Graffelman A Willy, Knuistingh Neven Arie, le Cessie Saskia, Kroes Aloys C M, Springer Machiel P, van den Broek Peterhans J
Department of General Practice and Nursing Home Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Br J Gen Pract. 2004 Jan;54(498):15-9.
There are few investigations into the aetiology of lower respiratory tract infections (LRTIs) in general practice.
To describe the aetiology of LRTI among adult patients in general practice in The Netherlands.
Prospective observational study.
General practices in the Leiden region, The Netherlands.
Adult patients with a defined LRTI were included. Standard medical history and physical examination were performed. Sputum, blood and throat swabs were collected for diagnostic tests. Aetiological diagnosis, categorised as definite or possible, was based on the results of bacterial and viral cultures, serological techniques, and on polymerase chain reaction. Proportions of pathogens causing LRTI were assessed in relation to chest X-ray findings.
A bacterial cause was established in 43 (30%), and a viral cause in 57 (39%) of the 145 patients with a LRTI. Influenza virus A was the most frequently diagnosed microorganism, followed by Haemophilus influenzae, and Mycoplasma pneumoniae. Streptococcus pneumoniae was found in 6% of the patients.
Pathogens were found in two-thirds of the patients. In half of these patients there was a viral cause. Influenza virus A was the most frequently found pathogen. The treatment with antibiotics of at least one-third of the patients with LRTI was superfluous. This observation should result in changes in the prescription of antibiotics in LRTI.
在全科医疗中，对下呼吸道感染（LRTIs）病因的调查较少。
描述荷兰全科医疗中成年患者LRTI的病因。
前瞻性观察研究。
荷兰莱顿地区的全科诊所。
纳入确诊为LRTI的成年患者。进行标准病史采集和体格检查。采集痰液、血液和咽喉拭子进行诊断检测。病因诊断分为明确或可能，基于细菌和病毒培养、血清学技术以及聚合酶链反应的结果。根据胸部X线检查结果评估引起LRTI的病原体比例。
145例LRTI患者中，43例（30%）确定为细菌病因，57例（39%）为病毒病因。甲型流感病毒是最常诊断出的微生物，其次是流感嗜血杆菌和肺炎支原体。6%的患者发现有肺炎链球菌。
三分之二的患者发现有病原体。其中一半患者为病毒病因。甲型流感病毒是最常发现的病原体。至少三分之一的LRTI患者使用抗生素治疗是多余的。这一观察结果应导致LRTI抗生素处方的改变。
