Download WALTER REED DOM GME Snapshot Dec 2016 RESEARCH AND

WALTER REED DOM GME Snapshot
Dec 2016
RESEARCH AND ACADEMIC SUCCESS
ID Week 2016
Infectious Disease Fellows and Internal Medicine Resident Present Their Posters
ID Fellow, CPT Evan Ewers - "Preliminary Clinical and Microbiological Characteristics of Campylobacter Infection at
a Military Medical Center in Hawaii"
"Preliminary Clinical and Microbiological Characteristics of Campylobacter Infection at a Military Medical Center
in Hawaii"
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