Factors Associated with Sequelae of Campylobacter and Non-typhoidal Salmonella Infections: A Systematic Review

Abstract

Despite the significant global burden of gastroenteritis and resulting sequelae, there is limited evidence on risk factors for sequelae development. We updated and extended previous systematic reviews by assessing the role of antibiotics, proton pump inhibitors (PPI) and symptom severity in the development of sequelae following campylobacteriosis and salmonellosis. We searched four databases, including PubMed, from 1 January 2011 to 29 April 2016. Observational studies reporting sequelae of reactive arthritis (ReA), Reiter's syndrome (RS), irritable bowel syndrome (IBS) and Guillain-Barré syndrome (GBS) following gastroenteritis were included. The primary outcome was incidence of sequelae of interest amongst cases of campylobacteriosis and salmonellosis. A narrative synthesis was conducted where heterogeneity was high. Of the 55 articles included, incidence of ReA (n=37), RS (n=5), IBS (n=12) and GBS (n=9) were reported following campylobacteriosis and salmonellosis. A pooled summary for each sequela was not estimated due to high level of heterogeneity across studies (I2>90%). PPI usage and symptoms were sparsely reported. Three out of seven studies found a statistically significant association between antibiotics usage and development of ReA. Additional primary studies investigating risk modifying factors in sequelae of GI infections are required to enable targeted interventions.

Keywords: Acid suppression; Antibiotics; Campylobacter; Gastroenteritis; Salmonella; Sequelae.

Fig. 1

Flowchart of included studies. Results of all database searches, screening of titles and abstracts, full-text screening, additional references and selected studies.

Fig. 2

Forest plot of studies reporting incidence of Campylobacter triggered ReA stratified by healthcare facility. Studies reporting the incidence of reactive arthritis following Campylobacter infection stratified by the type of healthcare facility/practitioner visited/utilised. No summary estimate was calculated due to high heterogeneity across all studies (I² > 90%).

Fig. 3

Forest plot of studies reporting incidence of NTS triggered ReA stratified by healthcare facility. Studies reporting the incidence of reactive arthritis following non-typhoidal Salmonella infection stratified by the type of healthcare facility/practitioner visited/utilised. No summary estimate was calculated due to high heterogeneity across all studies (I² > 90%).

Fig. 4

Forest plot of studies reporting incidence of RS following NTS infection. Studies reporting the incidence of Reiter's syndrome following non-typhoidal Salmonella infection. No summary estimate was calculated due to high heterogeneity across all studies (I² > 90%).

Fig. 5

Forest plot of studies reporting incidence of IBS following Campylobacter infection stratified by follow-up period. Studies reporting the incidence of irritable bowel syndrome following Campylobacter infection stratified by the length of follow-up from infection to sequelae. No summary estimate was calculated due to high heterogeneity across all studies (I² > 90%).

Fig. 6

Forest plot of studies reporting incidence of IBS following NTS infection stratified by follow-up period. Studies reporting the incidence of irritable bowel syndrome following non-typhoidal Salmonella infection stratified by the length of follow-up from infection to sequelae. No summary estimate was calculated due to high heterogeneity across all studies (I² > 90%).

Fig. 7

Forest plot of studies reporting incidence of GBS following Campylobacter infection. Studies reporting the incidence of Guillain-Barré syndrome following Campylobacter infection No summary estimate was calculated due to high heterogeneity across all studies (I² > 90%).