RT Journal Article
SR Electronic
T1 Management and clinical outcomes of Lyme disease in acute care facilities in 2 endemic regions of Quebec, Canada: a multicentre retrospective cohort study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E570
OP E576
DO 10.9778/cmajo.20210063
VO 10
IS 2
A1 Musonera, Jean B.
A1 Valiquette, Louis
A1 Baron, Geneviève
A1 Milord, François
A1 Marcoux, Dominique
A1 Thivierge, Karine
A1 Bedard-Dallaire, Samuel
A1 Pelletier, Andrée A.
A1 Lachance, Raphaël
A1 Bourget, Jeremy
A1 Simard, Catherine
A1 Cantin, Emmanuelle
A1 Abbasi, Farhad
A1 Haraoui, Louis-Patrick
A1 Carignan, Alex
YR 2022
UL http://www.cmajopen.ca/content/10/2/E570.abstract
AB Background: Despite increases in cases of Lyme disease, little is known about the management and clinical course of the disease in Canada. We aimed to describe the management and clinical course of Lyme disease in patients treated in acute care facilities in Quebec and to assess adherence to the 2006 Infectious Diseases Society of America (IDSA) guideline.Methods: This retrospective multicentre cohort study included pediatric and adult patients with serologically confirmed Lyme disease treated in acute care facilities (12 community hospitals and 2 tertiary care centres) of 2 endemic regions of Quebec (Estrie and Montérégie), from 2004 to 2017. We considered drug choice, prescribed dose and treatment duration in assessing adherence of prescriptions to the 2006 IDSA guideline. The main outcome was complete resolution of symptoms at 3 months after the initiation of treatment.Results: We included 272 patients from 14 institutions (age range 3–87 yr). Early disseminated Lyme disease (140 patients [51%]) was predominant. Adherence to the IDSA guideline was observed in 235 (90%) of the 261 cases with complete information, and adherence was stable over time (2004–2013: 57/64 [89%]; 2014–2015: 64/71 [90%]; 2016–2017: 114/126 [90%]; p = 0.8). Non-adherence to the guideline (n = 26) was predominantly due to longer-than-recommended treatment duration (16/26 [62%]). Resolution of objective signs at 3 months after treatment initiation occurred in 265 (99%) of 267 patients, whereas post-treatment Lyme disease syndrome was observed in 27 patients (10%) with increasing incidence over time (2004–2013: 3/65 [5%]; 2014–2015: 4/73 [5%]; 2016–2017: 20/129 [16%]; p = 0.02).Interpretation: We observed clinical resolution of Lyme disease in 99% of the patients, and most treatments (90%) complied with the 2006 IDSA guideline. The incidence of post-treatment Lyme disease syndrome increased over the study period, warranting further prospective studies.