Suchergebnisse

While most cases of acute cough are self-limiting, antibiotics are prescribed to over 50%. This proportion is inappropriately high given that benefit from treatment with amoxicillin could only be demonstrated in adults with pneumonia (based on chest radiograph) or combined viral-bacterial infection (based on modern microbiological methodology). As routine use of chest radiographs and microbiological testing is costly, clinical prediction rules could be used to identify these patient subsets. In this secondary analysis of data from a multicentre randomised controlled trial in adults presenting to primary care with acute cough, we used prediction rules for pneumonia or combined infection and assessed the effect of amoxicillin in patients predicted to have pneumonia or combined infection on symptom duration, symptom severity and illness deterioration. In total, 2056 patients that fulfilled all inclusion criteria were randomised, 1035 to amoxicillin, 1021 to placebo. Neither patients with a predicted pneumonia nor patients with a predicted combined infection were significantly more likely to benefit from amoxicillin. While the studied clinical prediction rules may help primary care clinicians to reduce antibiotic prescribing for low-risk patients, they did not identify adult acute cough patients that would benefit from amoxicillin treatment. ; GRACE was funded by the European Commission's Framework Programme 6 (LSHMCT-2005-518226). R.B. is funded as a postdoctoral researcher by FWO Flanders (grant 12I6319N). The work was supported by the Methusalem financing program of the Flemish Government. N.H. acknowledges support from the University of Antwerp scientific chair in Evidence-Based Vaccinology, financed in 2009−2019 by a gift from Pfizer and in 2016–2020 from GSK. We are grateful to key members of the GRACE Project group whose hard work has made this study possible, including Niels Adriaenssens, Jordi Almirall, Zuzana Bielicka, Francesco Blasi, Lidewij Broekhuizen, Pascale Bruno, Slawomir Chlabicz, Jo Coast, Mel Davies, Pim de Jong, An De Sutter, Patricia Fernandez, Maciek Godycki-Cwirko, Iris Hering, Kerenza Hood, Helena Hupkova, Janko Kersnik, Anna Kowalczyk, Christina Lannering, Marieke Lemiengre, Frank Leus, Katherine Loens, Christine Lammens, Bo-Eric Malmvall, Artur Mierzecki, Sigvard Mölstad, Karel Moons, Michael Moore, Magdalena Muras, Nuria Sanchez Romano, Matteu Serra Prat, Tom Schaberg, Richard Smith, Igor Svab, Jackie Swain, Paolo Tarsia, Antoni Torres, Pia Touboul, Saskia van Vugt, Robert Veen, and Tricia Worby, Peter Zuithoff, and all the clinicians and patients who consented to be part of GRACE. Conflicts of Interest: The authors declare no conflict of interest

Objectives: To better target new vaccines and treatments being developed for respiratory syncytial virus (RSV) and influenza virus (influenza), we studied the association of age with prevalence, diagnostic features and course of illness of these infections in primary care patients. Methods: Secondary analysis of observational data on the aetiology, diagnosis and prognosis in adults presenting to primary care with acute cough in 12 European countries (2007-2010) using regression analyses corrected for clustering of patients within countries. Age groups were 18-59 years, 60-74 years, and 75 years and older (75+). Results: Nasopharyngeal swabs for 144 (4.6%), 169 (5.4%) and 104 (3.4%) out of 3104 patients were polymerase chain reaction (PCR) positive for RSV, influenza A and influenza B, respectively. RSV prevalence in patients 75+ (8.5%) was twice the prevalence in those under 60 years (4.2%). Influenza prevalence was not associated with age. Diagnostic features for these viruses were not associated with age. Symptom duration was associated with age for RSV and influenza B, but not for influenza A. The odds of unresolved symptoms after 28 days were associated with age for RSV only. Illness deterioration was associated with age for RSV, with patients 75+ at increased risk, but not for influenza. Conclusion: In adults presenting to primary care with acute cough, the diagnostic features of RSV or influenza infection are not associated with age. For RSV both the prevalence and illness course are significantly worse at higher age, for influenza only the illness course is. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. ; RB is funded as a postdoctoral researcher by the Research Foundation -Flanders (FWO). SC, CB, NH, PB and HG are members of the Respiratory Syncytial Virus Consortium in Europe (RESCUE). RESCUE has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement no. 116019. NH acknowledges support from the University of Antwerp scientific chair in Evidence-Based Vaccinology, financed in 2009-2020 by a gift from Pfizer and in 2016-2019 from GSK. The GRACE project was funded by the European Community's Sixth Framework Programme (grant agreement 518226). Work in the UK was also supported by the National Institute for Health Research. Work in Barcelona was also supported by 2009 SGR 911 Ciber de Enfermedades Respiratorias (Ciberes CB06/06/0028). Work in Belgium was also supported by the Methusalem financing programme of the Flemish Government and by FWO (G.0274.08N). This work was also supported through the European Science Foundation (ESF), in the framework of the Research Networking Programme TRACE (www.esf.org/trace). ; Bruyndonckx, R (corresponding author), Hasselt Univ, DSI, Martelarenlaan 42, B-3500 Hasselt, Belgium. robin.bruyndonckx@uhasselt.be

Objective: We aimed to assess the effects of amoxicillin treatment in adult patients presenting to primary care with a lower respiratory tract infection (LRTI) who were infected with a potential bacterial, viral, or mixed bacterial/viral infection. Methods: This multicentre randomized controlled trial focused on adults with LRTI not suspected for pneumonia. Patients were randomized to receive either antibiotic (amoxicillin 1 g) or placebo three times daily for 7 consecutive days using computer-generated random numbers (follow-up 28 days). In this secondary analysis of the trial, symptom duration (primary outcome), symptom severity (scored 0-6), and illness deterioration (reconsultation with new or worsening symptoms, or hospital admission) were analysed in pre-specified subgroups using regression models. Subgroups of interest were patients with a (strictly) bacterial, (strictly) viral, or combined infection, and patients with elevated values of procalcitonin, C-reactive protein, or blood urea nitrogen. Results: 2058 patients (amoxicillin n = 1036; placebo n = 1022) were randomized. Treatment did not affect symptom duration (n = 1793). Patients from whom a bacterial pathogen only was isolated (n = 207) benefited from amoxicillin in that symptom severity (n = 804) was reduced by 0.26 points (95% CI -0.48 to -0.03). The odds of illness deterioration (n = 2024) was 0.24 (95% CI 0.11 to 0.53) times lower from treatment with amoxicillin when both a bacterial and a viral pathogen were isolated (combined infection; n = 198). Conclusions: Amoxicillin may reduce the risk of illness deterioration in patients with a combined bacterial and viral infection. We found no clinically meaningful benefit from amoxicillin treatment in other subgroups. (C) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. ; The authors have no conflicts of interest to declare. GRACE was funded by the European Community's Sixth Framework Programme (grant agreement 518226). Work in the UK was also supported by the National Institute for Health Research, in Barcelona by 2009 SGR 911 Ciber de Enfermedades Respiratorias (Ciberes CB06/06/0028), and in Belgium by the Research Foundationd-Flanders (FWO; G.0274.08N). Financial support from the Methusalem financing program of the Flemish Government is also gratefully acknowledged. NH acknowledges support from the University of Antwerp scientific chair in evidence-based vaccinology, financed in 2009-2017 by a gift from Pfizer and GSK. This publication has been financially supported through the European Science Foundation, in the framework of the Research Networking Program TRACE (www.esf.org/trace). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Objectives: In order to improve antimicrobial (AM) use, a policy of providing technical and financial support to AM management teams (AMTs) was rolled out in all Belgian hospitals between 2002 and 2008. We aimed to analyse the association of this policy with AM use for the two indications accounting for the largest number of patients receiving AM: prophylaxis for major lower limb orthopaedic surgery and pneumonia. Design, setting, participants: We used patient-level data routinely collected in all Belgian acute care hospitals between 1999 and 2010. We modelled trends for selected quality indicators (QIs) using the year of AMT implementation in each hospital as the main 'change point', with fine-tuned case-mix adjustment. Of all admissions for lower limb orthopaedic surgery, and pneumonia between 1999 and 2010, 90% (325 094) and 95% (327 635), respectively, were found eligible for analyses. Outcomes: The surgery QI was defined as: cefazolin, dose in the expected range, and no use of other AM. For pneumonia, QIs were: ratio of oral/parenteral defined daily doses (DDD, O/P QI), and mean number of DDD minus penicillin, per 100 days of hospitalisation (DDD QI). Results: Between 1999 and 2010, the surgery QI improved from 59% to 71%, the O/P QI from 0.72 to 0.97, and the DDD QI from 96 to 64. Heterogeneity between hospitals was high. Overall, no association was found with the year of implementation of the AMT. Conclusions: Improvements have been observed but could not be related at the national level to the policy under study. However, these results cannot be extrapolated to other QIs for AM use in hospitals. Our findings do not question the need for AMT, nor the need for continuation of AMT funding. Several recommendations can be made in order to make the best of Belgium's unique political and financial commitments in that field. ; This study was funded by the Scientific Institute of Public Health (internal grant, 99 429 Euros, project number W3035.0116.1). Data have been generated as part of the routine work of the Ministry of Health and National Sick Fund. RB acknowledges support from a Methusalem research grant from the Flemish government not specific for this project.