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

      Affiliations

    • Department of General Practice, Maastricht University, Care and Public Health Research Institute, PO Box 616, Maastricht 6200 MD, The Netherlands
    • Corresponding Author InformationCorresponding author.
    • ,
  • E.E. Stobberingh

      Affiliations

    • Department of Medical Microbiology, Maastricht University, Care and Public Health Research Institute, Maastricht 6200 MD, The Netherlands
    • ,
  • J.A. Knottnerus

      Affiliations

    • Department of General Practice, Maastricht University, Care and Public Health Research Institute, PO Box 616, Maastricht 6200 MD, The Netherlands
    • ,
  • J.W.M. Muris

      Affiliations

    • Department of General Practice, Maastricht University, Care and Public Health Research Institute, PO Box 616, Maastricht 6200 MD, The Netherlands
    • ,
  • P. Nelemans

      Affiliations

    • Department of Epidemiology, Maastricht University, Care and Public Health Research Institute, Maastricht 6200 MD, The Netherlands
    • ,
  • P.E.L.M. Rinkens

      Affiliations

    • Department of General Practice, Maastricht University, Care and Public Health Research Institute, PO Box 616, Maastricht 6200 MD, The Netherlands
    • ,
  • G.J. Dinant

      Affiliations

    • Department of General Practice, Maastricht University, Care and Public Health Research Institute, PO Box 616, Maastricht 6200 MD, The Netherlands

,Accepted 27 August 2004.

References 

  1. Jacobs MR, Felmingham D, Appelbaum PC, Gruneberg RN, The Alexander Project G . The Alexander Project 1998-2000: susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents. J Antimicrob Chemother. 2003;52:229–246
  2. Friedland IR, McCracken GH. Management of infections caused by antibiotic-resistant Streptococcus pneumoniae. [see comments] N Engl J Med. 1994;331:377–382
  3. Jacoby GA. Prevalence and resistance mechanisms of common bacterial respiratory pathogens. Clin Infect Dis. 1994;18:951–957
  4. Schwartz B. Preventing the spread of spread of antimicrobial resistance among bacterial respiratory pathogens in industrialized countries: the case for judicious antimicrobial use. Clin Infect Dis. 1999;28:211–213
  5. Seppala H, Klaukka T, Vuopio-Varkila J, Muotiala A, Helenius H, Lager K, et al. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance. N Engl J Med. 1997;337:441–446
  6. Swartz MN. Use of antimicrobial agents and drug resistance. N Engl J Med. 1997;337:491–492
  7. Magee JT, Pritchard EL, Fitzgerald KA, Dunstan FD, Howard AJ. Antibiotic prescribing and antibiotic resistance in community practice: retrospective study, 1996-8. BMJ. 1999;319:1239–1240
  8. Priest P, Yudkin P, McNulty C, Mant D. Antibacterial prescribing and antibacterial resistance in English general practice: cross sectional study. BMJ. 2001;323:1037–1041
  9. Butler CC, Rollnick S, Pill R, Maggs Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats. BMJ. 1998;317:637–642
  10. Falck G, Heyman L, Gnarpe J, Gnarpe H. Chlamydia pneumoniae (TWAR): a common agent in acute bronchitis. [see comments] Scand J Infect Dis. 1994;26:179–187
  11. Marrie TJ, Peeling RW, Fine MJ, Singer DE, Coley CM, Kapoor WN. Ambulatory patients with community-acquired pneumonia: the frequency of atypical agents and clinical course. Am J Med. 1996;101:508–515
  12. Fang GD, Fine M, Orloff J, Arisumi D, Yu VL, Kapoor W, et al. New and emerging etiologies for community-acquired pneumonia with implications for therapy: a prospective multicenter study of 359 cases. Med Baltimore. 1990;69:307–316
  13. Coenen S, Van Royen P, Vermeire E, Hermann I, Denekens J. Antibiotics for coughing in general practice: a qualitative decision analysis. Fam Pract. 2000;17:380–385
  14. Okkes IM, Oskam SK, Lamberts H. Van klacht naar diagnose: episodegegevens uit de huisartspraktijk [From complaint to diagnosis: disease episodes in general practice]. Bussum: Couthino; 1998;
  15. van der Velden J, De Bakker DH, Claessens AAMC, Schellevis FG. Dutch National Survey of General Practice. Morbidity in general practice. Utrecht: NIVEL; 1992;
  16. Woodhead MA, Macfarlane JT, McCracken JS, Rose DH, Finch RG. Prospective study of the aetiology and outcome of pneumonia in the community. Lancet. 1987;1:671–674
  17. Jokinen C, Heiskanen L, Juvonen H, Kallinen S, Karkola K, Korppi M, et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol. 1993;137:977–988
  18. Metlay JP, Kapoor WN, Fine MJ. Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA. 1997;278:1440–1445
  19. Melbye H, Straume B, Aasebo U, Dale K. Diagnosis of pneumonia in adults in general practice: relative importance of typical symptoms and abnormal chest signs evaluated against a radiographic reference standard. Scand J Prim Health Care. 1992;10:226–233
  20. Hopstaken RM, Muris JWM, Knottnerus JA, Kester ADM, Rinkens PELM, Dinant GJ. Contributions of symptoms, signs, erythrocyte sedimentation rate and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection. Br J Gen Pract. 2003;53:358–364
  21. Kuyvenhoven MM, Verheij TJ, de Melker RA, van der Velden J. Antimicrobial agents in lower respiratory tract infections in Dutch general practice. Br J Gen Pract. 2000;50:133–134
  22. Macfarlane J, Lewis SA, Macfarlane R, Holmes W. Contemporary use of antibiotics in 1089 adults presenting with acute lower respiratory tract illness in general practice in the U.K.: implications for developing management guidelines. Respir Med. 1997;91:427–434
  23. Huchon GJ, Gialdroni Grassi G, Leophonte P, Manresa F, Schaberg T, Woodhead M. Initial antibiotic therapy for lower respiratory tract infection in the community: a European survey. Eur Respir J. 1996;9:1590–1595
  24. Smucny JJ, Becker LA, Glazier RH, McIsaac W. Are antibiotics effective treatment for acute bronchitis? A meta-analysis. J Fam Pract. 1998;47:453–460
  25. Bent S, Saint S, Vittinghoff E, Grady D. Antibiotics in acute bronchitis: a meta-analysis. Am J Med. 1999;107:62–67
  26. Jonsson JS, Sigurdsson JA, Kristinsson KG, Guthnadottir M, Magnusson S. Acute bronchitis in adults: how close do we come to its aetiology in general practice?. Scand J Prim Health Care. 1997;15:156–160
  27. Macfarlane JT, Colville A, Guion A, Macfarlane RM, Rose DH. Prospective study of aetiology and outcome of adult lower-respiratory-tract infections in the community. Lancet. 1993;341:511–514
  28. Hopstaken RM, Nelemans P, Stobberingh EE, Muris JWM, Rinkens PELM, Dinant GJ. Is roxithromycin better than amoxicillin in the treatment of acute lower respiratory tract infections in primary care? A double-blind randomized controlled trial. J Fam Pract. 2002;51:329–336
  29. Woodhead M, Gialdroni Grassi G, Huchon GJ, Leophonte P, Manresa F, Schaberg T. Use of investigations in lower respiratory tract infection in the community: a European survey. [see comments] Eur Respir J. 1996;9:1596–1600
  30. Farr BM, Kaiser DL, Harrison BD, Connolly CK. Prediction of microbial aetiology at admission to hospital for pneumonia from the presenting clinical features. Thorax. 1989;44:1031–1035
  31. Cicchetti DV, Feinstein AR. High agreement but low kappa: II. Resolving the paradoxes. J Clin Epidemiol. 1990;43:551–558
  32. Macfarlane J, Holmes W, Gard P, Macfarlane R, Rose D, Weston V, et al. Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax. 2001;56:109–114
  33. BTS Guidelines for the Management of Community Acquired Pneumonia in Adults. Thorax. 2001;56(Suppl 4):1–64
  34. Holmberg H, Bodin L, Jonsson I, Krook A. Rapid aetiological diagnosis of pneumonia based on routine laboratory features. Scand J Infect Dis. 1990;22:537–545
  35. Korppi M, Kroger L. C-reactive protein in viral and bacterial respiratory infection in children. Scand J Infect Dis. 1992;2:207–213
  36. Hjortdahl P, Landaas S, Urdal P, Steinbakk M, Fuglerud P, Nygaard B. C-reactive protein: a new rapid assay for managing infectious disease in primary health care. Scand J Prim Health Care. 1991;9:3–10
  37. Virkki R, Juven T, Rikalainen H, Svedstrom E, Mertsola J, Ruuskanen O. Differentiation of bacterial and viral pneumonia in children. Thorax. 2002;57:438–441
  38. Soderstrom M, Blomberg J, Christensen P, Hovelius B. Erythromycin and phenoxymethylpenicillin (penicillin V) in the treatment of respiratory tract infections as related to microbiological findings and serum C-reactive protein. Scand J Infect Dis. 1991;23:347–354
  39. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken R. Manual of clinical microbiology. Washington, DC: ASM Press; 1999;
  40. Isenberg HD. Clinical microbiology procedures handbook. Washington, DC: American Society for Microbiology; 1994;
  41. Sachs AP, van der Waaij D, Groenier KH, Koeter GH, Schiphuis J. Oropharyngeal flora in asthma and in chronic obstructive pulmonary disease: indigenous oropharyngeal microorganisms in outpatients with asthma or chronic obstructive pulmonary disease. Am Rev Respir Dis. 1993;148:1302–1307
  42. Tong CY, Sillis M. Detection of Chlamydia pneumoniae and Chlamydia psittaci in sputum samples by PCR. J Clin Pathol. 1993;46:313–317
  43. DeLong ER, DeLong DM, Clarke Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–845
  44. Harrell FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–387
  45. Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001;163:1730–1754
  46. Bartlett JG, Dowell SF, Mandell LA, File TM, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis. 2000;312:347–382
  47. Melbye H, Straume B, Aasebo U, Brox J. The diagnosis of adult pneumonia in general practice: the diagnostic value of history, physical examination and some blood tests. Scand J Prim Health Care. 1988;6:111–117
  48. Bates JH, Campbell GD, Barron AL, McCracken GA, Morgan PN, Moses EB, et al. Microbial etiology of acute pneumonia in hospitalized patients. [see comments] Chest. 1992;101:1005–1012
  49. van den Brandhof WE, Bartelds AIM, Peeters MF, Wilbrink B, Heijnen MLA. ARI-EL: een case-controle onderzoek naar Acute Respiratoire Infecties in de Eerste Lijn. Tussenrapportage over okt. 2000 t/m sept. 2001. Bilthoven: Rijksinstituut voor Volksgezondheid en Milieu (RIVM); 2001;
  50. Byington CL, Castillo H, Gerber K, Daly JA, Brimley LA, Adams S, et al. The effect of rapid respiratory viral diagnostic testing on antibiotic use in a children's hospital. Arch Pediatr Adolesc Med. 2002;156:1230–1234
  51. Boldy DA, Skidmore SJ, Ayres JG. Acute bronchitis in the community: clinical features, infective factors, changes in pulmonary function and bronchial reactivity to histamine. Respir Med. 1990;84:377–385
  52. Bartlett JG, Mundy LM. Community-acquired pneumonia. N Engl J Med. 1995;333:1618–1624
  53. Huchon G, Woodhead M. Management of adult community-acquired lower respiratory tract infections. Eur Respir Rev. 1998;8:391–426
  54. Schrijnemakers . EARSS Annual report 2001. Bilthoven, The Netherlands: RIVM; 2001;
  55. Wilson S, Delaney BC, Roalfe A, Roberts L, Redman V, Wearn AM, et al. Randomised controlled trials in primary care: case study. BMJ. 2000;321:24–27
  56. Knottnerus JA, van Weel C, Muris JWM. Evaluation of diagnostic procedures. BMJ. 2002;324:477–480
  57. Hopstaken R, Hay AD, Butler CC. Diagnosis of bacterial LRTI. Br J Gen Pract. 2004;54:216

 The study was supported by a grant from the Care and Public Health Research Institute, Maastricht.

PII: S0895-4356(04)00229-X

doi: 10.1016/j.jclinepi.2004.08.004

Journal of Clinical Epidemiology
Volume 58, Issue 2 , Pages 175-183 , February 2005

Article Tools

* Image Usage & Resolution