Predicting the presence of bacterial pathogens in the airways of primary care patients with acute cough
Predicting the presence of bacterial pathogens in the airways of primary care patients with acute cough
BACKGROUND: Bacterial testing of all patients who present with acute cough is not feasible in primary care. Furthermore, the extent to which easily obtainable clinical information predicts bacterial infection is unknown. We evaluated the diagnostic value of clinical examination and testing for C-reactive protein and procalcitonin for bacterial lower respiratory tract infection.
METHODS: Through a European diagnostic study, we recruited 3104 adults with acute cough (≤ 28 days) in primary care settings. All of the patients underwent clinical examination, measurement of C-reactive protein and procalcitonin in blood, and chest radiography. Bacterial infection was determined by conventional culture, polymerase chain reaction and serology, and positive results were defined by the presence of Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Bordetella pertussis or Legionella pneumophila. Using multivariable regression analysis, we examined the association of diagnostic variables with the presence of bacterial infection.
RESULTS: Overall, 539 patients (17%) had bacterial lower respiratory tract infection, and 38 (1%) had bacterial pneumonia. The only item with diagnostic value for lower respiratory tract infection was discoloured sputum (area under the receiver operating characteristic [ROC] curve 0.56, 95% confidence interval [CI] 0.54–0.59). Adding C-reactive protein above 30 mg/L increased the area under the ROC curve to 0.62 (95% CI 0.59–0.65). For bacterial pneumonia, comorbidity, fever and crackles on auscultation had diagnostic value (area under ROC curve 0.68, 95% CI 0.58–0.77). Adding C-reactive protein above 30 mg/L increased the area under the ROC curve to 0.79 (95% CI 0.71–0.87). Procalcitonin did not add diagnostic information for any bacterial lower respiratory tract infection, including bacterial pneumonia.
INTERPRETATION: In adults presenting with acute lower respiratory tract infection, signs, symptoms and C-reactive protein showed diagnostic value for a bacterial cause. However, the ability of these diagnostic indicators to exclude a bacterial cause was limited. Procalcitonin added no clinically relevant information.
E50-E55
Teepe, Jolien
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Broekhuizen, Berna D.L.
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Loens, Katherine
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Lammens, Christine
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Ieven, Margareta
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Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Little, Paul
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Butler, Chris C.
cedab343-9e0c-420f-ba80-f2f824969687
Coenen, Samuel
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Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Verheij, Theo J.M.
817a26b8-7db9-4e79-b00e-c0457f19f236
16 January 2017
Teepe, Jolien
54285976-b741-4a48-8d78-4e92f17d6023
Broekhuizen, Berna D.L.
58780c58-a133-4b22-ab3d-b30261859a62
Loens, Katherine
4c3dc94c-70c4-47d4-bde5-9a41d2d904f3
Lammens, Christine
5c95854e-7ed4-4932-a4c1-55c3555d5bb5
Ieven, Margareta
c138048d-d838-4c8e-848d-a43e309f4cf0
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Butler, Chris C.
cedab343-9e0c-420f-ba80-f2f824969687
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Verheij, Theo J.M.
817a26b8-7db9-4e79-b00e-c0457f19f236
Teepe, Jolien, Broekhuizen, Berna D.L., Loens, Katherine, Lammens, Christine, Ieven, Margareta, Goossens, Herman, Little, Paul, Butler, Chris C., Coenen, Samuel, Godycki-Cwirko, Maciek and Verheij, Theo J.M.
,
GRACE Consortium
(2017)
Predicting the presence of bacterial pathogens in the airways of primary care patients with acute cough.
Canadian Medical Association Journal, 189 (2), .
(doi:10.1503/cmaj.151364).
Abstract
BACKGROUND: Bacterial testing of all patients who present with acute cough is not feasible in primary care. Furthermore, the extent to which easily obtainable clinical information predicts bacterial infection is unknown. We evaluated the diagnostic value of clinical examination and testing for C-reactive protein and procalcitonin for bacterial lower respiratory tract infection.
METHODS: Through a European diagnostic study, we recruited 3104 adults with acute cough (≤ 28 days) in primary care settings. All of the patients underwent clinical examination, measurement of C-reactive protein and procalcitonin in blood, and chest radiography. Bacterial infection was determined by conventional culture, polymerase chain reaction and serology, and positive results were defined by the presence of Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Bordetella pertussis or Legionella pneumophila. Using multivariable regression analysis, we examined the association of diagnostic variables with the presence of bacterial infection.
RESULTS: Overall, 539 patients (17%) had bacterial lower respiratory tract infection, and 38 (1%) had bacterial pneumonia. The only item with diagnostic value for lower respiratory tract infection was discoloured sputum (area under the receiver operating characteristic [ROC] curve 0.56, 95% confidence interval [CI] 0.54–0.59). Adding C-reactive protein above 30 mg/L increased the area under the ROC curve to 0.62 (95% CI 0.59–0.65). For bacterial pneumonia, comorbidity, fever and crackles on auscultation had diagnostic value (area under ROC curve 0.68, 95% CI 0.58–0.77). Adding C-reactive protein above 30 mg/L increased the area under the ROC curve to 0.79 (95% CI 0.71–0.87). Procalcitonin did not add diagnostic information for any bacterial lower respiratory tract infection, including bacterial pneumonia.
INTERPRETATION: In adults presenting with acute lower respiratory tract infection, signs, symptoms and C-reactive protein showed diagnostic value for a bacterial cause. However, the ability of these diagnostic indicators to exclude a bacterial cause was limited. Procalcitonin added no clinically relevant information.
More information
Accepted/In Press date: 16 August 2016
e-pub ahead of print date: 24 October 2016
Published date: 16 January 2017
Organisations:
Primary Care & Population Sciences
Identifiers
Local EPrints ID: 407645
URI: http://eprints.soton.ac.uk/id/eprint/407645
ISSN: 0820-3946
PURE UUID: ee8de289-0404-4094-a755-f65ffd76f372
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Date deposited: 16 Apr 2017 17:09
Last modified: 11 Jul 2024 01:35
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Contributors
Author:
Jolien Teepe
Author:
Berna D.L. Broekhuizen
Author:
Katherine Loens
Author:
Christine Lammens
Author:
Margareta Ieven
Author:
Herman Goossens
Author:
Chris C. Butler
Author:
Samuel Coenen
Author:
Maciek Godycki-Cwirko
Author:
Theo J.M. Verheij
Corporate Author: GRACE Consortium
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