[When should empirical antibiotic therapy be indicated in acute community-onset XXXX of suspected bacterial etiology].

@entity1 @entity32 @entity1904 @entity294 @entity281 @entity5746 @entity1850 @entity1851
BACKGROUND: The aims of this study were to describe the basic parameters of adult @entity1 with acute community-onset @entity5746 or campylobacteriosis responsible for more than 90 % of all cases of community-onset @entity294 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. @entity1 with systemic signs of @entity281 having at least 2 signs of @entity1850 ( @entity1850 ) or with elevated serum @entity1904 levels (more than 0.5 ng/ml) were classified as being at risk for the invasive form of the disease. The remaining @entity1 were classified as having the simple intestinal form of the disease. @entity1 with community-onset post-antibiotic @entity294 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 @entity1850 classification), even after being adjusted for age: body temperature above 38   C, peripheral blood white cell count (WBC) above 12 * 10   /l, neutrophil count above 9 * 10   /l and @entity1851 level above 150 mg/l. The risk form of the disease occurred in 60 cases (18.7 %). The mean WBC was 9.4 * 10   /l (median, 8.4; range, 1.7-89.0). The WBC within the normal range was seen in 194 cases (60.4 %). The mean @entity1851 level was 92.9 mg/l (median, 77.0; range, 1.0-342.0). An elevated @entity1904 level was seen in 21 @entity1 ; the marker was not routinely measured. Positive blood culture results were obtained in 2 @entity1 with @entity5746 ; the examination was not routinely performed. There were 34 @entity1 (10.6 %) with documented immune system dysfunction; the risk form of @entity5746 or campylobacteriosis was seen in only 11 of them (3.4 %). A total of 306 @entity1 (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 @entity5746 /campylobacteriosis should not be indicated only due to elevated @entity1851 levels but rather after comprehensive evaluation of the duration of symptoms, individual risk factors and dynamic changes in markers of @entity32 . Blood culture tests should be carried out more frequently.
