Davido B, Makhloufi S, Matt M, Calin R, Senard O, Perronne C, Dinh A, Salomon J
Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 104 Bd Raymond Poincaré, 92380 Garches, France.
Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 104 Bd Raymond Poincaré, 92380 Garches, France; Université Versailles-Saint-Quentin en Yvelines, F78180, France.
Int J Infect Dis. 2017 Aug;61:62-66. doi: 10.1016/j.ijid.2017.06.005. Epub 2017 Jun 13.
Eosinopenia as a criterion of sepsis has been the subject of debate for decades. Different authors have proposed different cut-off values.
A prospective study was conducted from February to August 2016. Hospitalized adults suffering from a bacterial infection with eosinopenia, defined as an eosinophil count <100/mm, were included. Patients were divided into two groups according to the first day of effective antimicrobial therapy. They were observed for 5days in order to evaluate whether recovery from eosinopenia was predictive of an appropriate antibiotic regimen.
One hundred and twenty-two patients were screened and 96 were included. Group 1 patients (n=70) received effective antimicrobial therapy from day 0. Their eosinophil count increased significantly between day 0 and day 1 (p<0.0001). Group 2 patients (n=26) received delayed effective antimicrobial therapy, and there was no significant difference in eosinophil count between day 0 and day 1 (p=0.55). Moreover, eosinophil counts normalized on day 5 in both groups. The mean duration of antimicrobial therapy was comparable in the two groups (7.7±1.16 days). The antibiotics most often prescribed in both groups were intravenous cephalosporins. During follow-up, all patients were considered to be cured after day 30.
The eosinophil count appears to normalize faster than C-reactive protein (CRP) and polymorphonuclear neutrophils in eosinopenic patients on appropriate antimicrobial therapy. This simple test is easy to perform as part of a regular complete blood count, with no additional costs as required for CRP or procalcitonin.
嗜酸性粒细胞减少作为脓毒症的一项标准，数十年来一直是争论的焦点。不同的作者提出了不同的临界值。
于2016年2月至8月进行了一项前瞻性研究。纳入住院的患有细菌感染且嗜酸性粒细胞减少（定义为嗜酸性粒细胞计数<100/mm）的成年人。根据有效抗菌治疗的第一天将患者分为两组。对他们进行5天的观察，以评估嗜酸性粒细胞减少的恢复是否可预测适当的抗生素治疗方案。
共筛查了122例患者，纳入96例。第1组患者（n = 70）从第0天开始接受有效抗菌治疗。他们的嗜酸性粒细胞计数在第0天至第1天之间显著增加（p<0.0001）。第2组患者（n = 26）接受延迟有效抗菌治疗，第0天至第1天嗜酸性粒细胞计数无显著差异（p = 0.55）。此外，两组患者的嗜酸性粒细胞计数在第5天均恢复正常。两组抗菌治疗的平均持续时间相当（7.7±1.16天）。两组最常使用的抗生素均为静脉用头孢菌素。随访期间，所有患者在第30天后均被视为治愈。
在接受适当抗菌治疗的嗜酸性粒细胞减少患者中，嗜酸性粒细胞计数似乎比C反应蛋白（CRP）和多形核中性粒细胞更快恢复正常。这项简单的检测作为常规全血细胞计数的一部分易于实施，无需像检测CRP或降钙素原那样额外付费。
