Médecine et maladies infectieuses
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We had for objectives: i) to evaluate the accuracy of serologic testing for Lyme borreliosis performed in a private medical laboratory (PML); ii) to evaluate the impact of these tests on the practices of infectious diseases specialists (IDS). ⋯ The serological test performed in the PML were positive most of the time, but were not confirmed by tests performed at the NRC. This discrepancy lead to multiple and prolonged consultations in infectious diseases clinics, and discordance in the indications for antibiotics.
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The empiric treatment of acute pyelonephritis (APN) with third generation cephalosporins (3GC) or fluoroquinolones (FQ) has been challenged by Escherichia coli resistance reported by community surveillance networks. But these could overestimate resistance because they do not discriminate between uncomplicated and complicated, or between community and care-related infections. ⋯ The resistance rates of 3GC and aminoglycosides were <10% in patients hospitalized for APN. FQ resistance rates reached 15% but only 6% in uncomplicated APN. Hence, FQ empiric regimen should now be restricted to the treatment of uncomplicated APN without severe sepsis.
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The emergency unit is one of the main places for acute medical care and therefore, has a pivotal role in determining a diagnosis of bacterial infection and initiating antibiotic therapy. There is an unquestionable and growing interest for infection biomarkers because of the polymorphism of septic state presentations in the emergency unit and the lack of accuracy of available biological tools. The C Reactive protein (CRP) is a biomarker of inflammation, not of infection. ⋯ Moreover, many authors of interventional studies have validated the contribution of PCT in decision taking for antibiotic therapy when suspecting low respiratory tract infection. It is currently the first-line biomarker of infection in the emergency unit. Other biomarkers such as presepsin (sCD14) may be contributive for the diagnosis and prognosis.
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Letter Case Reports
[Diagnosing a case of disseminated histoplasmosis with a blood smear].