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):20-4.
The majority of patients with lower respiratory tract infections (LRTIs) are treated with antibiotics; some of them are unnecessary because of a viral cause. Information on prediction of the aetiology, especially in a general practice setting, is missing.
To differentiate between viral and bacterial LRTI on simple clinical criteria, easily obtained at the bedside.
Prospective observational study.
General practices in the Leiden region of The Netherlands.
Adult patients with LRTI were included. Standard medical history and physical examination were performed. Sputum, blood and throat swabs were collected for diagnostic tests. According to microbiological findings, patients were classified as bacterial, viral, dual infection and unknown cause. In a logistic regression model independent predictors were determined. Scoring systems were developed. The accuracies of the diagnostic rules were tested by using receiver operating characteristic (ROC) curves.
One-hundred and forty-five patients were classified as having bacterial (n = 35), viral (n = 49), or dual infection (n = 8), or infection of unknown cause (n = 53), respectively. Independent predictors for bacterial infection were fever (odds ratio [OR] = 8.0; 95% confidence interval [CI] = 0.9 to 71.0), headache (OR = 4.3; 95% CI = 1.0 to 19.1) cervical painful lymph nodes (OR = 8.7; 95% CI = 1.1 to 68.0), diarrhoea (OR = 0.3; 95% CI = 0.1 to 1.0) and rhinitis (OR = 0.3; 95% CI = 0.1 to 0.9). As an additional independent predictor, an infiltrate on chest X-ray (OR = 5.0; 95% CI = 1.2 to 20.5) was found. The diagnostic rules developed from these variables classified the aetiology of LRTI with a ROC curve area of 0.79 (clinical score), 0.77 (simplified score) and 0.83 (extended score).
A diagnostic rule was developed, based on information that is easy to obtain at the bedside, to predict a bacterial infection. This diagnostic rule may be a tool for general practitioners in their management of patients with LRTI.
大多数下呼吸道感染（LRTIs）患者接受抗生素治疗；其中一些治疗是不必要的，因为病因是病毒感染。目前缺少关于病因预测的信息，尤其是在全科医疗环境中。
根据简单的临床标准区分病毒性和细菌性下呼吸道感染，这些标准可在床边轻松获取。
前瞻性观察性研究。
荷兰莱顿地区的全科医疗诊所。
纳入患有下呼吸道感染的成年患者。进行标准的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。根据微生物学检查结果，将患者分为细菌感染、病毒感染、双重感染和病因不明组。在逻辑回归模型中确定独立预测因素。开发评分系统。通过使用受试者工作特征（ROC）曲线来测试诊断规则的准确性。
145例患者分别被分类为患有细菌感染（n = 35）、病毒感染（n = 49）、双重感染（n = 8）或病因不明的感染（n = 53）。细菌感染的独立预测因素为发热（比值比[OR]=8.0；95%置信区间[CI]=0.9至71.0）、头痛（OR = 4.3；95% CI = 1.0至19.1）、颈部疼痛性淋巴结（OR = 8.7；95% CI = 1.1至68.0）、腹泻（OR = 0.3；95% CI = 0.1至1.0）和鼻炎（OR = 0.3；95% CI = 0.1至0.9）。作为额外的独立预测因素，胸部X线片上的浸润影（OR = 5.0；95% CI = 1.2至20.5）被发现。根据这些变量开发的诊断规则对下呼吸道感染病因的分类，ROC曲线面积分别为0.79（临床评分）、0.77（简化评分）和0.83（扩展评分）。
基于床边易于获取的信息开发了一种诊断规则，用于预测细菌感染。该诊断规则可能是全科医生管理下呼吸道感染患者的一种工具。
