Teepe Jolien, Broekhuizen Berna D L, Loens Katherine, Lammens Christine, Ieven Margareta, Goossens Herman, Little Paul, Butler Christopher C, Coenen Samuel, Godycki-Cwirko Maciek, Verheij Theo
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
Ann Fam Med. 2016 Nov;14(6):534-539. doi: 10.1370/afm.1974.
Bacterial pathogens are assumed to cause an illness course different from that of nonbacterial causes of acute cough, but evidence is lacking. We evaluated the disease course of lower respiratory tract infection (LRTI) with a bacterial cause in adults with acute cough.
We conducted a secondary analysis of a multicenter European trial in which 2,061 adults with acute cough (28 days' duration or less) were recruited from primary care and randomized to amoxicillin or placebo. For this analysis only patients in the placebo group (n = 1,021) were included, reflecting the natural course of disease. Standardized microbiological and serological analyses were performed at baseline to define a bacterial cause. All patients recorded symptoms in a diary for 4 weeks. The disease course between those with and without a bacterial cause was compared by symptom severity in days 2 to 4, duration of symptoms rated moderately bad or worse, and a return consultation.
Of 1,021 eligible patients, 187 were excluded for missing diary records, leaving 834 patients, of whom 162 had bacterial LRTI. Patients with bacterial LRTI had worse symptoms at day 2 to 4 after the first office visit ( = .014) and returned more often for a second consultation, 27% vs 17%, than those without bacterial LRTI ( = .004). Resolution of symptoms rated moderately bad or worse did not differ ( = .375).
Patients with acute bacterial LRTI have a slightly worse course of disease when compared with those without an identified bacterial cause, but the relevance of this difference is not meaningful.
一般认为细菌性病原体导致的病程与非细菌性急性咳嗽病因不同，但缺乏相关证据。我们评估了成人急性咳嗽由细菌引起的下呼吸道感染（LRTI）的病程。
我们对一项欧洲多中心试验进行了二次分析，该试验从初级保健机构招募了2061名急性咳嗽（持续时间28天或更短）的成人，并将其随机分为阿莫西林组或安慰剂组。本次分析仅纳入安慰剂组的患者（n = 1021），以反映疾病的自然病程。在基线时进行标准化的微生物学和血清学分析以确定细菌病因。所有患者在日记中记录症状，为期4周。通过第2至4天的症状严重程度、中度或更严重症状的持续时间以及复诊情况，比较有细菌病因和无细菌病因患者的病程。
在1021名符合条件的患者中，187名因日记记录缺失而被排除，剩余834名患者，其中162名患有细菌性LRTI。与无细菌性LRTI的患者相比，细菌性LRTI患者在首次就诊后的第2至4天症状更严重（P = 0.014），复诊的频率更高，分别为27%和17%（P = 0.004）。中度或更严重症状的缓解情况无差异（P = 0.375）。
与未明确细菌病因的患者相比，急性细菌性LRTI患者的病程略差，但这种差异的相关性不大。
