Antibiotics | Clinical Characteristics and Treatment Strategies in a Cohort of Patients with Tularemia in Germany: A Multicenter Analysis

This study conducted the first multicenter retrospective analysis of clinical characteristics and treatment strategies in 65 tularemia patients in Germany, highlighting the impact of delayed diagnosis and initial inappropriate treatment on disease progression and recovery time, providing key insights for empirical treatment.

 

Literature Overview
This article titled "Clinical Characteristics and Treatment Strategies in a Cohort of Patients with Tularemia: A Retrospective Multicenter Analysis of 65 Cases in Germany" is published in the journal Antibiotics. It reviews and summarizes the clinical manifestations, transmission routes, laboratory diagnostic methods, and antibiotic treatment outcomes in patients diagnosed with tularemia in Germany between 2010 and 2025. The study highlights the increasing incidence of this disease in Germany and emphasizes the importance of early diagnosis and appropriate antibiotic selection for improving patient prognosis.

Background Knowledge
Tularemia is a rare zoonotic disease caused by Francisella tularensis, with high infectivity primarily transmitted through arthropod bites (e.g., ticks, mosquitoes) or contact with infected animal tissues. In Europe, the disease is mainly caused by subspecies holarctica (Type B), which has a lower fatality rate but can lead to prolonged disease and relapses if diagnosis is delayed or ineffective antibiotics (e.g., β-lactams) are used. Although the incidence of tularemia has been rising in Germany in recent years, clinical experience remains limited, and the disease is often misdiagnosed. Therefore, this study aimed to systematically analyze clinical features, transmission routes, laboratory diagnostic methods, and treatment strategies through a multicenter retrospective approach, providing data support to enhance clinical understanding and optimize treatment.

 

 

Research Methods and Experiments
The research team obtained clinical data of 65 tularemia patients diagnosed between 2010 and 2025 from five treatment centers in Germany (Berlin, Düsseldorf, Leipzig, Munich, and Stuttgart) via the STAKOB network. Potential cases were identified using ICD-10 coding, and diagnosis was confirmed by combining clinical symptoms with serological tests (ELISA, Western blot), PCR, and blood culture results. The data analysis included patient demographics, clinical presentations, transmission routes, laboratory findings, treatment regimens, and recovery duration.

Key Conclusions and Perspectives

• Among the 65 patients, 66.2% were male, with a median age of 48.5 years. The most common clinical presentation was the ulceroglandular form (70.7%), followed by oropharyngeal (13.8%) and pneumonic (10.8%).
• The median incubation period was 7 days (IQR: 4–10). The most frequent symptoms were fever (96.9%) and lymphadenopathy (46.2%).
• 49.2% of patients initially received β-lactam antibiotics, which are ineffective against tularemia. However, 96.9% of patients were later treated with fluoroquinolones, tetracyclines, or aminoglycosides, in line with clinical guidelines.
• The median recovery time was 56 days for patients diagnosed early (≤3 weeks), compared to 84 days for those with delayed diagnosis (p=0.015), indicating that early treatment significantly improves prognosis.
• 58.5% of patients underwent surgical intervention, with significantly higher rates in the delayed diagnosis group compared to the early diagnosis group (70.7% vs 37.5%; p=0.018), suggesting the necessity of surgical intervention when antibiotic treatment fails.

Research Significance and Prospects
This study represents the largest retrospective analysis of tularemia in Germany in recent years, revealing key clinical features, transmission routes, and the impact of treatment delays. It underscores the importance of increased clinical vigilance in endemic areas, optimization of serological and PCR testing, and the avoidance of empirical β-lactam therapy. Future prospective studies are needed to validate the relationship between diagnostic timing and treatment efficacy, and to explore more sensitive methods for early detection.

 

 

Conclusion
This study systematically analyzed the clinical features and treatment strategies of tularemia patients in Germany, identifying delayed diagnosis and inappropriate initial antibiotic use as significant contributors to prolonged recovery and increased surgical intervention rates. It emphasizes the importance of heightened clinical suspicion, optimized early detection methods, and rational antibiotic selection in endemic regions. Although limited by sample size, the study provides valuable reference for the clinical management of tularemia in Europe. Further multicenter prospective studies are warranted to confirm these findings.

 

Benjamin Arnold, Henning Trawinski, Nils Kellner, Kathrin Marx, and Christoph Lübbert. Clinical Characteristics and Treatment Strategies in a Cohort of Patients with Tularemia: A Retrospective Multicenter Analysis of 65 Cases in Germany. Antibiotics.