Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care.

Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. Research Abstract Details 

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Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. Abstract Text:

Anette Holm,Joergen Nexoe,Lene A Bistrup,Svend S Pedersen,Niels Obel,Lars P Nielsen,Court Pedersen,

BACKGROUND: Knowledge of predominant pathogens and their association with outcome are of importance for the management of lower respiratory tract infection (LRTI). As antibiotic therapy is indicated in pneumonia and not in acute bronchitis, a predictor of pneumonia is needed. AIM: To describe the aetiology and outcome of LRTI in adults with pneumonic and adults with non-pneumonic LRTI treated in general practice and to identify predictors of radiographic pneumonia. DESIGN OF STUDY: Prospective, observational study. SETTING: Forty-two general practices and an outpatient clinic at the Department of Infectious Diseases, Odense University Hospital, Denmark. METHOD: A total of 364 adults diagnosed with community-acquired LRTI by their GP were studied with chest radiography, vital signs, biochemical markers of inflammation (C-reactive protein [CRP] and leukocyte count), and microbiological examinations. Primary outcome measure was hospitalisation within 4 weeks. RESULTS: Pneumonia was radiographically verified in 48 of 364 patients (13%). Bacterial infection was seen more often in patients with pneumonia (33% versus 17%, P<0.001), and viral infection more often in non-pneumonic patients (26% versus 13%, P<0.05). Hospitalisation was more common in patients with pneumonia compared to non-pneumonic patients (19 versus 3%, P<0.001); and in patients with pneumococcal infection compared with patients without pneumococcal infection (26 versus 4%, P = 0.001). The positive predictive value of GPs' diagnosis of pneumonia was low (0.23), but the vital signs, CRP, and leukocyte count had comparably low positive predictive values (0.23-0.30). CONCLUSION: Streptococcus pneumoniae was the most common bacterial pathogen. The risk of hospitalisation was highest among patients with pneumonia or pneumococcal infection; this emphasises the importance of coverage of S. pneumoniae when treatment is indicated. CRP should not be introduced for diagnosis of radiographic pneumonia in general practice before its use has been investigated in prospective, controlled intervention trials using CRP-guided treatment algorithms.

Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. Publishing Authors By Initials

A Holm,J Nexoe,LA Bistrup,SS Pedersen,N Obel,LP Nielsen,C Pedersen,

For similar investigative techniques: epidemiologic methods: epidemiologic study characteristics as topic: epidemiologic studies: cohort studies: longitudinal studies: prospective studies research abstracts see: investigative techniques: epidemiologic methods: epidemiologic study characteristics as topic: epidemiologic studies: cohort studies: longitudinal studies: prospective studies research

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Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. Journal Published:

PUBLICATION TYPE: Research Support, Non-U.S. Gov

Journal: The British journal of general practice : the jour

VOLUME: 57

Page Numbers: 547-54

Journal Abbreviation:

ISSN: 0960-1643

DAY: 28

MONTH: Jul

YEAR: 2007

Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. Information

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LANGUAGE: eng

NlmUniqueID: 9005323

Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. Keywords Mesh Terms:

KEYWORDS: Prospective Studies

MESH TERMS: etiology

Chemical & Substance for Abstract: Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. Information

Substance Name: C-Reactive Protein

Registry Number: 9007-41-4

Grant and Affiliation Information for Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care.

AFFILIATION: Department of Infectious Diseases C, Odense University Hospital, Denmark. anette.holm@ouh.regionsyddanmark.dk

Country: England

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MEDLINETA: Br J Gen Pract

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