Advice to Clinicians

Campylobacter bacteria isolated from clinical samples from ill people in this outbreak were resistant to recommended, first-line antibiotics used to treat severe Campylobacter infections.

• Whole genome sequencing analysis of 56 isolates from stool from ill people found that 46 (82%) were resistant to azithromycin, ciprofloxacin, clindamycin, erythromycin, nalidixic acid, telithromycin, and tetracycline.

Clinicians should consider the following when managing patients who have suspected or confirmed Campylobacter infection and exposure to puppies purchased from pet stores:

• Supportive care (for example, rehydration and electrolyte repletion) should be sufficient for most patients.
• For patients who may require antibiotics—for example, those who are at high risk for serious illness, such as infants and young children, adults aged 65 years and older, pregnant women, and people with compromised immunity:
  • Order stool culture and antibiotic susceptibility testing.
  • Choose an antibiotic based on the results of the patient’s stool cultures and antibiotic susceptibility testing.
  • Consider consulting an infectious disease specialist.
• When empiric treatment is required, avoid agents to which the outbreak strain is resistant. This includes the antibiotics listed above as well as penicillins, amoxicillin-clavulanic acid, cephalosporins, metronidazole, and trimethoprim-sulfamethoxazole, to which Campylobacter jejuni are inherently resistant.
  • Carbapenem antibiotics (such as meropenem or imipenem) may be used for infections that are resistant to recommended treatment agents.
• Follow local health department requirements for reporting campylobacteriosis, which is a nationally notifiable illness.
  • Refer to local or state guidelines for Campylobacter reporting and isolate submission requirements. Always reach out to your state public health laboratory for guidance prior to submitting isolates.