Clinical presentation, microbiological aetiology and disease course in patients with flu-like illness: a post hoc analysis of randomised controlled trial data.

Autor:	Verheij TJ; Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands., Cianci D; Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands., van der Velden AW; Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands., Butler CC; Nuffield Department of Primary Care, University of Oxford Medical Sciences Division, Oxford, UK., Bongard E; Nuffield Department of Primary Care, University of Oxford Medical Sciences Division, Oxford, UK., Coenen S; Department of Primary and Interdisciplinary Care (ELIZA) - Centre for General Practice, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp, Belgium., Colliers A; Department of Primary and Interdisciplinary Care (ELIZA) - Centre for General Practice, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp, Belgium., Francis NA; Primary Care and Population Sciences, University of Southampton, Southampton, UK., Little P; Primary Care and Population Sciences, University of Southampton, Southampton, UK., Godycki-Cwirko M; Division of Public Health, Centre for Family and Community Medicine, Medical University of Lodz, Lodz, Poland., Llor C; University of Copenhagen, Copenhagen, Denmark; University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain., Chlabicz S; Department of Family Medicine, Medical University of Bialystok, Bialystok, Poland., Lionis C; Clinic of Social and Family Medicine, University of Crete School of Medicine, Heraklion, Greece., Sundvall PD; Research and Development Primary Health Care, Västra Götalandsregionen, University of Gothenburg; Sahlgrenska Academy, Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Gothenburg, Sweden., Bjerrum L; University of Copenhagen, Copenhagen, Denmark., De Sutter A; Department of Public Health and Primary Care, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium., Aabenhus R; University of Copenhagen, Copenhagen, Denmark., Harbin NJ; Antibiotic Center for Primary Care, Department of General Practice, Faculty of Medicine, University of Oslo, Oslo, Norway., Lindbæk M; Antibiotic Center for Primary Care, Department of General Practice, Faculty of Medicine, University of Oslo, Oslo, Norway., Glinz D; Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland., Bucher HC; Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland., Kovács B; Drug Research Center, Balatonfüred, Hungary., Seifert B; Department of General Practice, Charles University, Prague, Czech Republic., Jurgute RR; JSC Mano Seimos Gydytojas, Klaipeda, Lithuania., Lundgren PT; Départment de Santé Publique, Université Côte d'Azur Faculté de Médecine, Nice, France., de Paor M; Royal College of Surgeons in Ireland, Dublin, Ireland., Matheeussen V; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute, University Hospital Antwerp, Antwerp, Belgium., Goossens H; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute, University Hospital Antwerp, Antwerp, Belgium., Ieven M; Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute, University Hospital Antwerp, Antwerp, Belgium.
Jazyk:	angličtina
Zdroj:	The British journal of general practice : the journal of the Royal College of General Practitioners [Br J Gen Pract] 2022 Feb 24; Vol. 72 (716), pp. e217-e224. Date of Electronic Publication: 2022 Feb 24 (Print Publication: 2022).
DOI:	10.3399/BJGP.2021.0344
Abstrakt:	Background: There is little evidence about the relationship between aetiology, illness severity, and clinical course of respiratory tract infections (RTIs) in primary care. Understanding these associations would aid in the development of effective management strategies for these infections. Aim: To investigate whether clinical presentation and illness course differ between RTIs where a viral pathogen was detected and those where a potential bacterial pathogen was found. Design and Setting: Post hoc analysis of data from a pragmatic randomised trial on the effects of oseltamivir in patients with flu-like illness in primary care ( n = 3266) in 15 European countries. Method: Patient characteristics and their signs and symptoms of disease were registered at baseline. Nasopharyngeal (adults) or nasal and pharyngeal (children) swabs were taken for polymerase chain reaction analysis. Patients were followed up until 28 days after inclusion. Regression models and Kaplan-Meier curves were used to analyse the relationship between aetiology, clinical presentation at baseline, and course of disease including complications. Results: Except for a less prominent congested nose (odds ratio [OR] 0.55, 95% confidence interval [CI] = 0.35 to 0.86) and acute cough (OR 0.42, 95% CI = 0.27 to 0.65) in patients with flu-like illness in whom a possible bacterial pathogen was isolated, there were no clear clinical differences in presentations between those with a possible bacterial aetiology compared with those with a viral aetiology. Also, course of disease and complications were not related to aetiology. Conclusion: Given current available microbiological tests and antimicrobial treatments, and outside pandemics such as COVID-19, microbiological testing in primary care patients with flu-like illness seems to have limited value. A wait-and-see policy in most of these patients with flu-like illness seems the best option. (© The Authors.)
Databáze:	MEDLINE
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