Importance of the reticulocyte hemoglobin equivalent in the exclusion of latent iron deficiency.

BACKGROUND: Iron deficiency is an underdiagnosed public health problem, especially in developing countries, that can conceal serious underlying illnesses. Early diagnosis and treatment of latent iron deficiency (LID) is crucial. Reticulocyte hemoglobin equivalent (RET-He), was reported to be a cost-effective tool that reflects the iron availability at erythropoiesis. The aims of this study were to evaluate the RET-He in the exclusion of LID. METHODS: Transversal study was carried out in the laboratory of clinical biology of Ben Arous regional hospital, it included volunteers in apparently good health. We performed a complete blood count and a serum ferritin assay. Participants with normal hemoglobin were divided into two groups: Control group G1: normal ferritin (≥ 15 ng/mL)/LID group G2: low ferritin (< 15 ng/mL). We compared the blood count parameters of the two groups. RESULTS: We selected 108 participants (G1: 88 (81.5%), G2: 20 (18.5%)), mean age = 36 years, gender-ratio = 0.92. We noted, in G2, significantly lower rates for hemoglobin Hb (p < 0.001), hematocrit (p < 0.001), mean corpuscular hemoglobin MCH (p = 0.026), reticulocyte count (p = 0.039) and RET-He (p < 0.001) and significantly higher rate for RDW/CV (p = 0.009). RET-He averages were 29.1 pg in G2 and 31.1pg in G1. In multivariate analysis, only RET-He showed a significant difference between the two groups. Area under the curve was 0.872, the cutoff = 30.9 (sensitivity 100%, specificity 61%, PPV 37%, NPV 100%). CONCLUSION: RET-He is an accessible and affordable parameter of the iron status, with an excellent NPV. It would be interesting to evaluate our results on a larger sample to define reference values in our population.

Antimicrobial Susceptibility Patterns of Escherichia coli among Tunisian Outpatients with Community-Acquired Urinary Tract Infection (2012-2018).

INTRODUCTION: Community-acquired urinary tract infection is one of the most common reasons for consultation in everyday practice; it represents a major source of antibiotic consumption. Escherichia coli (E. coli) is the main pathogen incriminated. OBJECTIVE: The aim of this study was to evaluate antimicrobial susceptibility patterns of community-acquired uropathogenic E coli throughout a 7-year period. METHODOLOGY: All strains of E. coli isolated from urine samples between January 1st 2012 and December 31st 2018 were included. Presence of ≥ 103 CFU/ml in urine culture media was considered as significant for urinary tract infection. The identification of E. coli strains was realized using standard laboratory techniques. Antibiotic susceptibility testing was performed using the disk diffusion method according to the CA-SFM/ EUCAST criteria. RESULTS: A total of 1,335 E. coli strains were isolated. Overall susceptibility rates to antimicrobial agents were as follows: ampicillin 39.1%, amoxicillin-clavulanic acid 64.9%, cefotaxime 94.9%, trimethoprim/sulfamethox-azole 67.6%, ciprofloxacin 89.2%, ofloxacin 86.9%, amikacin 98.6%, gentamicin 93.9%, nitrofurantoin 97.6% and fosfomycin 99.3%. All isolates were susceptible to carbapenems. The frequency of extended spectrum beta-lactamases-producing E. coli strains was 4.7%. Susceptibility rates of E. coli for ampicillin, trimethoprim/sulfamethoxazole and amikacin remained relatively stable over the study period, whereas susceptibility to amoxicillin-clavulanic acid, cefotaxime and fluoroquinolones showed a 2-phase pattern. As for gentamicin, a continuous decrease in susceptibility rates was observed. CONCLUSION: Antimicrobial susceptibility profiles of uropathogenic E. coli are constantly changing, due to modifications in the antibiogram interpretation criteria and antibiotic prescription habits. Rigorous surveillance of resistance rate is necessary to determine appropriate empirical treatment and limit the spread of multiresistant strains.