What Is Different When Dealing with Bacteremic Brucellosis?

Abstract

Background Bacteremic brucellosis is an acute febrile disease often associated with digestive complaints and biological inflammatory syndrome. In this perspective, our study aimed to determine predictive factors of bacteremia in patients with brucellosis.Methods We conducted a retrospective study including all patients hospitalized with brucellosis between 1990 and 2014.ResultsWe included 161 cases of brucellosis among which bacteremia was documented in 30 cases (18.6%). Mean age was of 39.6 ± 17 years. Brucella melitensis was solely isolated. In bacteremic brucellosis, there were more fever (93.3% vs. 78%; P = 0.049; HR=4), nausea (16.7% vs. 4.6%; P = 0.033; HR = 4.2), and splenomegaly (20% vs. 7.6%; P = 0.049; HR = 3). The acute form was significantly more common in bacteremic brucellosis (66.7% vs. 42%; P = 0.015; HR = 2.7). Bacteremic brucellosis patients had a significantly higher frequence of anemia (76.7% vs. 51.6%; P = 0.013; HR=3.2) and higher C-reactive protein value (85.5 ± 45 vs. 35 ± 20 mg/L; P < 0.001). Commonly used antimicrobial regimens consisted of rifampicin plus doxycycline given for 6 weeks in both bacteremic and non-bacteremic brucellosis (86.7% vs. 72%; P = 0.1). A favorable outcome was significantly associated with bacteremic brucellosis (73.3% vs. 52%; P = 0.03; HR=2.38). Multivariate analysis using logistic regression revealed that the presence of nausea (HR = 9; CI95% 14–60; P = 0.002), acute form of brucellosis (HR = 4.5; CI95% 1.2–17; P = 0.025) and C-reactive protein value (HR = 1.12; CI95% 1.1–1.2; P = 0.02) were independent predictors of bacteremic brucellosis.Conclusion Our study highlighted clinical and biological particularities of bacteremic brucellosis which may help clinicians to establish a prompt diagnosis and suitable treatment, two main conditions to improve patients’ prognosis.Disclosures All authors: No reported disclosures.