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Pathogens involved in lower respiratory tract infections in general practice
A Willy Graffelman1, Arie Knuistingh Neven, Saskia le Cessie
1Department of General Practice and Nursing Home Medicine, Leiden University Medical Center, Leiden, The Netherlands. a.w.graffelman@lumc.nl
Background:
There are few investigations into the aetiology of lower respiratory tract infections (LRTIs) in general practice.
Aim:
To describe the aetiology of LRTI among adult patients in general practice in The Netherlands.
Design Of Study:
Prospective observational study.
Setting:
General practices in the Leiden region, The Netherlands.
Method:
Adult patients with a defined LRTI were included. Standard medical history and physical examination were performed. Sputum, blood and throat swabs were collected for diagnostic tests. Aetiological diagnosis, categorised as definite or possible, was based on the results of bacterial and viral cultures, serological techniques, and on polymerase chain reaction. Proportions of pathogens causing LRTI were assessed in relation to chest X-ray findings.
Results:
A bacterial cause was established in 43 (30%), and a viral cause in 57 (39%) of the 145 patients with a LRTI. Influenza virus A was the most frequently diagnosed microorganism, followed by Haemophilus influenzae, and Mycoplasma pneumoniae. Streptococcus pneumoniae was found in 6% of the patients.
Conclusions:
Pathogens were found in two-thirds of the patients. In half of these patients there was a viral cause. Influenza virus A was the most frequently found pathogen. The treatment with antibiotics of at least one-third of the patients with LRTI was superfluous. This observation should result in changes in the prescription of antibiotics in LRTI.