Evidence map›Paper›PMID 27777252›Full record

ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2017

Predicting the presence of bacterial pathogens in the airways of primary care patients with acute cough.

Jolien Teepe, Berna D L Broekhuizen, Katherine Loens, Christine Lammens, Margareta Ieven, Herman Goossens, Paul Little, Chris C Butler, Samuel Coenen, Maciek Godycki-Cwirko and 2 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 1 pooled it
1.0field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.

  1. Pooled it
  2. Clinical presentation, microbiological aetiology and disease course in patients with flu-like illness: a post hoc analysis of randomised controlled trial data.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022
    Trial
  3. Trial
  4. Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: secondary analysis of a multicentre European trial.The British journal of general practice : the journal of the Royal College of General Practitioners · 2018
    Trial
  5. Article
  6. Review
  7. Observational
  8. Article
  9. Article
  10. Article
  11. Review
  12. Review
  13. Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis by bacterial and viral aetiology.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2018
    Article
  14. Analytical performance of a platform for point-of-care CRP testing in adults consulting for lower respiratory tract infection in primary care.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2018
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 5 institutions in 4 countries.

Jolien TeepeJulius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland j.teepe-2@umcutrecht.nl.
Berna D L BroekhuizenJulius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland.
Katherine LoensJulius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland.
Christine LammensJulius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland.
Margareta IevenJulius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland.
Herman GoossensJulius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland.
Paul LittleJulius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland.
Chris C ButlerJulius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland.
Samuel CoenenJulius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland.
Maciek Godycki-CwirkoJulius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland.
Theo J M VerheijJulius Center for Health Sciences and Primary Care (Teepe, Broekhuizen, Verheij), University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO) (Loens, Lammens, Ieven, Goossens, Coenen), and Centre for General Practice, Primary and Interdisciplinary Care (Coenen), University of Antwerp, Antwerp, Belgium; Primary Care Medical Group (Little), University of Southampton Medical School, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Butler), University of Oxford, Oxford, UK; Faculty of Health Sciences (Godycki-Cwirko), Medical University of Lodz, Lodz, Poland.
GRACE Consortium
University Medical Center Utrecht · NLMedical University of Lodz · PLUniversity of Antwerp · BEUniversity of Southampton · GBUniversity of Oxford · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBacterial testing of all patients who present with acute cough is not feasible in primary care. Furthermore, the extent to which easily obtainable clinical information predicts bacterial infection is unknown. We evaluated the diagnostic value of clinical examination and testing for C-reactive protein and procalcitonin for bacterial lower respiratory tract infection.

methodsThrough a European diagnostic study, we recruited 3104 adults with acute cough (≤ 28 days) in primary care settings. All of the patients underwent clinical examination, measurement of C-reactive protein and procalcitonin in blood, and chest radiography. Bacterial infection was determined by conventional culture, polymerase chain reaction and serology, and positive results were defined by the presence of

resultsOverall, 539 patients (17%) had bacterial lower respiratory tract infection, and 38 (1%) had bacterial pneumonia. The only item with diagnostic value for lower respiratory tract infection was discoloured sputum (area under the receiver operating characteristic [ROC] curve 0.56, 95% confidence interval [CI] 0.54-0.59). Adding C-reactive protein above 30 mg/L increased the area under the ROC curve to 0.62 (95% CI 0.59-0.65). For bacterial pneumonia, comorbidity, fever and crackles on auscultation had diagnostic value (area under ROC curve 0.68, 95% CI 0.58-0.77). Adding C-reactive protein above 30 mg/L increased the area under the ROC curve to 0.79 (95% CI 0.71-0.87). Procalcitonin did not add diagnostic information for any bacterial lower respiratory tract infection, including bacterial pneumonia.

interpretationIn adults presenting with acute lower respiratory tract infection, signs, symptoms and C-reactive protein showed diagnostic value for a bacterial cause. However, the ability of these diagnostic indicators to exclude a bacterial cause was limited. Procalcitonin added no clinically relevant information.

Identifiers

PMID27777252
PMCPMC5235925
OpenAlexW2537266392

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.