Clinical items not helpful in differentiating viral from bacterial lower respiratory tract infections in general practice

Hopstaken, R.M.; Stobberingh, E.E.; Knottnerus, J.A.; Muris, J.W.M.; Nelemans, P.; Rinkens, P.E.L.M.; Dinant, G.J.

doi:10.1016/j.jclinepi.2004.08.004

« Previous Next »Journal of Clinical Epidemiology
Volume 58, Issue 2 , Pages 175-183, February 2005

Clinical items not helpful in differentiating viral from bacterial lower respiratory tract infections in general practice

R.M. Hopstaken
- Department of General Practice, Maastricht University, Care and Public Health Research Institute, PO Box 616, Maastricht 6200 MD, The Netherlands
- Corresponding author.
E.E. Stobberingh
- Department of Medical Microbiology, Maastricht University, Care and Public Health Research Institute, Maastricht 6200 MD, The Netherlands
J.A. Knottnerus
- Department of General Practice, Maastricht University, Care and Public Health Research Institute, PO Box 616, Maastricht 6200 MD, The Netherlands
J.W.M. Muris
- Department of General Practice, Maastricht University, Care and Public Health Research Institute, PO Box 616, Maastricht 6200 MD, The Netherlands
P. Nelemans
- Department of Epidemiology, Maastricht University, Care and Public Health Research Institute, Maastricht 6200 MD, The Netherlands
P.E.L.M. Rinkens
- Department of General Practice, Maastricht University, Care and Public Health Research Institute, PO Box 616, Maastricht 6200 MD, The Netherlands
G.J. Dinant
- Department of General Practice, Maastricht University, Care and Public Health Research Institute, PO Box 616, Maastricht 6200 MD, The Netherlands

Accepted 27 August 2004.

Abstract

Objective

Incorrect and unnecessary antibiotic prescribing enhancing bacterial resistance rates might be reduced if viral and bacterial lower respiratory tract infections (LRTI) could be differentiated clinically. Whether this is possible is often doubted but has rarely been studied in general practice.

Study design and setting

This was an observational cohort study in 15 general practice surgeries in the Netherlands.

Results

Etiologic diagnoses were obtained in 112 of 234 patients with complete data (48%). Viral pathogens were found as often as bacterial pathogens. Haemophilus (para-) influenzae was most frequently found. None of the symptoms and signs correlated statistically significantly with viral or bacterial LRTI. Erythrocyte sedimentation rate >50 (odds ratio [OR] 2.3–3.3) and C-reactive protein (CRP) >20 (OR 2.1–4.6) were independent predictors for viral LRTI and bacterial LRTI when compared with microbiologically unexplained LRTI.

Conclusion

Extensive history-taking and physical examination did not provide items that predict viral or bacterial LRTI in adult patients in daily general practice. We could not confirm CRP to differentiate between viral and bacterial LRTI.

Keywords: Respiratory tract infections, Diagnosis, Predictive value of tests, Etiology, c-Reactive protein, General practice