Identifying factors associated with treatment delay in leptospirosis: A retrospective study of patients admitted to hospital in Reunion (Indian Ocean) between 2014 and 2015 - 13/05/20
Identification des déterminants du délai thérapeutique des patients atteints de leptospirose : étude rétrospective des cas hospitaliers à La Réunion en 2014–2015
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Highlights |
• | The morbidity and mortality of leptospiros is have been associated with the delay between the onset of symptoms and treatment. |
• | Our study performed in Reunion, a French island in the Indian Ocean, investigated the determinants of treatment delay. |
• | We demonstrate that the treatment delay is longer if the patient first consults a general practitioner, and if the infection occurs during the winter period (dry season). |
Abstract |
Background |
Leptospirosis is a life-threatening zoonotic disease for which delayed treatment onset has been associated to poor prognosis. The purpose of the study was to identify the determinants of therapeutic delay in hospitalized leptospirosis cases.
Patients and methods |
We carried out a retrospective multicenter study in the 4 public hospitals of Reunion Island, South Western Indian Ocean. Medical records of confirmed leptospirosis cases occurring in 2014–2015 were reviewed for socio-economic, demographic, geographic and medical data. The primary outcome measure was the therapeutic delay, defined as the time elapsed between the onset of symptoms and initiation of antibiotics.
Results |
Of the 117 patients included, 107 were men, with an average age of 44.9±15years. The median therapeutic delay was 4 days (interquartile: 2–5 days) and this delay was not found to be associated with severity. The following were found to be at increased risk of having a longer therapeutic delay: cases occurring outside the epidemic period, or rainy season (OR 2.8 [1.08–7.3], P=0.04) and cases with first medical evaluation in primary health care (OR 4.63 [1.43–14.93]; P=0.01) instead of emergency unit. No socio-economic or geographic characteristics were found to be linked to a longer therapeutic delay.
Conclusion |
Although delayed treatment was not associated to disease severity, our results indicate that leptospirosis awareness is needed all year in the subtropical area of Reunion Island and particularly in primary care.
Il testo completo di questo articolo è disponibile in PDF.Résumé |
Objectif |
La leptospirose est une affection potentiellement mortelle pour laquelle le retard thérapeutique a été associé à sa gravité. Le but de l’étude était d’identifier les déterminants du délai thérapeutique chez les patients hospitalisés pour leptospirose.
Patients et méthodes |
Étude rétrospective menée dans les 4 centres hospitaliers publics de La Réunion en 2014–2015. Les caractéristiques socioéconomiques, démographiques, géographiques et médicales ont été recueillies à partir des dossiers médicaux. Elles ont été analysées selon le critère de jugement principal : le délai thérapeutique, durée entre l’apparition des symptômes et l’initiation du traitement antibiotique.
Résultats |
Sur 117 patients inclus, 107 étaient des hommes et l’âge moyen était de 44,9±15 ans. Le délai thérapeutique était en médiane de 4 jours (interquartile : 2–5) et n’était pas associé à la gravité de la maladie. Les patients vus en dehors de la période épidémique de l’été austral (saison des pluies) avaient un risque majoré d’avoir un délai thérapeutique allongé (OR 2,75 [1,09–6,96] ; p=0,03), de même que ceux consultant leur médecin généraliste en premier lieu (OR 4,63 [1,43–14,93] ; p=0,01). Aucune des autres données recueillies n’était associée à un délai thérapeutique plus long.
Conclusion |
Le délai de prise en charge pour leptospirose n’était pas associé à la gravité de la maladie dans notre étude mais ce délai était majoré en saison sèche. Le diagnostic de leptospirose doit être évoqué même en dehors de la période épidémique et le diagnostic rendu plus aisé pour les soins de premier recours de ville.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Delay, Leptospirosis, Reunion, Severity
Mots clés : Délai thérapeutique, Leptospirose, Réunion, Sévérité
Mappa
Vol 50 - N° 4
P. 352-360 - Giugno 2020 Ritorno al numero
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