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| |  Diagnostic Tools Are Needed in Brucellosis Cases: Presented at ICAAC/IDSA By Maggie Schwarz WASHINGTON, DC -- October 30, 2008 -- Diagnostic criteria and/or decision tools would save both physicians and patients from carrying out extensive blood tests and hospitalisations for brucellosis, researchers stated here at the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and Infectious Diseases Society of America (IDSA) 46th Annual Meeting. "Brucellosis carries a good prognosis and [too] much … testing and hospitalisation are occurring unnecessarily," said Robert Satran, MD, Soroka University Medical Center, Beer-Sheva, Israel. Dr. Satran and colleagues assessed the outcomes and costs of brucellosis, presenting their results here in a poster presentation on October 25. While there is limited evidence of person-to-person transmission of Brucella spp. in North America, Brucellosis is endemic in southern Israel and has reached a peak of 52 per 100,000 inhabitants. Brucella spp. is highly contagious to humans, and, as such, is classified as biosafety level 3 microorganisms. Dr. Satran's team performed a retrospective cohort study of patients hospitalised with a diagnosis of brucellosis from 2000 through 2005. They assessed age, gender, ethnicity, residency, exposure history, referral diagnosis, admission diagnosis, diagnostic tests, length of stay, days of delay to diagnosis, and mortality rate. Indications for isolation precautions were also included in the analysis. Of 159 cases examined, 67% were male, with a mean age of 21.63 +- 18.6 years; 86% were seminomadic Bedouins. Forty-three percent had a referral diagnosis of suspected brucellosis, and 59% had an admission diagnosis of brucellosis. Other hospital admission diagnoses were fever (44.6%) and arthritis (21%). A total of 125 (52.5%) of 239 blood cultures were positive to Brucella spp. The mean length of hospital stay was 7.64 +- 4.348 days and the mean diagnostic delay was 2 +- 1.9 days. The mortality rate was 0.6%, and no clinical complications were noted. No indications for isolation precautions were established. Dr. Satran said the delay of 2 days to diagnosis and 7-day length of stay is excessive for an infection with a positive prognosis. "Brucellosis could be treated on an outpatient basis," Dr. Satran concluded. "[In these cases], it took longer to diagnose and treat patients than necessary. Many more blood chemistries and tests were performed than should have been. If we just had diagnostic criteria or at least some decision tools it would prevent a lot of hospitalisation and reduce costs," he concluded. [Presentation title: Lack of Decision Support Tolls for Hospitalization in Patients With Acute Brucellosis. Abstract L-630]
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