Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, F75012, France.
Santé publique France, Saint-Maurice, F94410, France.
BMC Prim Care. 2023 Aug 24;24(1):163. doi: 10.1186/s12875-023-02108-3.
Serological testing of patients consulting for typical erythema migrans (EM) is not recommended in European recommendations for diagnosis of Lyme borreliosis (LB). Little is known on the level of adherence of French general practitioners to these recommendations. The objectives were to estimate the proportion of Lyme borreliosis serological test prescription in patients with erythema migrans seen in general practice consultations in France, and to study the factors associated with this prescription.
LB cases with an EM reported by the French general practitioners (GPs) of the Sentinelles network between January 2009 and December 2020 were included. To assess the associations with a prescription of a serological test, multilevel logistic regression models were used.
Among the 1,831 EM cases included, a prescription for a LB serological test was requested in 24.0% of cases. This proportion decreased significantly over the study period, from 46.8% in 2009 to 15.8% in 2020. A LB serological prescription was associated with patients with no reported tick bite (Odds Ratio (OR): 1.95; 95% confidence interval [1.23-3.09]), multiple EM (OR: 3.82 [1.63-8.92]), EM of five centimeters or more (OR: 4.34 [2.33-8.08]), and GPs having diagnosed less than one EM case per year during the study period (OR: 5.28 [1.73-16.11]).
Serological testing of patients consulting for EM is not recommended in European recommendations for diagnosis of Lyme borreliosis. Therefore, the significant decrease in the rate of LB serological test for EM over the study period is encouraging. The factors identified in this study can be used to improve messaging to GPs and patients. Further efforts are needed to continue to disseminate diagnostic recommendations for LB to GPs, especially those who rarely see patients with EM.
欧洲莱姆病（LB）诊断建议不推荐对出现典型游走性红斑（EM）的患者进行血清学检测。关于法国全科医生对这些建议的遵从程度，知之甚少。本研究的目的是评估法国普通诊所就诊的 EM 患者中进行 LB 血清学检测的比例，并研究与该检测处方相关的因素。
本研究纳入了法国 Sentinelles 网络的全科医生于 2009 年 1 月至 2020 年 12 月报告的 LB 病例。为评估与血清学检测处方相关的因素，使用多水平逻辑回归模型。
在纳入的 1831 例 EM 病例中，24.0%的病例开具了 LB 血清学检测。与 2009 年的 46.8%相比，这一比例在研究期间显著下降，2020 年降至 15.8%。LB 血清学检测处方与未报告蜱叮咬（比值比[OR]：1.95；95%置信区间[1.23-3.09]）、多个 EM（OR：3.82 [1.63-8.92]）、直径为 5 厘米或更大的 EM（OR：4.34 [2.33-8.08]）以及在研究期间每年诊断不到 1 例 EM 的全科医生相关（OR：5.28 [1.73-16.11]）。
欧洲莱姆病诊断建议不推荐对 EM 患者进行血清学检测。因此，研究期间 EM 患者 LB 血清学检测率显著下降是令人鼓舞的。本研究确定的因素可用于改进向全科医生和患者传达信息。需要进一步努力，继续向全科医生传播 LB 的诊断建议，尤其是那些很少看到 EM 患者的医生。
