Hopstaken R M, Stobberingh E E, Knottnerus J A, Muris J W M, Nelemans P, Rinkens P E L M, Dinant G J
Department of General Practice, Maastricht University, Care and Public Health Research Institute, PO Box 616, Maastricht 6200 MD, The Netherlands.
J Clin Epidemiol. 2005 Feb;58(2):175-83. 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.
如果能在临床上区分病毒和细菌引起的下呼吸道感染（LRTI），那么不正确且不必要的抗生素处方（这会提高细菌耐药率）可能会减少。人们常常怀疑这是否可行，但在全科医疗中对此进行的研究很少。
这是一项在荷兰15家全科医疗诊所进行的观察性队列研究。
在234例有完整数据的患者中，112例（48%）获得了病因诊断。发现病毒病原体和细菌病原体的频率相同。最常发现的是（副）流感嗜血杆菌。没有任何症状和体征与病毒或细菌引起的LRTI有统计学上的显著相关性。与微生物学上无法解释的LRTI相比，红细胞沉降率>50（比值比[OR]2.3 - 3.3）和C反应蛋白（CRP）>20（OR 2.1 - 4.6）是病毒引起的LRTI和细菌引起的LRTI的独立预测因素。
在日常全科医疗中，详细的病史采集和体格检查并未提供能够预测成年患者病毒或细菌引起的LRTI的指标。我们无法证实CRP可用于区分病毒和细菌引起的LRTI。
