The Health Burden of Campylobacter Infection and the Impact of Antimicrobial Resistance: Playing Chicken

Extract

Campylobacter species are among the most common pathogens in humans and are commensal in birds, swine, and cattle. It is the most common cause of culture-proven bacterial gastroenteritis in developed and developing countries, responsible for 400 million–500 million cases of diarrhea each year. In the United States, >1% of the population acquires the infection each year. Although diarrhea is the most frequent clinical manifestation of Campylobacter species infection, a broad clinical spectrum is associated with this infection, from asymptomatic carriage to systemic illness and bacteremia to localized infection and association with Guillain-Barré syndrome, a severe immunoreactive complication.

In the United States, an estimated 2 million cases of campylobacteriosis occur each year. It is the most common bacterial cause of foodborne illness [1]. The overall incidence of laboratory-confirmed Campylobacter infection in 2005 in the United States was 12.7 cases per 100,000 population, representing a 30% decrease since 1996 [2]. However, the incidence of symptomatic Campylobacter species infection has been estimated at 760–1100 cases per 100,000 population [3]. Age-specific rates of Campylobacter jejuni isolation in patients with diarrhea differ among countries. In industrialized countries, C. jejuni is isolated from 5%–16% of children with diarrhea, with a prevalence of infection in healthy children of 0%–1.5% [1]. In children <5 years of age, the incidence of laboratory-confirmed Campylobacter species infection is 43.4 cases per 100,000 person-years (up to 54.3 cases per 100,000 person-years in children <1 year of age), and the associated male-female ratio is 1.34 : 1 [4]. It is the third most common cause of hospitalization for gastroenteritis after rotavirus and Salmonella species infection, with a hospitalization rate of 10.8% for all Campylobacter species infections [5–7]. Studies of the disease burden of Campylobacter species infection in The Netherlands have estimated that intestinal infection in general accounts for 67,000 disability-adjusted life years per year and that Campylobacter species infections represent at least one-third of the disease burden of all intestinal infections [8]. The cost per case of gastrointestinal infection in Europe has been estimated to be US$94–US$132. In England, the total cost of gastrointestinal infections was estimated to be US$1.23 billion each year. Of this amount, US$116 million is spent on cases of Campylobacter species infection, the highest cost associated with a particular pathogen (including rotavirus and Salmonella) [9].