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Aetiology of lower respiratory tract infection in adults in primary care: A prospective study in 11 European Countries

Aetiology of lower respiratory tract infection in adults in primary care: A prospective study in 11 European Countries
Aetiology of lower respiratory tract infection in adults in primary care: A prospective study in 11 European Countries
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.
1198-743X
Ieven, Margareta
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Coenen, Samuel
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Loens, Katherine
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Lammens, Christine
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Coenjaerts, Frank
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Vanderstraeten, Anouk
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Henriques-Normark, Birgitta
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Crook, Derrick
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Huygen, Kris
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Butler, Christopher
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Verheij, Theo J. M.
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Little, Paul
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Zlateva, Kalina
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van Loon, Anton
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Claas, Eric CJ.
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Goossens, Herman
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Ieven, Margareta
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Coenen, Samuel
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Loens, Katherine
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Lammens, Christine
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Coenjaerts, Frank
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Vanderstraeten, Anouk
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Henriques-Normark, Birgitta
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Crook, Derrick
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Huygen, Kris
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Butler, Christopher
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Verheij, Theo J. M.
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Little, Paul
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Zlateva, Kalina
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van Loon, Anton
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Claas, Eric CJ.
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Goossens, Herman
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Ieven, Margareta, Coenen, Samuel, Loens, Katherine, Lammens, Christine, Coenjaerts, Frank, Vanderstraeten, Anouk, Henriques-Normark, Birgitta, Crook, Derrick, Huygen, Kris, Butler, Christopher, Verheij, Theo J. M., Little, Paul, Zlateva, Kalina, van Loon, Anton, Claas, Eric CJ. and Goossens, Herman (2018) Aetiology of lower respiratory tract infection in adults in primary care: A prospective study in 11 European Countries. Clinical Microbiology and Infection. (doi:10.1016/j.cmi.2018.02.004).

Record type: Article

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.

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GRACE WP3 Detailed description mixed infections CMI
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GRACE WP3 etiology by PCN
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Accepted/In Press date: 3 February 2018
e-pub ahead of print date: 12 February 2018

Identifiers

Local EPrints ID: 418209
URI: http://eprints.soton.ac.uk/id/eprint/418209
ISSN: 1198-743X
PURE UUID: 361e9e5a-8545-45ea-b917-6e27978e3542

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Date deposited: 23 Feb 2018 17:30
Last modified: 30 Jan 2020 05:04

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Contributors

Author: Margareta Ieven
Author: Samuel Coenen
Author: Katherine Loens
Author: Christine Lammens
Author: Frank Coenjaerts
Author: Anouk Vanderstraeten
Author: Birgitta Henriques-Normark
Author: Derrick Crook
Author: Kris Huygen
Author: Christopher Butler
Author: Theo J. M. Verheij
Author: Paul Little
Author: Kalina Zlateva
Author: Anton van Loon
Author: Eric CJ. Claas
Author: Herman Goossens

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