Suzuki Satoshi, Ishimaru Naoto, Akashi Yusaku, Takeuchi Yuto, Ueda Atsuo, Ushiki Akihito, Kinami Saori, Suzuki Hiromichi, Tokuda Yasuharu, Maeno Tetsuhiro
Division of General Medicine Tone Chuo Hospital Gunma Japan.
Department of General Internal Medicine Akashi Medical Center Japan.
J Gen Fam Med. 2020 Jun 25;21(6):226-234. doi: 10.1002/jgf2.350. eCollection 2020 Nov.
Patients with acute respiratory tract infections are frequently prescribed antimicrobials despite high rates of virus detection. Physicians may overprescribe antimicrobials owing to the concern of bacterial infections, including those because of atypical pathogens. We investigated the accuracy of clinical predictions concerning atypical pathogen infections.
We prospectively enrolled adult patients who presented with a fever and cough in outpatient clinics between December 2016 and August 2018. After taking a history and performing physical examinations, physicians predicted the possibility of respiratory infections because of atypical pathogens. Disease probabilities were categorized into 3 grades (high: ≥50%, intermediate: 20% ≥ and <50%, and low: <20%) and were judged by physicians who were taking care of the patients. Confirmation of atypical pathogens was performed by comprehensive molecular analyses of respiratory samples.
Atypical pathogens were detected in 21 of 210 patients. A close contact history (odds ratio [OR]: 11.4, 95% confidence interval [CI]: 2.4-53.5) and the presence of pneumonia (OR: 12.9, CI: 4.3-39.2) were associated with the detections. Atypical pathogens were detected in 32.3% of high-probability cases (10/31), while atypical pathogens were only detected in 8.8% of intermediate-probability cases (8/91) and 3.4% of low-probability cases (3/88) ( < .001).
The current study indicates that physicians' predictions were associated with the detection of atypical pathogens; however, overestimation was observed.
尽管病毒检测率很高，但急性呼吸道感染患者仍经常被开具抗菌药物。由于担心细菌感染，包括非典型病原体引起的感染，医生可能会过度开具抗菌药物。我们调查了关于非典型病原体感染的临床预测准确性。
我们前瞻性纳入了2016年12月至2018年8月在门诊出现发热和咳嗽的成年患者。在采集病史和进行体格检查后，医生预测非典型病原体引起呼吸道感染的可能性。疾病概率分为3级（高：≥50%，中：20%≥且<50%，低：<20%），由负责照顾患者的医生进行判断。通过对呼吸道样本进行综合分子分析来确认非典型病原体。
210例患者中有21例检测到非典型病原体。密切接触史（优势比[OR]：11.4，95%置信区间[CI]：2.4 - 53.5）和肺炎的存在（OR：12.9，CI：4.3 - 39.2）与检测结果相关。高概率病例中有32.3%（10/31）检测到非典型病原体，而中概率病例中仅8.8%（8/91）检测到，低概率病例中为3.4%（3/88）（<0.001）。
当前研究表明医生的预测与非典型病原体的检测相关；然而，存在高估现象。
