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Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: Secondary analysis of a multicentre European trial

Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: Secondary analysis of a multicentre European trial
Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: Secondary analysis of a multicentre European trial
Background:
The impact of antimicrobial resistance on clinical outcomes in patients with lower respiratory tract infection in primary care is largely unknown.

Aim:
We determined the illness course of infections with resistant bacteria in adults presenting with acute cough to primary care.

Design and setting:
Secondary analysis of a multicentre European trial in primary care.

Method:
2,061 adults with acute cough (≤ 28 days) were recruited from primary care and randomised to amoxicillin or placebo. To reflect the natural course of disease, only patients in the placebo group (n = 1,021) were eligible. Nasopharyngeal flocked swabs and/or sputa (when available) were analysed at baseline and Streptococcus pneumoniae and Haemophilus influenzae isolates underwent susceptibility testing. Patients recorded their symptoms in a diary every day for four weeks. Patients with and without resistant bacterial infection were compared with regards to symptom severity, duration of symptoms and a return consultation.

Results:
Of the 834 patients with diary records, 104 showed S. pneumoniae and/or H. influenzae infection. Of this number, 54/104 (52%) were antibiotic-resistant, while 7/104 (7%) were resistant to penicillin. Neither duration of symptoms rated “moderately bad or worse” (hazard ratio 1.27, 95% CI 0.67-2.44) nor mean symptom severity (difference -0.48, 95% CI -1.17-0.21) nor worsening of illness (odds ratio 0.31, 95% CI 0.07-1.41) differed significantly between the antibiotic resistant and antibiotic sensitive groups.

Conclusion:
The illness course of antibiotic-resistant lower respiratory tract infection does not differ from that caused by sensitive bacteria.
0960-1643
e627-e632
Teepe, Jolien
54285976-b741-4a48-8d78-4e92f17d6023
Broekhuizen, Berna D.L.
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Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Horjijk, Patricia Marinka
6ec5dd7a-e804-4911-99bb-784c063e9a9c
Loens, Katherine
4c3dc94c-70c4-47d4-bde5-9a41d2d904f3
Lammens, Christine
5c95854e-7ed4-4932-a4c1-55c3555d5bb5
Ieven, Margareta
c138048d-d838-4c8e-848d-a43e309f4cf0
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Butler, Chris C.
cedab343-9e0c-420f-ba80-f2f824969687
Coenen, Samuel
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Godycki-Cwirko, Maciek
306b5836-4955-470d-bf1f-77c6ac282138
Henriques-Normark, Birgitta
1918bc3a-c927-463d-87ae-c5f1cf582a53
Verheij, Theo J. M.
0164f6e4-2c95-4233-8c2e-29b616c8ff66
Teepe, Jolien
54285976-b741-4a48-8d78-4e92f17d6023
Broekhuizen, Berna D.L.
58780c58-a133-4b22-ab3d-b30261859a62
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Horjijk, Patricia Marinka
6ec5dd7a-e804-4911-99bb-784c063e9a9c
Loens, Katherine
4c3dc94c-70c4-47d4-bde5-9a41d2d904f3
Lammens, Christine
5c95854e-7ed4-4932-a4c1-55c3555d5bb5
Ieven, Margareta
c138048d-d838-4c8e-848d-a43e309f4cf0
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
Henriques-Normark, Birgitta
1918bc3a-c927-463d-87ae-c5f1cf582a53
Verheij, Theo J. M.
0164f6e4-2c95-4233-8c2e-29b616c8ff66

Teepe, Jolien, Broekhuizen, Berna D.L., Goossens, Herman, Horjijk, Patricia Marinka, Loens, Katherine, Lammens, Christine, Ieven, Margareta, Little, Paul, Butler, Chris C., Coenen, Samuel, Godycki-Cwirko, Maciek, Henriques-Normark, Birgitta and Verheij, Theo J. M. (2018) Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: Secondary analysis of a multicentre European trial. British Journal of General Practice, 68 (674), e627-e632. (doi:10.3399/bjgp18X698333).

Record type: Article

Abstract

Background:
The impact of antimicrobial resistance on clinical outcomes in patients with lower respiratory tract infection in primary care is largely unknown.

Aim:
We determined the illness course of infections with resistant bacteria in adults presenting with acute cough to primary care.

Design and setting:
Secondary analysis of a multicentre European trial in primary care.

Method:
2,061 adults with acute cough (≤ 28 days) were recruited from primary care and randomised to amoxicillin or placebo. To reflect the natural course of disease, only patients in the placebo group (n = 1,021) were eligible. Nasopharyngeal flocked swabs and/or sputa (when available) were analysed at baseline and Streptococcus pneumoniae and Haemophilus influenzae isolates underwent susceptibility testing. Patients recorded their symptoms in a diary every day for four weeks. Patients with and without resistant bacterial infection were compared with regards to symptom severity, duration of symptoms and a return consultation.

Results:
Of the 834 patients with diary records, 104 showed S. pneumoniae and/or H. influenzae infection. Of this number, 54/104 (52%) were antibiotic-resistant, while 7/104 (7%) were resistant to penicillin. Neither duration of symptoms rated “moderately bad or worse” (hazard ratio 1.27, 95% CI 0.67-2.44) nor mean symptom severity (difference -0.48, 95% CI -1.17-0.21) nor worsening of illness (odds ratio 0.31, 95% CI 0.07-1.41) differed significantly between the antibiotic resistant and antibiotic sensitive groups.

Conclusion:
The illness course of antibiotic-resistant lower respiratory tract infection does not differ from that caused by sensitive bacteria.

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Accepted/In Press date: 30 April 2018
e-pub ahead of print date: 30 August 2018
Published date: 1 September 2018

Identifiers

Local EPrints ID: 420315
URI: http://eprints.soton.ac.uk/id/eprint/420315
ISSN: 0960-1643
PURE UUID: 52b2ae89-e21e-408c-be8a-6e4ac4d6c3ab

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Date deposited: 04 May 2018 16:30
Last modified: 24 Jan 2020 05:02

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Contributors

Author: Jolien Teepe
Author: Berna D.L. Broekhuizen
Author: Herman Goossens
Author: Patricia Marinka Horjijk
Author: Katherine Loens
Author: Christine Lammens
Author: Margareta Ieven
Author: Paul Little
Author: Chris C. Butler
Author: Samuel Coenen
Author: Maciek Godycki-Cwirko
Author: Birgitta Henriques-Normark
Author: Theo J. M. Verheij

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