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

• Published in: Journal of clinical epidemiology Vol. 58; no. 2; pp. 175 - 183
• Main Authors: Hopstaken, R.M., Stobberingh, E.E., Knottnerus, J.A., Muris, J.W.M., Nelemans, P., Rinkens, P.E.L.M., Dinant, G.J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2005; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Antibiotics; Bacterial infections; Bacterial Infections - diagnosis; Biological and medical sciences; Biomarkers - blood; Blood Sedimentation; c-Reactive protein; C-Reactive Protein - analysis; Clinical medicine; Cohort Studies; Confidence intervals; Diagnosis; Diagnosis, Differential; Drug therapy; Epidemiology; Etiology; Family physicians; Female; General practice; Humans; Infections; Laboratories; Leukocyte Count; Logistic Models; Lung Diseases - microbiology; Lung Diseases - virology; Male; Medical sciences; Middle Aged; Pneumology; Predictive value of tests; Primary Health Care; Respiratory system : syndromes and miscellaneous diseases; Respiratory tract infections; Streptococcus infections; Viral infections; Virus Diseases - diagnosis; Respiratory tract infections; c-Reactive protein; General practice; Diagnosis; Etiology; Predictive value of tests; Human; Lung disease; Respiratory disease; Respiratory system; Epidemiology; Differential diagnostic; Infection; Virus; Lower respiratory tract; Antibiotic; Chemotherapy; Acute phase protein; Viral disease; Bacteriosis; Predictive value; C reactive protein; Pneumopathy; Public health
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/j.jclinepi.2004.08.004

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