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Mésinèle L, Pujol T, Brunetti N, Neiss M, Trivalle C, Souques C, Houenou-Quenum N, Verdier S, Simon P, Vetillard AL, Houdre J, Collarino R, Mary M, Vidal JS, Kahn JE, Guichardon M, Duron E, Baudouin E. Association between low eosinophil count and acute bacterial infection, a prospective study in hospitalized older adults. BMC Geriatr 2023; 23:852. [PMID: 38093181 PMCID: PMC10720062 DOI: 10.1186/s12877-023-04581-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The incidence of sepsis increases significantly with age, including a high incidence of bacterial infection in the old adults. Eosinopenia and the CIBLE score have been proposed in critically ill adults and in internal medicine wards. This study aimed to assess whether a low eosinophil count was associated with acute bacterial infection among hospitalized older adults, and to find the most efficient eosinophil count cut-off to differentiate acute bacterial infection from other inflammatory states. METHODS This was a prospective study from July 2020 to July 2022 in geriatric wards of the University Paul Brousse Hospital (Villejuif, France) including patients aged of 75 y/o or over suffering from fever or biological inflammation. Acute bacterial infection was assessed using biological identification and/or clinical and radiological data. RESULTS A total of 156 patients were included. Eighty-two (53%) patients suffered from acute bacterial infection (mean age (SD) 88.7 (5.9)). Low eosinophil count was independently associated with acute bacterial infection: OR [CI95%] 3.03 [1.04-9.37] and 6.08 [2.42-16.5] for eosinophil count 0-0.07 G/L and 0.07-0.172 G/L respectively (vs. eosinophil count > 0.172 G/L). Specificity and sensitivity for eosinophil count < 0.01 G/L and CIBLE score were 84%-49% and 72%-62%, respectively with equivalent AUCs (0.66 and 0.67). CONCLUSION Eosinophil count < 0.01 G/L is a simple, routinely used and inexpensive tool which can easily participate in antibiotic decisions for older adults. Further studies are needed to assess clinical benefits. TRIAL REGISTRATION The study was registered at Clinical trial.gov (NCT04363138-23/04/2020).
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Affiliation(s)
- Léa Mésinèle
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Tom Pujol
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Nicoletta Brunetti
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Marie Neiss
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Christophe Trivalle
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Cecile Souques
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Nadège Houenou-Quenum
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Sébastien Verdier
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Pauline Simon
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Anne-Laure Vetillard
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Julie Houdre
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Rocco Collarino
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Morgane Mary
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Jean-Sébastien Vidal
- Département de Gériatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Paris, France
- Université Paris Descartes, INSERM, Paris, France
| | - Jean-Emmanuel Kahn
- Department of Internal Medicine, APHP, Ambroise Paré Hospital, Université de Versailles-Saint- Quentin en Yvelines, Yvelines, France
| | - Magali Guichardon
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Emmanuelle Duron
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
- CESP, Team MOODS, Université Paris-Saclay, UVSQ, Le Kremlin-Bicêtre, France
| | - Edouard Baudouin
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France.
- CESP, Team MOODS, Université Paris-Saclay, UVSQ, Le Kremlin-Bicêtre, France.
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Antibiotic Culture: A History of Antibiotic Use in the Second Half of the 20th and Early 21st Century in the People’s Republic of China. Antibiotics (Basel) 2023; 12:antibiotics12030510. [PMID: 36978376 PMCID: PMC10044684 DOI: 10.3390/antibiotics12030510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Antimicrobial resistance is now widely regarded as a global public health threat. A growing number of studies suggest that antibiotic resistance is higher in China than in most western countries. Despite the current official regulation prohibiting pharmacies from the unrestricted selling of antibiotics, there is little sign of declining consumer demand. China now ranks as the second largest consumer of antibiotics in the world, after India. Drawing on published historical data, unpublished archival documents, and recently collected oral interviews, this paper provides a historical overview of antibiotic use and abuse in the People’s Republic of China (PRC) from the second half of the 20th century to the present. It demonstrates how the political demand for health improvement, along with the state-sponsored popularization of allopathic medicine, on the one hand, and the lack of access to adequate medical care for the majority of the population, as well as the existing culture of self-medication, on the other hand, are working in tandem to create antibiotic dependency in China. In addition, the privatization and marketization of biomedicine and health care in post-Mao China have helped to build a new and ever-thriving network of production, distribution, and marketing of antibiotics, which has often proven difficult for the authorities to monitor. At the same time, increased purchasing power and easier accessibility created by this new network of production, distribution, and marketing have further contributed to the prevalence of antibiotic overuse in the late 20th and early 21st centuries.
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