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Clin Microbiol Infect. 2018 Feb 12. pii: S1198-743X(18)30152-6. doi: 10.1016/j.cmi.2018.02.004. [Epub ahead of print]
Aetiology of Lower Respiratory Tract Infection in Adults in Primary Care: A prospective Study in 11 European Countries.
Ieven M1, Coenen S2, Loens K3, Lammens C3, Coenjaerts F4, Vanderstraeten A3, Henriques-Normark B5, Crook D6, Huygen K7, Butler CC6, Verheij TJ8, Little P9, Zlateva K10, van Loon A4, Claas EC10, Goossens H3; GRACE consortium.
Author information
Abstract
OBJECTIVES:
To describe the role of bacteria (including bacterial resistance), viruses (including those recently described), and mixed bacterial-viral infections in adults presenting to primary care with lower respiratory tract infection (LRTI).
METHODS:
We enrolled 3104 adults with LRTI, 141 (4.5%) of whom had community-acquired pneumonia (CAP), and 2985 matched controls in a prospective study in 16 primary care networks in Europe, and followed patients up at 28-35 days. We detected S. pneumoniae and H. influenzae and assessed susceptibility, atypical bacteria and viruses.
RESULTS:
A potential pathogen was detected in 1844 (59%) (in 350 (11%) bacterial pathogens only, in 1190 (38%) viral pathogens only, and in 304 (10%) both bacterial and viral pathogens). The most common bacterial pathogens isolated were S. pneumoniae (5.5% overall, 9.2% in CAP patients) and H. influenzae (5.4% overall, 14.2% in CAP patients). <1% of S. pneumoniae were highly resistant to penicillin and 12.6% of H. influenzae were beta-lactamase positive. The most common viral pathogens detected were human rhinovirus (HRV; 20.1%), influenza viruses (FLU; 9.9%), and human coronavirus (HCoV; 7.4%). FLU, human parainfluenzaviruses and human respiratory syncytial virus as well as HRV, HCoV, human metapneumovirus were detected significantly more frequently in LRTI patients than in controls.
CONCLUSIONS:
A bacterial pathogen is identified in approximately one in five adult patients with LRTI in primary care, and a viral pathogen in just under half, with mixed infections in one in ten. Penicillin resistant pneumococci and beta-lactamase producing H. influenzae are uncommon. These new findings support a restrictive approach to antibiotic prescribing for LRTI and the use of first-line, narrow spectrum agents in primary care.
Copyright ? 2018. Published by Elsevier Ltd.
KEYWORDS:
Aetiology; LRTI; Lower Respiratory; Respiratory; Tract Infection
PMID: 29447989 DOI: 10.1016/j.cmi.2018.02.004
Aetiology of Lower Respiratory Tract Infection in Adults in Primary Care: A prospective Study in 11 European Countries.
Ieven M1, Coenen S2, Loens K3, Lammens C3, Coenjaerts F4, Vanderstraeten A3, Henriques-Normark B5, Crook D6, Huygen K7, Butler CC6, Verheij TJ8, Little P9, Zlateva K10, van Loon A4, Claas EC10, Goossens H3; GRACE consortium.
Author information
Abstract
OBJECTIVES:
To describe the role of bacteria (including bacterial resistance), viruses (including those recently described), and mixed bacterial-viral infections in adults presenting to primary care with lower respiratory tract infection (LRTI).
METHODS:
We enrolled 3104 adults with LRTI, 141 (4.5%) of whom had community-acquired pneumonia (CAP), and 2985 matched controls in a prospective study in 16 primary care networks in Europe, and followed patients up at 28-35 days. We detected S. pneumoniae and H. influenzae and assessed susceptibility, atypical bacteria and viruses.
RESULTS:
A potential pathogen was detected in 1844 (59%) (in 350 (11%) bacterial pathogens only, in 1190 (38%) viral pathogens only, and in 304 (10%) both bacterial and viral pathogens). The most common bacterial pathogens isolated were S. pneumoniae (5.5% overall, 9.2% in CAP patients) and H. influenzae (5.4% overall, 14.2% in CAP patients). <1% of S. pneumoniae were highly resistant to penicillin and 12.6% of H. influenzae were beta-lactamase positive. The most common viral pathogens detected were human rhinovirus (HRV; 20.1%), influenza viruses (FLU; 9.9%), and human coronavirus (HCoV; 7.4%). FLU, human parainfluenzaviruses and human respiratory syncytial virus as well as HRV, HCoV, human metapneumovirus were detected significantly more frequently in LRTI patients than in controls.
CONCLUSIONS:
A bacterial pathogen is identified in approximately one in five adult patients with LRTI in primary care, and a viral pathogen in just under half, with mixed infections in one in ten. Penicillin resistant pneumococci and beta-lactamase producing H. influenzae are uncommon. These new findings support a restrictive approach to antibiotic prescribing for LRTI and the use of first-line, narrow spectrum agents in primary care.
Copyright ? 2018. Published by Elsevier Ltd.
KEYWORDS:
Aetiology; LRTI; Lower Respiratory; Respiratory; Tract Infection
PMID: 29447989 DOI: 10.1016/j.cmi.2018.02.004