Physicians' prediction for the assessment of atypical pathogens in respiratory tract infections. (25th June 2020)

• Record Type: Journal Article
• Authors: Suzuki, Satoshi; Ishimaru, Naoto; Akashi, Yusaku; Takeuchi, Yuto; Ueda, Atsuo; Ushiki, Akihito; Kinami, Saori; Suzuki, Hiromichi; Tokuda, Yasuharu; Maeno, Tetsuhiro
• Is Part Of: Journal of general and family medicine. Volume 21:Number 6(2020)
• Page Start: 226
• Page End: 234
• Publication Date: 2020-06-25
• Subjects: Atypical pathogen -- Bordetella pertussis -- Chlamydophila pneumoniae -- Infectious diseases -- Mycoplasma pneumoniae -- the Japanese Respiratory Society guideline; Primary care (Medicine) -- Periodicals; Family medicine -- Periodicals; Family Practice; Primary Health Care; Japan; Periodicals; 610
• DOI: 10.1002/jgf2.350
• Languages: English
• ISSNs: 2189-7948

Abstract

Abstract: Background: Patients with acute respiratory tract infections are frequently prescribed antimicrobials despite high rates of virus detection. Physicians may overprescribe antimicrobials owing to the concern of bacterial infections, including those because of atypical pathogens. We investigated the accuracy of clinical predictions concerning atypical pathogen infections. Methods: We prospectively enrolled adult patients who presented with a fever and cough in outpatient clinics between December 2016 and August 2018. After taking a history and performing physical examinations, physicians predicted the possibility of respiratory infections because of atypical pathogens. Disease probabilities were categorized into 3 grades (high: ≥50%, intermediate: 20% ≥ and <50%, and low: <20%) and were judged by physicians who were taking care of the patients. Confirmation of atypical pathogens was performed by comprehensive molecular analyses of respiratory samples. Results: Atypical pathogens were detected in 21 of 210 patients. A close contact history (odds ratio [OR]: 11.4, 95% confidence interval [CI]: 2.4‐53.5) and the presence of pneumonia (OR: 12.9, CI: 4.3‐39.2) were associated with the detections. Atypical pathogens were detected in 32.3% of high‐probability cases (10/31), while atypical pathogens were only detected in 8.8% of intermediate‐probability cases (8/91) and 3.4% of low‐probability cases (3/88) ( P < .001). Conclusions: The current study indicates that physicians' predictions were associated with the detection of atypical pathogens; however, overestimation was observed. Abstract : Our study indicates that while physicians' predictions were associated with the detection of atypical pathogens, overestimation was observed. The criteria for atypical pneumonia did not perform well for accurately diagnosing atypical pathogen infection in patients with a fever and cough.