Skip to main content
NCBI home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 2004 Jan;54(498):15–19.

Pathogens involved in lower respiratory tract infections in general practice.

A Willy Graffelman 1, Arie Knuistingh Neven 1, Saskia le Cessie 1, Aloys C M Kroes 1, Machiel P Springer 1, Peterhans J van den Broek 1
PMCID: PMC1314772  PMID: 14965401

Abstract

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.

Full Text

The Full Text of this article is available as a PDF (36.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bohte R., van Furth R., van den Broek P. J. Aetiology of community-acquired pneumonia: a prospective study among adults requiring admission to hospital. Thorax. 1995 May;50(5):543–547. doi: 10.1136/thx.50.5.543. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. El-Solh A. A., Sikka P., Ramadan F., Davies J. Etiology of severe pneumonia in the very elderly. Am J Respir Crit Care Med. 2001 Mar;163(3 Pt 1):645–651. doi: 10.1164/ajrccm.163.3.2005075. [DOI] [PubMed] [Google Scholar]
  3. Graffelman A. Willy, Knuistingh Neven Arie, le Cessie Saskia, Kroes Aloys C. M., Springer Machiel P., van den Broek Peterhans J. A diagnostic rule for the aetiology of lower respiratory tract infections as guidance for antimicrobial treatment. Br J Gen Pract. 2004 Jan;54(498):20–24. [PMC free article] [PubMed] [Google Scholar]
  4. Holmes W. F., Macfarlane J. T., Macfarlane R. M., Hubbard R. Symptoms, signs, and prescribing for acute lower respiratory tract illness. Br J Gen Pract. 2001 Mar;51(464):177–181. [PMC free article] [PubMed] [Google Scholar]
  5. Ieven M., Ursi D., Van Bever H., Quint W., Niesters H. G., Goossens H. Detection of Mycoplasma pneumoniae by two polymerase chain reactions and role of M. pneumoniae in acute respiratory tract infections in pediatric patients. J Infect Dis. 1996 Jun;173(6):1445–1452. doi: 10.1093/infdis/173.6.1445. [DOI] [PubMed] [Google Scholar]
  6. Kelsey M. C., Mitchell C. A., Griffin M., Spencer R. C., Emmerson A. M. Prevalence of lower respiratory tract infections in hospitalized patients in the United Kingdom and Eire--results from the Second National Prevalence Survey. J Hosp Infect. 2000 Sep;46(1):12–22. doi: 10.1053/jhin.2000.0775. [DOI] [PubMed] [Google Scholar]
  7. Macfarlane J. T., Colville A., Guion A., Macfarlane R. M., Rose D. H. Prospective study of aetiology and outcome of adult lower-respiratory-tract infections in the community. Lancet. 1993 Feb 27;341(8844):511–514. doi: 10.1016/0140-6736(93)90275-l. [DOI] [PubMed] [Google Scholar]
  8. Macfarlane J. T., Finch R. G., Ward M. J., Macrae A. D. Hospital study of adult community-acquired pneumonia. Lancet. 1982 Jul 31;2(8292):255–258. doi: 10.1016/s0140-6736(82)90334-8. [DOI] [PubMed] [Google Scholar]
  9. Macfarlane J. T., Miller A. C., Roderick Smith W. H., Morris A. H., Rose D. H. Comparative radiographic features of community acquired Legionnaires' disease, pneumococcal pneumonia, mycoplasma pneumonia, and psittacosis. Thorax. 1984 Jan;39(1):28–33. doi: 10.1136/thx.39.1.28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Macfarlane J., Holmes W., Gard P., Macfarlane R., Rose D., Weston V., Leinonen M., Saikku P., Myint S. Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax. 2001 Feb;56(2):109–114. doi: 10.1136/thorax.56.2.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Melbye H., Berdal B. P., Straume B., Russell H., Vorland L., Thacker W. L. Pneumonia--a clinical or radiographic diagnosis? Etiology and clinical features of lower respiratory tract infection in adults in general practice. Scand J Infect Dis. 1992;24(5):647–655. doi: 10.3109/00365549209054652. [DOI] [PubMed] [Google Scholar]
  12. Ortqvist A. Treatment of community-acquired lower respiratory tract infections in adults. Eur Respir J Suppl. 2002 Jul;36:40s–53s. doi: 10.1183/09031936.02.00309002. [DOI] [PubMed] [Google Scholar]
  13. Raherison C., Peray P., Poirier R., Romand P., Grignet J. P., Arsac P., Taytard A., Daures J. P. Management of lower respiratory tract infections by French general practitioners: the AIR II study. Analyse Infections Respiratoires. Eur Respir J. 2002 Feb;19(2):314–319. doi: 10.1183/09031936.02.00219102. [DOI] [PubMed] [Google Scholar]
  14. Rosón B., Carratalà J., Dorca J., Casanova A., Manresa F., Gudiol F. Etiology, reasons for hospitalization, risk classes, and outcomes of community-acquired pneumonia in patients hospitalized on the basis of conventional admission criteria. Clin Infect Dis. 2001 Jun 15;33(2):158–165. doi: 10.1086/321808. [DOI] [PubMed] [Google Scholar]
  15. Woodhead M. A., Macfarlane J. T., McCracken J. S., Rose D. H., Finch R. G. Prospective study of the aetiology and outcome of pneumonia in the community. Lancet. 1987 Mar 21;1(8534):671–674. doi: 10.1016/s0140-6736(87)90430-2. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES