Clinical impact of stool cultures for Campylobacter in adults with acute or chronic diarrhea

Campylobacter jejuni has emerged as a frequent cause of diarrhea. During a 12-month period at the Houston Veterans Administration Medical Center, we isolated C jejuni from 3.4% of the 290 stool cultures from patients with diarrhea. This compared to an isolation rate of 4.1% for Salmonella and 3.1% for Shigella. During the same period, 17 additional cases of Campylobacter-associated diarrhea were identified in adults at the two other Baylor College of Medicine teaching hospitals. We correlated the clinical history, treatment, and outcome of these 27 cases of Campylobacter-associated diarrhea (22 cases of acute diarrhea and five of chronic diarrhea). In most patients with acute disease, the diarrhea was resolving by the time the results of the cultures were available. The duration of illness was the same whether treated with antibiotics to which Campylobacter was susceptible (effective therapy) or antibiotics to which it was not susceptible (ineffective therapy); the mean duration of diarrhea after submitting the culture was 5.2 days for those with ineffective therapy versus 5.6 days for those receiving effective therapy. Thus, antibiotic therapy did not appear to shorten the duration of acute diarrhea due to Campylobacter. Five patients had chronic diarrhea; all had an unrelated underlying disease, and antibiotic treatment did not change the clinical course despite bacteriologic cure. This study raises questions as to the value of antibiotic therapy for campylobacteriosis, and in this light, we discuss the value of routine culturing for Campylobacter.