The value of signs and symptoms in differentiating between bacterial, viral and mixed aetiology in patients with community-acquired pneumonia.
Identifieur interne : 000126 ( Main/Curation ); précédent : 000125; suivant : 000127The value of signs and symptoms in differentiating between bacterial, viral and mixed aetiology in patients with community-acquired pneumonia.
Auteurs : Elisabeth G W. Huijskens [Pays-Bas] ; Marion Koopmans [Pays-Bas] ; Fernand M H. Palmen [Pays-Bas] ; Adriana J M. Van Erkel [Pays-Bas] ; Paul G H. Mulder [Pays-Bas] ; John W A. Rossen [Pays-Bas]Source :
- Journal of medical microbiology [ 1473-5644 ] ; 2014.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Analyse multifactorielle (MeSH), Co-infection (MeSH), Diagnostic différentiel (MeSH), Facteurs âges (MeSH), Femelle (MeSH), Humains (MeSH), Indice de gravité de la maladie (MeSH), Infections communautaires (diagnostic), Infections communautaires (microbiologie), Jeune adulte (MeSH), Mâle (MeSH), Pays-Bas (MeSH), Pneumopathie bactérienne (diagnostic), Pneumopathie bactérienne (microbiologie), Pneumopathie virale (diagnostic), Pneumopathie virale (microbiologie), RT-PCR (MeSH), Streptococcus pneumoniae (isolement et purification), Sujet âgé (MeSH), Sujet âgé de 80 ans ou plus (MeSH), Virus de la grippe A (isolement et purification), Études prospectives (MeSH).
- MESH :
- diagnostic : Infections communautaires, Pneumopathie bactérienne, Pneumopathie virale.
- isolement et purification : Streptococcus pneumoniae, Virus de la grippe A.
- microbiologie : Infections communautaires, Pneumopathie bactérienne, Pneumopathie virale.
- Adulte, Adulte d'âge moyen, Analyse multifactorielle, Co-infection, Diagnostic différentiel, Facteurs âges, Femelle, Humains, Indice de gravité de la maladie, Jeune adulte, Mâle, Pays-Bas, RT-PCR, Sujet âgé, Sujet âgé de 80 ans ou plus, Études prospectives.
- Wicri :
- geographic : Pays-Bas.
English descriptors
- KwdEn :
- Adult (MeSH), Age Factors (MeSH), Aged (MeSH), Aged, 80 and over (MeSH), Coinfection (MeSH), Community-Acquired Infections (diagnosis), Community-Acquired Infections (microbiology), Diagnosis, Differential (MeSH), Female (MeSH), Humans (MeSH), Influenza A virus (isolation & purification), Male (MeSH), Middle Aged (MeSH), Multivariate Analysis (MeSH), Netherlands (MeSH), Pneumonia, Bacterial (diagnosis), Pneumonia, Bacterial (microbiology), Pneumonia, Viral (diagnosis), Pneumonia, Viral (microbiology), Prospective Studies (MeSH), Reverse Transcriptase Polymerase Chain Reaction (MeSH), Severity of Illness Index (MeSH), Streptococcus pneumoniae (isolation & purification), Young Adult (MeSH).
- MESH :
- geographic : Netherlands.
- diagnosis : Community-Acquired Infections, Pneumonia, Bacterial, Pneumonia, Viral.
- isolation & purification : Influenza A virus, Streptococcus pneumoniae.
- microbiology : Community-Acquired Infections, Pneumonia, Bacterial, Pneumonia, Viral.
- Adult, Age Factors, Aged, Aged, 80 and over, Coinfection, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Multivariate Analysis, Prospective Studies, Reverse Transcriptase Polymerase Chain Reaction, Severity of Illness Index, Young Adult.
Abstract
Current diagnostics for community-acquired pneumonia (CAP) include testing for a wide range of pathogens, which is costly and not always informative. We compared clinical and laboratory parameters of patients with CAP caused by different groups of pathogens to evaluate the potential for targeted diagnostics and directed treatment. In a prospective study, conducted between April 2008 and April 2009, adult patients with CAP were tested for the presence of a broad range of possible respiratory pathogens using bacterial cultures, PCR, urinary antigen testing and serology. Of 408 patients with CAP, pathogens were detected in 263 patients (64.5%). Streptococcus pneumoniae and influenza A virus were the most frequently identified bacterial and viral pathogens, respectively. Age had a significant effect on the prediction of aetiology (P = 0.054), with an increase in the relative contribution of viruses with advancing age. Multivariate analyses further showed that the presence of cough increased the likelihood of detecting a viral pathogen [odds ratio (OR) 5.536, 95% confidence interval (CI) 2.130-14.390], the presence of immunodeficiency decreased the likelihood of detecting a bacterial pathogen (OR 0.595, 95 % CI 0.246-1.437) and an increase in pneumonia severity index score increased the likelihood of detecting a pathogen in general. Although several variables were independently associated with the detection of a pathogen group, substantial overlap meant there were no reliable clinical predictors to distinguish aetiologies. Therefore, testing for common respiratory pathogens is still necessary to optimize treatment.
DOI: 10.1099/jmm.0.067108-0
PubMed: 24344207
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Huijskens</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medical Microbiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.</nlm:affiliation><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Department of Medical Microbiology, Albert Schweitzer Hospital, Dordrecht</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:affiliation>Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, the Netherlands.</nlm:affiliation><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg</wicri:regionArea></affiliation></author><author><name sortKey="Koopmans, Marion" sort="Koopmans, Marion" uniqKey="Koopmans M" first="Marion" last="Koopmans">Marion Koopmans</name><affiliation wicri:level="1"><nlm:affiliation>National Institute of Public Health and the Environment, RIVM, Bilthoven, the Netherlands.</nlm:affiliation><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>National Institute of Public Health and the Environment, RIVM, Bilthoven</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:affiliation>Department of Virology, Erasmus Medical Centre, Rotterdam, the Netherlands.</nlm:affiliation><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Department of Virology, Erasmus Medical Centre, Rotterdam</wicri:regionArea></affiliation></author><author><name sortKey="Palmen, Fernand M H" sort="Palmen, Fernand M H" uniqKey="Palmen F" first="Fernand M H" last="Palmen">Fernand M H. 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Van Erkel</name><affiliation wicri:level="1"><nlm:affiliation>Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, the Netherlands.</nlm:affiliation><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg</wicri:regionArea></affiliation></author><author><name sortKey="Mulder, Paul G H" sort="Mulder, Paul G H" uniqKey="Mulder P" first="Paul G H" last="Mulder">Paul G H. Mulder</name><affiliation wicri:level="1"><nlm:affiliation>Amphia Academy, Amphia Hospital, Breda, the Netherlands.</nlm:affiliation><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Amphia Academy, Amphia Hospital, Breda</wicri:regionArea></affiliation></author><author><name sortKey="Rossen, John W A" sort="Rossen, John W A" uniqKey="Rossen J" first="John W A" last="Rossen">John W A. Rossen</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.</nlm:affiliation><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:affiliation>Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, the Netherlands.</nlm:affiliation><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg</wicri:regionArea></affiliation></author></analytic><series><title level="j">Journal of medical microbiology</title><idno type="eISSN">1473-5644</idno><imprint><date when="2014" type="published">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Age Factors (MeSH)</term><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Coinfection (MeSH)</term><term>Community-Acquired Infections (diagnosis)</term><term>Community-Acquired Infections (microbiology)</term><term>Diagnosis, Differential (MeSH)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Influenza A virus (isolation & purification)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Multivariate Analysis (MeSH)</term><term>Netherlands (MeSH)</term><term>Pneumonia, Bacterial (diagnosis)</term><term>Pneumonia, Bacterial (microbiology)</term><term>Pneumonia, Viral (diagnosis)</term><term>Pneumonia, Viral (microbiology)</term><term>Prospective Studies (MeSH)</term><term>Reverse Transcriptase Polymerase Chain Reaction (MeSH)</term><term>Severity of Illness Index (MeSH)</term><term>Streptococcus pneumoniae (isolation & purification)</term><term>Young Adult (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Analyse multifactorielle (MeSH)</term><term>Co-infection (MeSH)</term><term>Diagnostic différentiel (MeSH)</term><term>Facteurs âges (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Indice de gravité de la maladie (MeSH)</term><term>Infections communautaires (diagnostic)</term><term>Infections communautaires (microbiologie)</term><term>Jeune adulte (MeSH)</term><term>Mâle (MeSH)</term><term>Pays-Bas (MeSH)</term><term>Pneumopathie bactérienne (diagnostic)</term><term>Pneumopathie bactérienne (microbiologie)</term><term>Pneumopathie virale (diagnostic)</term><term>Pneumopathie virale (microbiologie)</term><term>RT-PCR (MeSH)</term><term>Streptococcus pneumoniae (isolement et purification)</term><term>Sujet âgé (MeSH)</term><term>Sujet âgé de 80 ans ou plus (MeSH)</term><term>Virus de la grippe A (isolement et purification)</term><term>Études prospectives (MeSH)</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Netherlands</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Community-Acquired Infections</term><term>Pneumonia, Bacterial</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Infections communautaires</term><term>Pneumopathie bactérienne</term><term>Pneumopathie virale</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>Influenza A virus</term><term>Streptococcus pneumoniae</term></keywords><keywords scheme="MESH" qualifier="isolement et purification" xml:lang="fr"><term>Streptococcus pneumoniae</term><term>Virus de la grippe A</term></keywords><keywords scheme="MESH" qualifier="microbiologie" xml:lang="fr"><term>Infections communautaires</term><term>Pneumopathie bactérienne</term><term>Pneumopathie virale</term></keywords><keywords scheme="MESH" qualifier="microbiology" xml:lang="en"><term>Community-Acquired Infections</term><term>Pneumonia, Bacterial</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Age Factors</term><term>Aged</term><term>Aged, 80 and over</term><term>Coinfection</term><term>Diagnosis, Differential</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Multivariate Analysis</term><term>Prospective Studies</term><term>Reverse Transcriptase Polymerase Chain Reaction</term><term>Severity of Illness Index</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse multifactorielle</term><term>Co-infection</term><term>Diagnostic différentiel</term><term>Facteurs âges</term><term>Femelle</term><term>Humains</term><term>Indice de gravité de la maladie</term><term>Jeune adulte</term><term>Mâle</term><term>Pays-Bas</term><term>RT-PCR</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Études prospectives</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Pays-Bas</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Current diagnostics for community-acquired pneumonia (CAP) include testing for a wide range of pathogens, which is costly and not always informative. We compared clinical and laboratory parameters of patients with CAP caused by different groups of pathogens to evaluate the potential for targeted diagnostics and directed treatment. In a prospective study, conducted between April 2008 and April 2009, adult patients with CAP were tested for the presence of a broad range of possible respiratory pathogens using bacterial cultures, PCR, urinary antigen testing and serology. Of 408 patients with CAP, pathogens were detected in 263 patients (64.5%). Streptococcus pneumoniae and influenza A virus were the most frequently identified bacterial and viral pathogens, respectively. Age had a significant effect on the prediction of aetiology (P = 0.054), with an increase in the relative contribution of viruses with advancing age. Multivariate analyses further showed that the presence of cough increased the likelihood of detecting a viral pathogen [odds ratio (OR) 5.536, 95% confidence interval (CI) 2.130-14.390], the presence of immunodeficiency decreased the likelihood of detecting a bacterial pathogen (OR 0.595, 95 % CI 0.246-1.437) and an increase in pneumonia severity index score increased the likelihood of detecting a pathogen in general. Although several variables were independently associated with the detection of a pathogen group, substantial overlap meant there were no reliable clinical predictors to distinguish aetiologies. Therefore, testing for common respiratory pathogens is still necessary to optimize treatment.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">24344207</PMID><DateCompleted><Year>2014</Year><Month>04</Month><Day>24</Day></DateCompleted><DateRevised><Year>2020</Year><Month>03</Month><Day>04</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1473-5644</ISSN><JournalIssue CitedMedium="Internet"><Volume>63</Volume><Issue>Pt 3</Issue><PubDate><Year>2014</Year><Month>Mar</Month></PubDate></JournalIssue><Title>Journal of medical microbiology</Title><ISOAbbreviation>J. Med. Microbiol.</ISOAbbreviation></Journal><ArticleTitle>The value of signs and symptoms in differentiating between bacterial, viral and mixed aetiology in patients with community-acquired pneumonia.</ArticleTitle><Pagination><MedlinePgn>441-452</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1099/jmm.0.067108-0</ELocationID><Abstract><AbstractText>Current diagnostics for community-acquired pneumonia (CAP) include testing for a wide range of pathogens, which is costly and not always informative. We compared clinical and laboratory parameters of patients with CAP caused by different groups of pathogens to evaluate the potential for targeted diagnostics and directed treatment. In a prospective study, conducted between April 2008 and April 2009, adult patients with CAP were tested for the presence of a broad range of possible respiratory pathogens using bacterial cultures, PCR, urinary antigen testing and serology. Of 408 patients with CAP, pathogens were detected in 263 patients (64.5%). Streptococcus pneumoniae and influenza A virus were the most frequently identified bacterial and viral pathogens, respectively. Age had a significant effect on the prediction of aetiology (P = 0.054), with an increase in the relative contribution of viruses with advancing age. Multivariate analyses further showed that the presence of cough increased the likelihood of detecting a viral pathogen [odds ratio (OR) 5.536, 95% confidence interval (CI) 2.130-14.390], the presence of immunodeficiency decreased the likelihood of detecting a bacterial pathogen (OR 0.595, 95 % CI 0.246-1.437) and an increase in pneumonia severity index score increased the likelihood of detecting a pathogen in general. Although several variables were independently associated with the detection of a pathogen group, substantial overlap meant there were no reliable clinical predictors to distinguish aetiologies. Therefore, testing for common respiratory pathogens is still necessary to optimize treatment.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Huijskens</LastName><ForeName>Elisabeth G W</ForeName><Initials>EGW</Initials><AffiliationInfo><Affiliation>Department of Medical Microbiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, the Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Koopmans</LastName><ForeName>Marion</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>National Institute of Public Health and the Environment, RIVM, Bilthoven, the Netherlands.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Virology, Erasmus Medical Centre, Rotterdam, the Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Palmen</LastName><ForeName>Fernand M H</ForeName><Initials>FMH</Initials><AffiliationInfo><Affiliation>Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, the Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>van Erkel</LastName><ForeName>Adriana J M</ForeName><Initials>AJM</Initials><AffiliationInfo><Affiliation>Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, the Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mulder</LastName><ForeName>Paul G H</ForeName><Initials>PGH</Initials><AffiliationInfo><Affiliation>Amphia Academy, Amphia Hospital, Breda, the Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rossen</LastName><ForeName>John W A</ForeName><Initials>JWA</Initials><AffiliationInfo><Affiliation>Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, the Netherlands.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2013</Year><Month>12</Month><Day>16</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>J Med Microbiol</MedlineTA><NlmUniqueID>0224131</NlmUniqueID><ISSNLinking>0022-2615</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000367" MajorTopicYN="N">Age Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D060085" MajorTopicYN="N">Coinfection</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017714" MajorTopicYN="N">Community-Acquired Infections</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003937" MajorTopicYN="N">Diagnosis, Differential</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009980" MajorTopicYN="N">Influenza A virus</DescriptorName><QualifierName UI="Q000302" MajorTopicYN="Y">isolation & purification</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015999" MajorTopicYN="N">Multivariate Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009426" MajorTopicYN="N" Type="Geographic">Netherlands</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018410" MajorTopicYN="N">Pneumonia, Bacterial</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020133" MajorTopicYN="N">Reverse Transcriptase Polymerase Chain Reaction</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012720" MajorTopicYN="N">Severity of Illness Index</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013296" MajorTopicYN="N">Streptococcus pneumoniae</DescriptorName><QualifierName UI="Q000302" MajorTopicYN="Y">isolation & purification</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2013</Year><Month>12</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2013</Year><Month>12</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate 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