Treatment Failure of Bartonella spp. Infections in the US

Infection (Pizzuti, M., et al.) 02.01.2024, ahead of publication online, “Epidemiology and treatment of invasive Bartonella spp. infections in the United States.” In this retrospective observational multicenter study, investigators describe the incidence of disseminated Bartonella spp. infections and the treatment-related outcomes. Patient data was collected January 1, 2014, through September 1, 2021. Patients included in the study had a diagnosis of bartonellosis via a diagnosis code. Patients had either positive serology or polymerase chain reaction (PCR) blood tests, 16/18S tests of blood or tissue, cultures of blood or tissue, or cell-free DNA of blood or tissue.

The primary cohort group was white, male, patients with a mean age of 50 years. Diagnosis of this cohort was determined primarily by serology (almost 83%). Bartonella henselae (the pathogen responsible for causing cat scratch disease) was detected in nearly 98% of patients. Treatment of patients was most often a combination of doxycycline and rifampin. Treatment failure was stated to be escalation of therapy during treatment or adverse events/intolerability that led to discontinuation of therapy. Researchers reported a 39% treatment failure rate in patients.

This study was the largest cohort of disseminated Bartonella spp. The high treatment failure rate supports the need for obtaining multiple diagnostic tests when Bartonella is suspected, and describes the many challenges of current treatment options.

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