Clinical features and treatment strategies of Helicobacter cinaedi infections in emergency departments: a descriptive study

Background: Helicobacter cinaedi, a Gram-negative spiral bacterium, is a rare cause of bacteraemia in humans. It is increasingly reported in both immunocompetent and immunocompromised patients. Nevertheless, little is known about H. cinaedi infections in the emergency departments (ED). Our study aimed to describe the clinical features of H. cinaedi infections in the ED.Methods: We conducted the descriptive study at the ED of Kobe City General Hospital between November 2011 and December 2020. We included all ED patients with H. cinaedi infections, and all H. cinaedi were isolated in blood cultures. Following bacterial culture, clinical specimens with gram-negative spiral bacilli underwent polymerase chain reactions to confirm H. cineadi infection. We retrospectively obtained the patient data from the electronic medical records and described patient characteristics, clinical course, and management of H. cinaedi bacteraemia. Results: During the study period, 22 patients in the ED were diagnosed with H. cinaedi bacteraemia. The youngest patient was 32 years old, and the oldest was 91 (median: 65.5 [interquartile range, 49.3 to 63.3] years). Diabetes mellitus was the most common comorbidity (7/22, 31.8%), followed by haematological malignancy and solid tumour (5/22, 22.7%), recent chemotherapy (4/22, 18.2%), while 3/22 (13.6%) patients had no comorbidities. In our cohort, complicated cases were identified: vertebral osteomyelitis (three cases), infected aortic aneurysm (two cases), and infected cyst (renal cyst, and pancreatic cyst with concomitant empyema) (two cases). Tetracycline (minocycline) was most commonly prescribed; administered intravenously in 5/15 (33.3%) and orally in 9/20 (45.0%) patients. Only one (4.5%) patient required surgical interventions. None died in the hospital.Conclusions: We reported 22 cases of H. cinaedi bacteraemia in the ED, most of which were successfully treated with antibiotics, primarily tetracycline. This report gives an important insight into the presentation and management of such infections. We suggest that future studies are warranted to evaluate the optimal choice and route of antibiotic treatment in H. cinaedi infections.