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

Mon Aug 15 22:36:32 EDT 2016

Hello Suhag,

With respect to the Campy, you may also want to consider testing for Fosfomycin, cefepime, and ceftolazone/tazo, although it may be hard to interpret some of these results.

Disk diffusion (Kirby Bauer) method may be a sufficient start to screen; if there is no zone of inhibition (i.e. growth right up to the disk), it's likely resistant. However, if there is a zone of inhibition, an MIC-based method would be required. The etest is a common MIC method, but historically, can be variable for some of the tested antibiotics. There is less information about test comparative performances for the newer antibiotics. Alternatively, the lab can consider agar dilution or broth microdilution method, but those are more laborious and may not be available.

An older article had also suggested paromomycin as a potential agent (Freydiere et al., Eur J Clin Microbiol. 1984), although this appears to be only in vitro testing and I could not find any clinical reports. Given that it is a non-absorbable aminoglycoside, it may be worth considering prior to transplant as an attempt for gut decolonization. It will obviously do nothing for the line-bacteremia, and it may need to be used in combination with other agents for decolonization.

Don

Donald C. Vinh, MD, FRCP(C)
Director, Infectious Disease Susceptibility Program
Assistant Professor, FRQS Clinician-Scientist
Dept of Medicine (Division of Infectious Diseases; Division of Allergy & Clinical Immunology)
Dept of Medical Microbiology; Dept of Human Genetics

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________________________________
From: CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
Sent: August-15-16 9:40 PM
To: CIS-PIDD
Subject: [cis-pidd] Multi drug resistant Campylobacter jejuni infection in RAG1 SCID

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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