Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: secondary analysis of a multicentre European trial.

Autor:	Teepe J; Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands., Broekhuizen BD; Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands., Goossens H; Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium., Hordijk PM; Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands., Loens K; Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium., Lammens C; Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium., Ieven M; Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium., Little P; Department of Primary Care and Population Sciences, University of Southampton Medical School, Southampton, UK., Butler CC; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK., Coenen S; Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, and Centre for General Practice, Department of Primary and Interdisciplinary Care (ELIZA) Antwerp, University of Antwerp, Antwerp, Belgium., Godycki-Cwirko M; Department of Family and Community Medicine, Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland., Henriques-Normark B; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Clinical Microbiology, Karolinska University Hospital, and the Swedish Institute for Infectious Disease Control, Stockholm, Sweden., Verheij TJ; Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
Jazyk:	angličtina
Zdroj:	The British journal of general practice : the journal of the Royal College of General Practitioners [Br J Gen Pract] 2018 Sep; Vol. 68 (674), pp. e627-e632. Date of Electronic Publication: 2018 Jul 30.
DOI:	10.3399/bjgp18X698333
Abstrakt:	Background: The impact of antimicrobial resistance on clinical outcomes in patients with lower respiratory tract infection in primary care is largely unknown. Aim: To determine the illness course of infections with resistant bacteria in adults presenting to primary care with acute cough. Design and Setting: Secondary analysis of a multicentre European trial in primary care. Method: A total of 2061 adults with acute cough (lasting ≤28 days) were recruited from primary care and randomised to amoxicillin or placebo. To reflect the natural course of disease, only patients in the placebo group ( n = 1021) were eligible. Nasopharyngeal flocked swabs and/or sputa (when available) were analysed at baseline and Streptococcus pneumoniae and Haemophilus influenzae isolates underwent susceptibility testing. Patients recorded their symptoms in a diary every day for 4 weeks. Patients with and without resistant bacterial infection were compared with regards to symptom severity, duration of symptoms, worsening of illness, and duration of interference with normal activities or work. Results: Of the 834 patients with diary records, 104 showed S. pneumoniae and/or H. influenzae infection. Of this number, 54 (52%) were resistant to antibiotics, while seven (7%) were resistant to penicillin. For the duration of symptoms rated 'moderately bad or worse' (hazard ratio 1.27, 95% confidence interval [CI] = 0.67 to 2.44), mean symptom severity (difference -0.48, 95% CI = -1.17 to 0.21), and worsening of illness (odds ratio 0.31, 95% CI = 0.07 to 1.41), there was no statistically significant difference between the antibiotic-resistant and antibiotic-sensitive groups. Conclusion: The illness course of antibiotic-resistant lower respiratory tract infection does not differ from that caused by antibiotic-sensitive bacteria. (© British Journal of General Practice 2018.)
Databáze:	MEDLINE
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