目的:描述症状,持续时间,严重程度,门诊患者下呼吸道感染(LRTI)的微生物学特征。
方法:对美国初级或紧急治疗成人进行前瞻性队列研究,主诉咳嗽和症状与LRTI一致。基线数据包括人口统计,标志,46种病毒和细菌的症状和PCR。通过日记和短信报告长达28天随访的症状严重程度。支气管炎严重程度评分(BSS)评估基线时的严重程度;总体严重程度定义为症状严重程度曲线下的面积。
结果:在718名具有完整基线数据的患者中,618有有效的PCR结果,并随访443例直至症状消退.在那些具有有效PCR的人中,100(16.2%)检测到1+病毒,211(34.1%)有1+细菌,168人(27.2%)两者都有。病毒或混合感染更可能出现的症状包括发热(36.7%至38.4%vs18.5%),发冷或出汗(36.0%至38.1%对17.9%),普遍不适(78.2%至81.3%vs64.9%),和肌痛(42.7%至48.2%vs28.6%)。彩色痰(42.9%vs23.2%至29.5%)在细菌感染中更为常见。病毒咳嗽的平均持续时间为14.7天(95%CI13.2-16.2),17.3细菌(95%CI15.9-18.6),混合感染16.9(95%CI15.2-18.6),18.4无检测(95%CI16.1-20.8)。病毒感染的咳嗽总体严重程度较低(20.9分,95%CI18.6-23.3)比其他组(范围24.2-26.3)。最常见的潜在细菌病原体是流感嗜血杆菌(28.0%),卡他莫拉菌(16.2%),肺炎链球菌(10.2%),而最常见的病毒病原体是鼻病毒(17.3%),流感(12.8%),SARS-CoV-2(11.5%),和季节性冠状病毒(8.1%)。
结论:咳嗽的平均持续时间为16.4天。与欧洲研究一致,感染类型或潜在病原体不是LRTI持续时间或严重程度的重要预测因子.
OBJECTIVE: To describe the symptoms, duration, severity, and microbiology of lower respiratory tract infection (LRTI) in outpatients.
METHODS: Prospective cohort study of adults in US primary or urgent care with a chief complaint of cough and symptoms consistent with LRTI. Baseline data included demographics, signs, symptoms, and PCR for 46 viruses and bacteria. The severity of symptoms reported for ≤28 days follow-up via diary and text message. The Bronchitis severity score assessed severity at baseline; overall severity was defined as the area under the symptom severity curve.
RESULTS: Of 718 patients with complete baseline data, 618 had valid PCR results, and 443 were followed until symptoms resolved. Of those with valid PCR, 100 (16.2%) had 1+ viruses detected, 211 (34.1%) had 1+ bacteria, and 168 (27.2%) had both. Symptoms more likely with viral or mixed infection included feverishness (36.7-38.4% vs. 18.5%), chills or sweats (36.0-38.1% vs. 17.9%), being generally unwell (78.2-81.3% vs. 64.9%), and myalgias (42.7-48.2% vs. 28.6%). Coloured sputum (42.9% vs. 23.2-29.5%) was more common with a bacterial infection. The mean duration of cough was 14.7 days with viruses (95% CI: 13.2-16.2), 17.3 with bacteria (95% CI: 15.9-18.6), 16.9 with mixed infection (95% CI: 15.2-18.6), and 18.4 with no detection (95% CI: 16.1-20.8). Overall severity of cough was lower for viral infections (20.9 points, 95% CI: 18.6-23.3) than for other groups (range 24.2-26.3). The most common potential bacterial pathogens were Haemophilus influenza (28.0%), Moraxella catarrhalis (16.2%), and Streptococcus pneumoniae (10.2%), whereas the most common viral pathogens were rhinovirus (17.3%), influenza (12.8%), SARS-CoV-2 (11.5%), and seasonal coronaviruses (8.1%).
CONCLUSIONS: The mean duration of cough was 16.4 days. Consistent with European studies, the type of infection or potential pathogen was not an important predictor of the duration or severity of LRTI.