Kdy indikovat empirickou antibiotickou léčbu u akutní komunitní gastroenterokolitidy suspektní bakteriální etiologie?

POLÁK, Pavel, Zbyněk BORTLÍČEK, M. VRBA, Jana JURÁNKOVÁ, M. FREIBERGEROVÁ and Petr HUSA. Kdy indikovat empirickou antibiotickou léčbu u akutní komunitní gastroenterokolitidy suspektní bakteriální etiologie? (When should empirical antibiotic therapy be indicated in acute community-onset diarrhea of suspected bacterial etiology). Klinická mikrobiologie a infekční lékařství. Praha: Trios, 2015, vol. 21, No 1, p. 24-28. ISSN 1211-264X.

Basic information

• Original name: Kdy indikovat empirickou antibiotickou léčbu u akutní komunitní gastroenterokolitidy suspektní bakteriální etiologie?
• Name (in English): When should empirical antibiotic therapy be indicated in acute community-onset diarrhea of suspected bacterial etiology
• Authors: POLÁK, Pavel (203 Czech Republic, guarantor, belonging to the institution), Zbyněk BORTLÍČEK (203 Czech Republic, belonging to the institution), M. VRBA (203 Czech Republic), Jana JURÁNKOVÁ (203 Czech Republic, belonging to the institution), M. FREIBERGEROVÁ (203 Czech Republic) and Petr HUSA (203 Czech Republic, belonging to the institution).
• Edition: Klinická mikrobiologie a infekční lékařství, Praha, Trios, 2015, 1211-264X.

Other information

• Original language: Czech
• Type of outcome: Article in a journal
• Field of Study: 30300 3.3 Health sciences
• Country of publisher: Czech Republic
• Confidentiality degree: is not subject to a state or trade secret
• RIV identification code: RIV/00216224:14110/15:00083617
• Organization unit: Faculty of Medicine
• Keywords (in Czech): Komunitní průjem; salmonelóza; kampylobakterióza; antibiotická léčba; rezistence k antibiotikům
• Keywords in English: Antibiotic resistance; Antibiotic treatment; Campylobacteriosis; Community-onset diarrhea; Salmonellosis
• Tags: EL OK
• Tags: International impact, Reviewed

Abstract

Cíl práce: Popsat základní charakteristiky dospělých pacientů s akutní komunitní salmonelózou či kampylobakteriózou. Dle výsledků analýzy aktualizovat diagnosticko-terapeutické algoritmy. Materiál a metody: Sběr dat probíhal retrospektivně v období od 1. 1. 2011 do 31. 12. 2013. Dle charakteristik při přijetí do nemocnice byli pacienti zařazeni do dvou skupin: skupina riziková se systémovými příznaky splňující alespoň dvě kritéria syndromu systémové zánětlivé odpovědi a pacienti s elevací prokalcitoninu v séru (nad 0,5 ng/ml). Onemocnění u ostatních pacientů bylo hodnoceno jako prostá intestinální forma. Pacienti s komunitní postantibiotickou kolitidou byli ze studie vyřazeni. Data byla statisticky zpracována.

Abstract (in English)

Background: The aims of this study were to describe the basic parameters of adult patients with acute community-onset salmonellosis or campylobacteriosis responsible for more than 90 % of all cases of community-onset diarrhea in the Czech Republic, and, according to the results of this analysis, to update the diagnostic and therapeutic algorithms. Materials and methods: The data were collected retrospectively between January 1, 2011 and December 31, 2013. Patients with systemic signs of infection having at least 2 signs of systemic inflammatory response syndrome (SIRS) or with elevated serum procalcitonin levels (more than 0.5 ng/ml) were classified as being at risk for the invasive form of the disease. The remaining patients were classified as having the simple intestinal form of the disease. Patients with community-onset post-antibiotic diarrhea were excluded. The data were statistically processed. Results: The following clinical factors were statistically significantly correlated with the high-risk form of the disease: duration of illness of less than 3 days before admission and any of the following (some of them are part of the SIRS classification), even after being adjusted for age: body temperature above 38 °C, peripheral blood white cell count (WBC) above 12 × 109/L, neutrophil count above 9 × 109/L and CRP level above 150 mg/L. The risk form of the disease occurred in 60 cases (18.7 %). The mean WBC was 9.4 × 109/1 (median, 8.4; range, 1.7-89.0). The WBC within the normal range was seen in 194 cases (60.4 %). The mean CRP level was 92.9 mg/1 (median, 77.0; range, 1.0-342.0). An elevated procalcitonin level was seen in 21 patients; the marker was not routinely measured. Positive blood culture results were obtained in 2 persons with salmonellosis; the examination was not routinely performed. There were 34 patients (10.6 %) with documented immune system dysfunction; the risk form of salmonellosis or campylobacteriosis was seen in only 11 of them (3.4 %). A total of 306 patients (95.3 %) were treated with antibiotics; the mean duration of antibiotic therapy was 8.7 days (median, 7; range, 2-31). Conclusions: Antibiotic treatment in salmonellosis/campylobacteriosis should not be indicated only due to elevated CRP levels but rather after comprehensive evaluation of the duration of symptoms, individual risk factors and dynamic changes in markers of inflammation. Blood culture tests should be carried out more frequently.