TY - JOUR
T1 - Clinical presentation, microbiological aetiology and disease course in patients with flu-like illness
T2 - a post hoc analysis of randomised controlled trial data
AU - Verheij, Theo
AU - Cianci, Daniela
AU - van der Velden, Alike
AU - Butler, Christopher C
AU - Bongard, Emily
AU - Coenen, Samuel
AU - Colliers, Annelies
AU - Francis, Nick
AU - Little, Paul
AU - Godycki-Cwirko, Maciek
AU - Llor, Carl
AU - Chlabicz, Slawomir
AU - Lionis, Christos
AU - Sundvall, Pär-Daniel
AU - Bjerrum, Lars
AU - De Sutter, An
AU - Aabenhus, Rune
AU - Jonassen Harbin, Nicolay
AU - Lindbaek, Morten
AU - Glinz, Dominik
AU - Bucher, Heiner
AU - Kovacs, Bernadett
AU - Seifert, Bohumil
AU - Radzeviciene JUrgute, Ruta
AU - Touboul Lundgren, Pia
AU - de Paor, Muireann
AU - Matheeussen, Veerle
AU - Goossens, Herman
AU - Ieven, Margareta
N1 - Funding Information:
Christopher C Butler reports grants from the National Institute for Health Research (NIHR) Health as NIHR Senior Investigator, grants from the NIHR Health Technology Assessment Programme to support the study, grants from NIHR Health Protection Research Unit on Health Care Associated Infections and Antimicrobial Resistance, grants from NIHR Health for the MedTech and In Vitro Diagnostics Cooperative for innovative diagnostics and monitoring technology to enhance community health care during the conduct of the study, personal fees from Pfizer and Roche Molecular Systems, and grants from Roche Molecular Diagnostics. Alike W van der Velden reports personal fees from Reckitt Benckiser. Christos Lionis reports grants from Abbott Diagnostics. Heiner C Bucher or his Institute has received, in the 36 months before the submission of this manuscript, grants, support for travelling, consultancy fees, and honoraria from Gilead, Bristol Myers Squibb, ViiV Healthcare, Idorsia, and Roche, outside the submitted work. He serves as the President of the Association Contre le HIV et Autres Infections Transmissibles. In this function he has received support from the Swiss HIV Cohort Study from ViiV Healthcare, Gilead, Bristol Myers Squibb, Merck Sharp & Dohme, and AbbVie. Theo J Verheij reports grants from the NIHR, Netherlands Organization of Health Research and Development, and the EU Innovative Medicines Initiative, which has Janssen Pharmaceuticals, Biocartis, bioMérieux, and Berry Consultants as partners, all outside the submitted work. All other authors have declared no competing interests.
Publisher Copyright:
© 2022 Royal College of General Practitioners. All rights reserved.
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - Diagnosis
KW - Oseltamivir
KW - Primary health care
KW - Randomised controlled trial
KW - Respiratory tract infections
UR - http://www.scopus.com/inward/record.url?scp=85125290317&partnerID=8YFLogxK
U2 - 10.3399/BJGP.2021.0344
DO - 10.3399/BJGP.2021.0344
M3 - Review article
C2 - 34990385
SN - 0960-1643
VL - 72
SP - e217-e224
JO - The British journal of general practice : the journal of the Royal College of General Practitioners
JF - The British journal of general practice : the journal of the Royal College of General Practitioners
IS - 716
ER -