背景:了解初级保健中急性感染的自然史,定义为在没有特定疗法或治疗的情况下疾病随时间推移的过程,可以告知临床医生和患者关于疾病康复的期望,但是这些证据在整个文献中是支离破碎的。本范围审查旨在绘制与急性感染自然史相关的现有研究和研究空白。
方法:我们搜索了MEDLINE,Embase和CENTRAL使用2阶段分层搜索方法。在阶段A,我们专注于确定系统评价,综合符合条件的感染的自然历史数据(急性呼吸道,泌尿,和皮肤和软组织)和治疗有效性的系统评价(安慰剂或无治疗组的RCT,或队列研究)。对于没有现有评论的感染,在B阶段,我们搜索了主要研究(安慰剂对照RCT或队列研究).两名评审员独立筛选和提取数据(研究特征,结果数据-例如,症状持续时间,在不同时间点与分辨率成比例)。
结果:我们确定了40篇系统评价,报告45例感染,最常见的(90%)呼吸道感染。其中六个(15%)旨在合成自然历史信息。大多数评论报告了在不同时间点/s症状缓解的参与者比例,58%的人提供了平均症状持续时间的数据。恢复数据显示某些人感染的自发消退。我们没有找到适合蜂窝织炎的研究,湿疹,碳水化合物,还有丹毒.
结论:我们的综述表明,许多常见急性感染存在自然史证据。临床医生可以利用它在初级保健中实施以患者为中心的抗生素管理策略。未来的研究应集中在为皮肤和软组织感染以及尿路感染提供自然史证据。
BACKGROUND: Knowing the natural history of acute infections in primary care, defined as the course of a disease over time in the absence of specific therapy or treatment, can inform clinicians\' and patients\' expectations about illness recovery, but this evidence is fragmented across the literature. This scoping review aimed to map existing research and research gaps relevant to the natural history of acute infections.
METHODS: We searched MEDLINE, Embase and CENTRAL using a 2-phase hierarchical search approach. In Phase A, we focused on identifying systematic reviews synthesising natural history data for eligible infections (acute respiratory, urinary, and skin and soft tissue) and systematic reviews of treatment effectiveness (of RCTs with placebo or no treatment arm, or cohort studies). For infections without existing reviews, in Phase B, we searched for primary studies (placebo-controlled RCTs or cohort studies). Two reviewers independently screened and extracted the data (study characteristics, outcome data - e.g., symptom duration, proportion with resolution at various time points).
RESULTS: We identified 40 systematic reviews, reporting on 45 infections, most commonly (90%) respiratory tract infections. Six (15%) of these aimed to synthesise natural history information. Most reviews reported the proportion of participants with symptom resolution at various time point/s, with 58% providing data on mean symptom duration. Recovery data show the spontaneous resolution of some infections in some people. We found no eligible studies for cellulitis, ecthyma, carbuncle, and erysipelas.
CONCLUSIONS: Our review has shown that natural history evidence exists for many common acute infections. It can be utilised by clinicians in implementing patient-centred antibiotic stewardship strategies in primary care. Future research should focus on generating natural history evidence for skin and soft tissue infections and urinary tract infections.