Identifying factors associated with treatment delay in leptospirosis : a retrospective study of patients admitted to hospital in Reunion (Indian Ocean) between 2014 and 2015

Background. - Leptospirosis is a life-threatening zoonotic disease for which delayed treatment onset has been associated to poor prognosis. The purpose of the study was to identify the determinants of therapeutic delay in hospitalized leptospirosis cases. Patients and methods. - We carried out a retrospective multicenter study in the 4 public hospitals of Reunion Island, South Western Indian Ocean. Medical records of confirmed leptospirosis cases occurring in 2014-2015 were reviewed for socio-economic, demographic, geographic and medical data. The primary outcome measure was the therapeutic delay, defined as the time elapsed between the onset of symptoms and initiation of antibiotics. Results. - Of the 117 patients included, 107 were men, with an average age of 44.9 +/- 15 years. The median therapeutic delay was 4 days (interquartile: 2-5 days) and this delay was not found to be associated with severity. The following were found to be at increased risk of having a longer therapeutic delay: cases occurring outside the epidemic period, or rainy season (OR 2.8 [1.08-7.3], P = 0.04) and cases with first medical evaluation in primary health care (OR 4.63 [1.43-14.93]; P = 0.01) instead of emergency unit. Nosocio-economic or geographic characteristics were found to be linked to a longer therapeutic delay. Conclusion. - Although delayed treatment was not associated to disease severity, our results indicate that leptospirosis awareness is needed all year in the subtropical area of Reunion Island and particularly in primary care