Antibiotic Use and Long-Term Outcome in Patients with Tick-Borne Encephalitis and Co-Infection with Borrelia Burgdorferi Sensu Lato in Central Europe. A Retrospective Cohort Study
Abstract
1. Introduction
2. Materials and Methods
2.1. Setting and Patients
2.2. Evaluation of Patients
2.3. Laboratory Evaluation
2.4. Statistical Analysis
3. Results
3.1. Patients’ Characteristics on Admission
3.2. Patients with Tick-Borne Encephalitis (TBE) and Proven Borrelial Co-Infection (TBE-Lyme Borreliosis (LB) Group)
3.3. Outcome in Patients with TBE and Possible Borrelial Co-Infection (TBE-Bb Group) According to Anti-Borrelial Antibiotic Therapy
3.4. Outcome in Patients with TBE in Relation to Borrelial Co-Infection
3.5. Intercurrent Antibiotics, Intercurrent Lyme Borreliosis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Study Period Country | Number of Patients and Patients’ Characteristics | Proven Borrelial Co-Infection | Proven Borrelial CNS Co-Infection b | Possible Borrelial Co-Infection c | Proven and Possible Borrelial Co-Infection |
---|---|---|---|---|---|
1992–1993 Slovenia [4] | 89 patients with TBE | 12 (13.5) | 6 (6.7) | / | / |
1994 Slovenia [5] | 492 patients with TBE | 82 (16.7) | 61/489 (12.5) | 60/484 (12.4) d | / |
1995–1996 Slovenia [6] | 36 patients with TBE out of 130 patients with acute febrile illness after a tick bite | 6 (16.7) | / | 3 (8.3) d | 9 (25) |
1999–2001 Russia [7] | 445 patients with TBE out of 1952 patients with acute febrile illness after a tick bite | / | / | 33 (7.4) e | / |
1995–2004 Slovenia [8] | 32 patients with TBE | / | 6 (18.8) f | 15 (46.9) g | / |
1993–2008 Poland [9] | 687 patients with TBE | / | 13 (1.9) | 116 (16.9) h | / |
2003–2009 Slovenia [10] | 11 patients with peripheral facial palsy out of 1218 patients with TBE | / | 1 (9.1) | 2 (18.2) d | 3 (27.3) |
2009–2012 Poland [11] | 110 patients with TBE | / | / | 30 (27) i | / |
2007–2012 Slovenia [12] | 717 patients with TBE | / | 22/661 (3.3) | 66/655 (10.1) g | / |
Characteristic | TBE n = 382 | TBE-LB n = 62 | TBE-Bb n = 240 | p Value a |
---|---|---|---|---|
Age | 49 (35–61) | 53 (43–68) | 59 (46–69) | <0.001 |
Male sex | 208 (54.5) | 39 (62.9) | 148 (61.7) | 0.143 |
Charlson comorbidity index | 1 (0–2) | 1 (0–2) | 2 (0–3) | <0.001 |
Vaccinated against TBE | 14 (3.7) | 2 (3.2) | 12 (5.0) | 0.670 |
Clinical presentation | 0.615 | |||
Meningitis | 91 (23.8) | 16 (25.8) | 50 (20.8) | |
Meningoencephalitis | 259 (67.8) | 38 (61.3) | 169 (70.4) | |
Meningoencephalomyelitis | 32 (8.4) | 8 (12.9) | 21 (8.8) | |
Severity of acute illness | 0.649 | |||
Mild | 99 (25.9) | 16 (25.8) | 54 (22.5) | |
Moderate | 232 (60.7) | 38 (61.3) | 145 (60.4) | |
Severe | 51 (13.4) | 8 (12.9) | 41 (17.1) | |
Severity score of acute illness | 12 (8–17) | 12 (6.8–17.8) | 12.5 (9–19) | 0.324 |
CSF leukocyte count (× 106/L) | 104 (54.8–192) | 101 (65.3–154) | 68.5 (35–134.3) | <0.001 |
OR (95% CI) a | p Value b | |
---|---|---|
Intercept | 0.05 (0.00–0.51) | 0.011 |
Antibiotic therapy (yes vs. no) | 1.23 (0.53–2.81) | 0.630 |
Time | ||
6 vs. 2 months | 0.24 (0.13–0.44) | <0.001 |
12 vs. 6 months | 0.50 (0.25–0.98) | 0.043 |
Sex (male vs. female) | 0.47 (0.20–1.08) | 0.075 |
Age, years | 1.05 (1.00–1.10) | 0.058 |
Charlson comorbidity index | 0.53 (0.32–0.87) | 0.012 |
Severity score of acute illness | 1.07 (1.02–1.13) | 0.007 |
All n = 684 | TBE n = 382 | TBE-LB n = 62 | TBE-Bb n = 240 | p Value a | |
---|---|---|---|---|---|
2 months post-hospitalization | 363/652 (55.7) | 202/361 (56.0) | 32/59 (54.2) | 129/232 (55.6) | 0.9698 |
6 months post-hospitalization | 170/462 (36.8) | 82/220 (37.3) | 16/50 (32.0) | 72/192 (37.5) | 0.757 |
12 months post-hospitalization | 95/294 (32.3) | 44/136 (32.4) | 10/30 (33.3) | 41/128 (32.0) | 0.991 |
At final evaluable visit | 219/653 (33.5) | 129/361 (35.7) | 15/59 (25.4) | 75/233 (32.2%) | 0.257 |
OR (95% CI) a | p Value b | |
---|---|---|
Intercept | 0.05 (0.01–0.22) | <0.001 |
TBE-LB vs. TBE | 0.82 (0.34–2.00) | 0.670 |
TBE-Bb vs. TBE | 1.05 (0.61–1.83) | 0.853 |
Time | ||
6 vs. 2 months | 0.21 (0.14–0.31) | <0.001 |
12 vs. 6 months | 0.48 (0.30–0.76) | 0.002 |
Sex (male vs. female) | 0.51 (0.31–0.86) | 0.011 |
Age, years | 1.04 (1.01–1.07) | 0.012 |
Charlson comorbidity index | 0.57 (0.41–0.80) | <0.001 |
Severity score of acute illness | 1.09 (1.06–1.13) | <0.001 |
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Velušček, M.; Blagus, R.; Cerar Kišek, T.; Ružić-Sabljić, E.; Avšič-Županc, T.; F Bajrović, F.; Stupica, D. Antibiotic Use and Long-Term Outcome in Patients with Tick-Borne Encephalitis and Co-Infection with Borrelia Burgdorferi Sensu Lato in Central Europe. A Retrospective Cohort Study. J. Clin. Med. 2019, 8, 1740. https://doi.org/10.3390/jcm8101740
Velušček M, Blagus R, Cerar Kišek T, Ružić-Sabljić E, Avšič-Županc T, F Bajrović F, Stupica D. Antibiotic Use and Long-Term Outcome in Patients with Tick-Borne Encephalitis and Co-Infection with Borrelia Burgdorferi Sensu Lato in Central Europe. A Retrospective Cohort Study. Journal of Clinical Medicine. 2019; 8(10):1740. https://doi.org/10.3390/jcm8101740
Chicago/Turabian StyleVelušček, Maša, Rok Blagus, Tjaša Cerar Kišek, Eva Ružić-Sabljić, Tatjana Avšič-Županc, Fajko F Bajrović, and Daša Stupica. 2019. "Antibiotic Use and Long-Term Outcome in Patients with Tick-Borne Encephalitis and Co-Infection with Borrelia Burgdorferi Sensu Lato in Central Europe. A Retrospective Cohort Study" Journal of Clinical Medicine 8, no. 10: 1740. https://doi.org/10.3390/jcm8101740
APA StyleVelušček, M., Blagus, R., Cerar Kišek, T., Ružić-Sabljić, E., Avšič-Županc, T., F Bajrović, F., & Stupica, D. (2019). Antibiotic Use and Long-Term Outcome in Patients with Tick-Borne Encephalitis and Co-Infection with Borrelia Burgdorferi Sensu Lato in Central Europe. A Retrospective Cohort Study. Journal of Clinical Medicine, 8(10), 1740. https://doi.org/10.3390/jcm8101740