门诊急性咳嗽：不同病毒和细菌引起的原因、持续时间和严重程度如何？

Acute cough in outpatients: what causes it, how long does it last, and how severe is it for different viruses and bacteria?

机构信息

Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.

Department of Family Medicine, Georgetown University, Washington, DC, USA.

出版信息

Clin Microbiol Infect. 2024 Dec;30(12):1569-1575. doi: 10.1016/j.cmi.2024.06.031. Epub 2024 Jul 6.

DOI:10.1016/j.cmi.2024.06.031

PMID:38977076

Abstract

OBJECTIVES

To describe the symptoms, duration, severity, and microbiology of lower respiratory tract infection (LRTI) in outpatients.

METHODS

Prospective cohort study of adults in US primary or urgent care with a chief complaint of cough and symptoms consistent with LRTI. Baseline data included demographics, signs, symptoms, and PCR for 46 viruses and bacteria. The severity of symptoms reported for ≤28 days follow-up via diary and text message. The Bronchitis severity score assessed severity at baseline; overall severity was defined as the area under the symptom severity curve.

RESULTS

Of 718 patients with complete baseline data, 618 had valid PCR results, and 443 were followed until symptoms resolved. Of those with valid PCR, 100 (16.2%) had 1+ viruses detected, 211 (34.1%) had 1+ bacteria, and 168 (27.2%) had both. Symptoms more likely with viral or mixed infection included feverishness (36.7-38.4% vs. 18.5%), chills or sweats (36.0-38.1% vs. 17.9%), being generally unwell (78.2-81.3% vs. 64.9%), and myalgias (42.7-48.2% vs. 28.6%). Coloured sputum (42.9% vs. 23.2-29.5%) was more common with a bacterial infection. The mean duration of cough was 14.7 days with viruses (95% CI: 13.2-16.2), 17.3 with bacteria (95% CI: 15.9-18.6), 16.9 with mixed infection (95% CI: 15.2-18.6), and 18.4 with no detection (95% CI: 16.1-20.8). Overall severity of cough was lower for viral infections (20.9 points, 95% CI: 18.6-23.3) than for other groups (range 24.2-26.3). The most common potential bacterial pathogens were Haemophilus influenza (28.0%), Moraxella catarrhalis (16.2%), and Streptococcus pneumoniae (10.2%), whereas the most common viral pathogens were rhinovirus (17.3%), influenza (12.8%), SARS-CoV-2 (11.5%), and seasonal coronaviruses (8.1%).

DISCUSSION

The mean duration of cough was 16.4 days. Consistent with European studies, the type of infection or potential pathogen was not an important predictor of the duration or severity of LRTI.

摘要

目的

描述门诊患者下呼吸道感染（LRTI）的症状、持续时间、严重程度和微生物学特征。

方法

对美国初级或紧急护理机构中以咳嗽为主诉且符合 LRTI 症状的成年人进行前瞻性队列研究。基线数据包括人口统计学、体征、症状以及针对 46 种病毒和细菌的聚合酶链反应（PCR）检测结果。通过日记和短信在 ≤28 天的随访期间报告症状的严重程度。采用支气管炎严重程度评分评估基线时的严重程度；总体严重程度定义为症状严重程度曲线下的面积。

结果

在 718 例具有完整基线数据的患者中，618 例具有有效的 PCR 结果，443 例患者随访至症状缓解。在具有有效 PCR 结果的患者中，100 例（16.2%）检测到 1+种病毒，211 例（34.1%）检测到 1+种细菌，168 例（27.2%）同时检测到病毒和细菌。病毒或混合感染更可能出现发热（36.7-38.4% vs. 18.5%）、寒战或出汗（36.0-38.1% vs. 17.9%）、一般不适（78.2-81.3% vs. 64.9%）和肌痛（42.7-48.2% vs. 28.6%）。细菌性感染更常出现带色痰（42.9% vs. 23.2-29.5%）。病毒感染的咳嗽持续时间平均为 14.7 天（95%CI：13.2-16.2），细菌感染为 17.3 天（95%CI：15.9-18.6），混合感染为 16.9 天（95%CI：15.2-18.6），未检测到病原体的患者为 18.4 天（95%CI：16.1-20.8）。病毒感染的咳嗽总体严重程度较低（20.9 分，95%CI：18.6-23.3），低于其他组（范围 24.2-26.3）。最常见的潜在细菌性病原体是流感嗜血杆菌（28.0%）、卡他莫拉菌（16.2%）和肺炎链球菌（10.2%），而最常见的病毒性病原体是鼻病毒（17.3%）、流感病毒（12.8%）、SARS-CoV-2（11.5%）和季节性冠状病毒（8.1%）。