title: [When should empirical antibiotic therapy be indicated in acute community-onset diarrhea of suspected bacterial etiology].
abstract: 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.
  
  
  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/l (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/l (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.
authors.affiliation: Department of Infectious Diseases, Faculty Hospital Brno, Czech Republic, e-mail: pavel.polak@fnbrno.cz.
authors.forename: Pavel
authors.initials: P
authors.lastname: Polák
authors.forename: Zbyněk
authors.initials: Z
authors.lastname: Bortlíček
authors.forename: Martin
authors.initials: M
authors.lastname: Vrba
authors.forename: Jana
authors.initials: J
authors.lastname: Juránková
authors.forename: Michaela
authors.initials: M
authors.lastname: Freibergerová
authors.forename: Petr
authors.initials: P
authors.lastname: Husa
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D002169:Campylobacter Infections / Q000188:drug therapy* / Q000453:epidemiology; D018153:Czech Republic / Q000453:epidemiology; D003967:Diarrhea / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005334:Fever; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D012189:Retrospective Studies; D012307:Risk Factors; D012480:Salmonella Infections / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002097:C-Reactive Protein