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Epidemiology and treatment of invasive Bartonella spp. infections in the United States

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Abstract

Objectives

Bartonella spp., renowned for cat-scratch disease, has limited reports of dissemination. Tissue and blood cultures have limitations in detecting this fastidious pathogen. Molecular testing (polymerase chain reaction, PCR) and cell-free DNA have provided an avenue for diagnoses. This retrospective observational multicenter study describes the incidence of disseminated Bartonella spp. and treatment-related outcomes.

Methods

Inclusion criteria were diagnosis of bartonellosis via diagnosis code, serology testing of blood, polymerase chain reaction (PCR) of blood, 16/18S tests of blood or tissue, cultures of blood or tissue, or cell-free DNA of blood or tissue from January 1, 2014, through September 1, 2021. Exclusions were patients who did not receive treatment, insufficient data on treatment course, absence of dissemination, or retinitis as dissemination.

Results

Patients were primarily male (n = 25, 61.0%), white (n = 28, 68.3%), with mean age of 50 years (SD 14.4), and mean Charlson comorbidity index of 3.5 (SD 2.1). Diagnosis was primarily by serology (n = 34, 82.9%), with Bartonella henselae (n = 40, 97.6%) as the causative pathogen. Treatment was principally doxycycline with rifampin (n = 17, 41.5%). Treatment failure occurred in 16 (39.0%) patients, due to escalation of therapy during treatment (n = 5, 31.3%) or discontinuation of therapy due to an adverse event or tolerability (n = 5, 31.3%).

Conclusions

In conclusion, this is the largest United States-based cohort of disseminated Bartonella spp. infections to date with a reported 39% treatment failure. This adds to literature supporting obtaining multiple diagnostic tests when Bartonella is suspected and describes treatment options.

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Data availability

The data that support the findings of this study are available from the corresponding author, MP, upon reasonable request.

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Acknowledgements

All authors contributed data and edits to manuscript. MP, PB, CD, and BB conceptualized and developed methodology. MP coordinated sites and compiled data. MP and BB did data analysis. MP and PB wrote manuscript.

Funding

There was no funding provided for this project.

Author information

Authors and Affiliations

  1. Prisma Health Richland, 5 Richland Medical Park Drive, Columbia, SC, 29203, USA

    Morgan Pizzuti, Pamela Bailey & Caroline Derrick

  2. University of South Carolina School of Medicine, 2 Richland Medical Park Drive, Suite 205, Columbia, SC, 29203, USA

    Pamela Bailey

  3. Emory University Hospital, Atlanta, GA, USA

    Benjamin Albrecht & Sarah B. Green

  4. AdventHealth Orlando, Orlando, FL, USA

    Amy L. Carr & Jillian Hayes

  5. Jackson Hospital, Montgomery, AL, USA

    Elizabeth W. Covington

  6. Duke University Hospital, Durham, NC, USA

    Connor R. Deri & Elizabeth Keil

  7. Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA

    Connor R. Deri

  8. Methodist University Hospital, Memphis, TN, USA

    Athena L. V. Hobbs & Jack G. Lukas

  9. The Medical University of South Carolina (MUSC) Health, Charleston, SC, USA

    Krutika Mediwala Hornback

  10. Sarasota Memorial Health Care System, Sarasota, FL, USA

    Megan Seddon

  11. Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA

    Alex D. Taylor

  12. Grady Health System, Atlanta, GA, USA

    Joseph Torrisi

  13. University of South Carolina College of Pharmacy, Columbia, SC, USA

    P. Brandon Bookstaver

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  1. Morgan Pizzuti
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  2. Pamela Bailey
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  14. Megan Seddon
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  15. Alex D. Taylor
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Contributions

All authors contributed data and edits to manuscript. MP, PB, CD, and PBB conceptualized and developed methodology. MP coordinated sites and compiled data. MP and PBB did data analysis. MP and PB wrote manuscript and revisions.

Corresponding authors

Correspondence to Morgan Pizzuti or Pamela Bailey.

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The authors declare no competing interests.

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Pizzuti, M., Bailey, P., Derrick, C. et al. Epidemiology and treatment of invasive Bartonella spp. infections in the United States. Infection (2024). https://doi.org/10.1007/s15010-024-02177-1

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