What is the treatment for Campylobacter ureolyticus abscess?

Treatment of Campylobacter ureolyticus Abscess

The treatment of Campylobacter ureolyticus abscess requires surgical drainage combined with erythromycin as the first-line antibiotic therapy for 5-7 days, with fluoroquinolones as an alternative in non-severe cases. 1

Surgical Management

1. Incision and drainage:

   • Primary treatment for all abscesses caused by C. ureolyticus 1
   • Complete drainage is essential to remove purulent material
   • Irrigation of the abscess cavity with sterile saline solution

2. Wound management:

   • Consider negative pressure wound therapy for larger abscesses
   • Leave wound open if necessary to allow for continued drainage
   • Regular wound assessment and dressing changes

Antimicrobial Therapy

First-line treatment:

• Erythromycin: 500 mg twice daily for 5-7 days 1, 2
  • Preferred due to good activity against Campylobacter species
  • Lower resistance rates compared to fluoroquinolones
  • Particularly effective for C. ureolyticus infections

Alternative regimens:

• Fluoroquinolones (for non-severe infections):

  • Ciprofloxacin 500 mg twice daily for 5-7 days
  • Note: Increasing resistance to fluoroquinolones has been reported in Campylobacter species 2

• For severe infections or immunocompromised patients:

  • Consider combination therapy with an aminoglycoside (e.g., amikacin) 3
  • Extend treatment duration to 10-14 days

Special Considerations

1. Antimicrobial resistance:

   • Obtain cultures before initiating antibiotics to guide therapy 1
   • Nearly one-third of C. ureolyticus isolates possess antimicrobial resistance genes, including ermA (macrolide resistance) 4
   • Adjust therapy based on susceptibility results

2. Polymicrobial nature:

   • C. ureolyticus is rarely isolated in pure culture and is usually found with other anaerobes 5
   • Consider broader antimicrobial coverage if polymicrobial infection is suspected
   • Anaerobic Gram-positive cocci frequently co-exist with C. ureolyticus 5

3. Monitoring response:

   • Evaluate clinical improvement within 72 hours of treatment initiation
   • If no improvement is seen, consider:
     • Inadequate drainage
     • Antimicrobial resistance
     • Presence of foreign body
     • Alternative diagnosis

Clinical Pearls

• C. ureolyticus is an emerging pathogen increasingly recognized in abscesses and blood cultures 4
• The organism requires specialized anaerobic culture techniques and may be missed with routine culture methods 5
• Incubation of primary cultures for at least 72 hours is necessary for isolation 5
• C. ureolyticus has been shown to adhere to intestinal epithelial cells and induce cellular damage 6

Treatment Algorithm

1. Surgical drainage of abscess
2. Obtain specimens for culture and sensitivity
3. Initiate empiric antimicrobial therapy with erythromycin
4. Adjust therapy based on culture results and clinical response
5. Continue antibiotics for 5-7 days in uncomplicated cases
6. Extend treatment to 10-14 days for severe infections or immunocompromised patients

By following this approach, the morbidity and mortality associated with C. ureolyticus abscesses can be minimized while ensuring optimal quality of life outcomes for affected patients.