tetano
Editor, Senior Moderator
J Med Microbiol. 2013 Dec 16. doi: 10.1099/jmm.0.067108-0. [Epub ahead of print]
The value of signs and symptoms in differentiating between bacterial, viral and mixed aetiology in patients with a community-acquired pneumonia.
Huijskens EG, Koopmans MP, Palmen FM, van Erkel AJ, Mulder PG, Rossen JW.
Author information
Abstract
Current diagnostics for community-acquired pneumonia (CAP) include testing for a wide range of pathogens, which is costly and not always informative. We compared clinical and laboratory parameters of patients with CAP caused by different groups of pathogens to evaluate the potential for targeted diagnostics and directed treatment. In a prospective study, between April 2008 and April 2009, adult patients with CAP were tested for the presence of a broad range of possible respiratory pathogens using bacterial cultures, PCR, urinary antigen testing and serology. Of 408 patients with CAP, pathogens were detected in 263 (64.5%) patients. S. pneumoniae and influenza A virus were the most frequently identified bacterial and viral pathogens, respectively. Age had a significant effect on the prediction of aetiology (p = 0.054), with an increase in the relative contribution of viruses with advancing age. Multivariate analyses showed further that presence of cough increased the likelihood of detecting a viral pathogen (OR 5.536 95%CI: 2.130-14.390), the presence of immunodeficiency decreased the likelihood of detecting a bacterial pathogen (OR 0.595 95%CI: 0.246-1.437), and an increase in pneumonia severity index score increased the likelihood of detecting a pathogen in general. Although several variables were independently associated with the detection of a pathogen group, there were no reliable clinical predictors to distinguish between aetiologies due to substantial overlap. Therefore, testing for common respiratory pathogens is still necessary to optimize treatment.
KEYWORDS:
Clinical microbiology, Diagnostic techniques, Molecular diagnostics, Respiratory infections, Viruses
PMID:
24344207
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/24344207
The value of signs and symptoms in differentiating between bacterial, viral and mixed aetiology in patients with a community-acquired pneumonia.
Huijskens EG, Koopmans MP, Palmen FM, van Erkel AJ, Mulder PG, Rossen JW.
Author information
Abstract
Current diagnostics for community-acquired pneumonia (CAP) include testing for a wide range of pathogens, which is costly and not always informative. We compared clinical and laboratory parameters of patients with CAP caused by different groups of pathogens to evaluate the potential for targeted diagnostics and directed treatment. In a prospective study, between April 2008 and April 2009, adult patients with CAP were tested for the presence of a broad range of possible respiratory pathogens using bacterial cultures, PCR, urinary antigen testing and serology. Of 408 patients with CAP, pathogens were detected in 263 (64.5%) patients. S. pneumoniae and influenza A virus were the most frequently identified bacterial and viral pathogens, respectively. Age had a significant effect on the prediction of aetiology (p = 0.054), with an increase in the relative contribution of viruses with advancing age. Multivariate analyses showed further that presence of cough increased the likelihood of detecting a viral pathogen (OR 5.536 95%CI: 2.130-14.390), the presence of immunodeficiency decreased the likelihood of detecting a bacterial pathogen (OR 0.595 95%CI: 0.246-1.437), and an increase in pneumonia severity index score increased the likelihood of detecting a pathogen in general. Although several variables were independently associated with the detection of a pathogen group, there were no reliable clinical predictors to distinguish between aetiologies due to substantial overlap. Therefore, testing for common respiratory pathogens is still necessary to optimize treatment.
KEYWORDS:
Clinical microbiology, Diagnostic techniques, Molecular diagnostics, Respiratory infections, Viruses
PMID:
24344207
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/24344207