tetano
Editor, Senior Moderator
Clin Microbiol Infect. 2018 Feb 12. pii: S1198-743X(18)30152-6. doi: 10.1016/j.cmi.2018.02.004. [Epub ahead of print]
[h=1]Aetiology of Lower Respiratory Tract Infection in Adults in Primary Care: A prospective Study in 11 European Countries.[/h] Ieven M[SUP]1[/SUP], Coenen S[SUP]2[/SUP], Loens K[SUP]3[/SUP], Lammens C[SUP]3[/SUP], Coenjaerts F[SUP]4[/SUP], Vanderstraeten A[SUP]3[/SUP], Henriques-Normark B[SUP]5[/SUP], Crook D[SUP]6[/SUP], Huygen K[SUP]7[/SUP], Butler CC[SUP]6[/SUP], Verheij TJ[SUP]8[/SUP], Little P[SUP]9[/SUP], Zlateva K[SUP]10[/SUP], van Loon A[SUP]4[/SUP], Claas EC[SUP]10[/SUP], Goossens H[SUP]3[/SUP]; GRACE consortium.
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]OBJECTIVES:[/h] 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).
[h=4]METHODS:[/h] 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.
[h=4]RESULTS:[/h] 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.
[h=4]CONCLUSIONS:[/h] 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.
[h=4]KEYWORDS:[/h] Aetiology; LRTI; Lower Respiratory; Respiratory; Tract Infection
PMID: 29447989 DOI: 10.1016/j.cmi.2018.02.004
[h=1]Aetiology of Lower Respiratory Tract Infection in Adults in Primary Care: A prospective Study in 11 European Countries.[/h] Ieven M[SUP]1[/SUP], Coenen S[SUP]2[/SUP], Loens K[SUP]3[/SUP], Lammens C[SUP]3[/SUP], Coenjaerts F[SUP]4[/SUP], Vanderstraeten A[SUP]3[/SUP], Henriques-Normark B[SUP]5[/SUP], Crook D[SUP]6[/SUP], Huygen K[SUP]7[/SUP], Butler CC[SUP]6[/SUP], Verheij TJ[SUP]8[/SUP], Little P[SUP]9[/SUP], Zlateva K[SUP]10[/SUP], van Loon A[SUP]4[/SUP], Claas EC[SUP]10[/SUP], Goossens H[SUP]3[/SUP]; GRACE consortium.
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]OBJECTIVES:[/h] 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).
[h=4]METHODS:[/h] 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.
[h=4]RESULTS:[/h] 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.
[h=4]CONCLUSIONS:[/h] 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.
[h=4]KEYWORDS:[/h] Aetiology; LRTI; Lower Respiratory; Respiratory; Tract Infection
PMID: 29447989 DOI: 10.1016/j.cmi.2018.02.004