Should I request an Infectious Disease (ID) consult for a patient with a campylobacter infection?

From the Guidelines

A consultation with an infectious disease specialist is generally not necessary for most uncomplicated cases of campylobacter infection, but it is crucial for patients with severe or complicated infections, including those with high fever, severe dehydration, bloody diarrhea persisting beyond 3-4 days, immunocompromised status, pregnancy, or signs of bacteremia or extraintestinal spread, as evidenced by studies such as 1 and 1. For healthy patients with mild to moderate symptoms, empiric treatment with azithromycin (500 mg daily for 3 days) or ciprofloxacin (500 mg twice daily for 5-7 days) is typically sufficient, along with fluid replacement and supportive care, as recommended by guidelines such as 1. However, the increasing resistance of Campylobacter spp. to fluoroquinolones, as reported in studies like 1, highlights the need for careful consideration of antimicrobial therapy and potential consultation with an ID specialist. Some key considerations for requesting an ID consult include:

• Severe or complicated infections, such as those with high fever, severe dehydration, or bloody diarrhea persisting beyond 3-4 days
• Immunocompromised status, pregnancy, or signs of bacteremia or extraintestinal spread
• Failure to respond to initial therapy, recurrent infections, or suspected antimicrobial resistance
• Presence of underlying conditions that may increase the risk of complications, such as Guillain-Barré syndrome or reactive arthritis, as mentioned in 1. By prioritizing these factors and considering the latest evidence, healthcare providers can ensure that patients with campylobacter infections receive appropriate and effective care, minimizing the risk of morbidity, mortality, and reducing the impact on quality of life, as supported by studies such as 1 and 1.

From the Research

Considerations for Requesting an ID Consult

• The decision to request an Infectious Disease (ID) consult for a patient with a campylobacter infection depends on several factors, including the severity of the infection, the patient's overall health, and the presence of any underlying conditions that may affect treatment 2, 3.
• Campylobacter infections can be self-limiting, but antimicrobial treatment may be necessary in severe or prolonged cases, particularly in patients with compromised immune systems 4, 5.
• Antimicrobial resistance is a concern in the treatment of campylobacter infections, with high levels of resistance to tetracycline and ciprofloxacin reported in many areas 4, 5.
• The choice of antimicrobial agent may depend on the results of susceptibility testing, which can help guide therapy and monitor resistance trends 4, 5.
• In some cases, alternative treatments such as oral gentamicin may be effective in eradicating persistent campylobacter infections, particularly in patients with macrolide- and fluoroquinolone-resistant isolates 3.

Factors to Consider in Requesting an ID Consult

• Severity of the infection: Patients with severe or prolonged campylobacter infections may benefit from an ID consult to guide treatment and management 2, 3.
• Underlying health conditions: Patients with compromised immune systems, such as those with agammaglobulinemia, may require an ID consult to manage their infection and prevent complications 3.
• Antimicrobial resistance: Patients with campylobacter infections that are resistant to multiple antimicrobial agents may require an ID consult to guide treatment and monitor resistance trends 4, 5.
• Treatment failure: Patients who have failed initial treatment with antimicrobial agents may benefit from an ID consult to guide alternative treatment options 3, 6.