Bacteraemia in emergency departments: effective antibiotic reassessment is associated with a better outcome.

Patients with bacteraemia constitute an useful population for an audit of antibiotic treatments. Empirical antibiotic therapy (EAT) and its reassessment must take into account clinical data and microbiological results. Our aim was to determine the impact of these sequential steps of the therapy on survival. This was a retrospective multicentre study which included patients admitted to emergency departments (ED) for whom blood cultures were positive over a 4-month period. Microbial results were compiled from the database of the laboratories. The relevant information was extracted from the computerized patient's chart. An efficient EAT was based on antibiotic susceptibility of the bacteria. An effective antibiotic reassessment (AR) was defined as any modification of the EAT. Unfavorable outcome was defined as death of the patient during in-hospital care. Three hospitals and two clinics took part in this study, 169 patients with bacteraemia being included. The diagnosis in ED was undetermined in 21 cases (12%), 35 patients (21%) required intensive care, and 23 died (14%). One hundred and thirty-six patients (80%) received an EAT, the latter being efficient in 107 cases (63%). An effective AR was performed in 116 cases (69%). In multivariate analysis, risks factors for death were: ongoing cancer AOR (adjusted odds ratio) 3.34, undetermined diagnosis in ED: AOR 9.34 and severe sepsis or shock: AOR 6.98. Effective AR was a protective factor: AOR 0.28 [0.09-0.81]. One third of bacteraemic patients in ED did not benefit from AR. Improvement of antimicrobial stewardship should be associated with a higher rate of survival.

A case of uveitis due to Rickettsia conorii infection in Southeastern France.

We describe a case of skin rash and bilateral uveitis secondary to Rickettsia conorii infection. A 60-year-old female patient, living in the rural hinterland of Cannes, was referred to our hospital in mid-August 2012 for skin rash, fever, and arthromyalgia. Blood tests showed increased inflammatory markers, hepatic cytolysis and anicteric cholestasis. Ophthalmic examination revealed bilateral papillitis and focal chorio-retinitis. Fluoroscopic angiography demonstrated early hypofluorescence, with a few arteriolar occlusions, and subsequent hyperfluorescence and focal vasculitis. R. conorii antibodies were identified by immunofluorescence antibody test. Investigation of other infective agents and the immunological panel were negative. A 2-week course of doxycycline 200 mg/day was prescribed, and fever rapidly subsided, the skin rash resolved and vision improved. Ophthalmic examination a month and a half later showed almost all retinal lesions had disappeared and inflammation markers had returned to normal.