Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: secondary analysis of a multicentre European trial
<strong>Background:</strong> The impact of antimicrobial resistance on clinical outcomes in patients with lower respiratory tract infection in primary care is largely unknown. <strong>Aim:</strong> To determine the illness course of infections with resistant bacteria in adu...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Journal article |
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Royal College of General Practitioners
2018
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| _version_ | 1826295744490897408 |
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| author | Teepe, J Broekhuizen, B Goossens, H Hordijk, P Loens, K Lammens, C Ieven, M Little, P Butler, C Coenen, S Godycki-Cwirko, M Henriques-Normark, B Verheij, T |
| author_facet | Teepe, J Broekhuizen, B Goossens, H Hordijk, P Loens, K Lammens, C Ieven, M Little, P Butler, C Coenen, S Godycki-Cwirko, M Henriques-Normark, B Verheij, T |
| author_sort | Teepe, J |
| collection | OXFORD |
| description | <strong>Background:</strong> The impact of antimicrobial resistance on clinical outcomes in patients with lower respiratory tract infection in primary care is largely unknown. <strong>Aim:</strong> To determine the illness course of infections with resistant bacteria in adults presenting to primary care with acute cough. <strong>Design and setting:</strong> Secondary analysis of a multicentre European trial in primary care. <strong>Method:</strong> 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. <strong>Results:</strong> 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. <strong>Conclusion:</strong> The illness course of antibiotic-resistant lower respiratory tract infection does not differ from that caused by antibiotic-sensitive bacteria. |
| first_indexed | 2024-03-07T04:05:46Z |
| format | Journal article |
| id | oxford-uuid:c6181f84-bc85-4031-a26c-949cb048398a |
| institution | University of Oxford |
| last_indexed | 2024-03-07T04:05:46Z |
| publishDate | 2018 |
| publisher | Royal College of General Practitioners |
| record_format | dspace |
| spelling | oxford-uuid:c6181f84-bc85-4031-a26c-949cb048398a2022-03-27T06:35:48ZClinical relevance of bacterial resistance in lower respiratory tract infection in primary care: secondary analysis of a multicentre European trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:c6181f84-bc85-4031-a26c-949cb048398aSymplectic Elements at OxfordRoyal College of General Practitioners2018Teepe, JBroekhuizen, BGoossens, HHordijk, PLoens, KLammens, CIeven, MLittle, PButler, CCoenen, SGodycki-Cwirko, MHenriques-Normark, BVerheij, T<strong>Background:</strong> The impact of antimicrobial resistance on clinical outcomes in patients with lower respiratory tract infection in primary care is largely unknown. <strong>Aim:</strong> To determine the illness course of infections with resistant bacteria in adults presenting to primary care with acute cough. <strong>Design and setting:</strong> Secondary analysis of a multicentre European trial in primary care. <strong>Method:</strong> 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. <strong>Results:</strong> 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. <strong>Conclusion:</strong> The illness course of antibiotic-resistant lower respiratory tract infection does not differ from that caused by antibiotic-sensitive bacteria. |
| spellingShingle | Teepe, J Broekhuizen, B Goossens, H Hordijk, P Loens, K Lammens, C Ieven, M Little, P Butler, C Coenen, S Godycki-Cwirko, M Henriques-Normark, B Verheij, T Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: secondary analysis of a multicentre European trial |
| title | Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: secondary analysis of a multicentre European trial |
| title_full | Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: secondary analysis of a multicentre European trial |
| title_fullStr | Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: secondary analysis of a multicentre European trial |
| title_full_unstemmed | Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: secondary analysis of a multicentre European trial |
| title_short | Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: secondary analysis of a multicentre European trial |
| title_sort | clinical relevance of bacterial resistance in lower respiratory tract infection in primary care secondary analysis of a multicentre european trial |
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