done few hours after placement of the central line is growing campylobacter. She also developed fever  5 days later.
Thus, this is  concerning for lack of efficacy of meropenem. We have added amikacin and due to persistence of fevers, added tigecycline today.

We plan to send the new culture isolates for sensitivity testing with extended panel of antibiotics, such as tigecycline, colistin, rifaximin, ceftazidime-avibactam. Can you recommend a lab experienced with campylobacter sensitivity testing for more comprehensive testing. We had sent the previous test to Mayo.

Any other supportive care recommendations? We are considering granulocyte transfusions during the neutropenic phase.

I am very concerned about our ability to control this infection in the post-transplant phase. I will appreciate if anyone can share experience with MDR campylobacter jejuni bacteremia in immune compromised patients and advice on management of this infection.


Regards,
Suhag

Suhag H. Parikh, M.D.
Associate Professor of Pediatrics
Duke University School of Medicine
Attending Physician
Pediatric Blood and Marrow Transplant Program
Duke University Medical Center
Box 3350, Durham, NC 27710
Tel: 919-668-1121
Fax: 919-668-1180


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