چکیده (انگلیسی):

Background:Serious lower respiratory tract infections (SLRTIs), especiallyStreptococcus pneumoniae (SP)-related
pneumonia cause considerable morbidity and mortality. Chest imaging, sputum and blood culture are not routinely
obtained by general practitioners (GPs). Antibiotic therapy is usually started empirically. The BinaxNOW® and Urine
Antigen Detection (UAD) assays have been developed respectively to detect a common antigen from all pneumococcal
strains and the 13 pneumococcal serotypes present in the vaccine Prevenar 13® (PCV13).
Methods:OPUS-B was a multicentre, prospective, case-control, observational study of patients with SLRTI in primary
care in Belgium, conducted during two winter seasons (2011–2013). A urine sample was collected at baseline for the
urine assays. GPs were blinded to the results. All patients with a positive BinaxNOW® test and twice as much randomly
selected BinaxNOW® negative patients were followed up.Recorded data included: socio-demographics, medical
history, vaccination history, clinical symptoms, CRB-65 score, treatments, hospitalization, blood cultures, healthcare
use, EQ-5D score. The objectives were to evaluate the percentage of SP SLRTI within the total number of SLRTIs,
to assess the percentage of SP serotypes and to compare the burden of disease between pneumococcal and
non-pneumococcal SLRTIs.
Results:There were 26 patients with a BinaxNOW® positive test and 518 patients with a BinaxNOW® negative
test. The proportion of pneumococcal SLRTI was 4.8 % (95 % CI: 3.1 %–7.2 %). Sixty-eight percent of positive cases
showed serotypes represented in PCV13. In the BinaxNOW-positive patients, women were more numerous, there
was less exposure to young children, seasonal influenzavaccination was less frequent, COPD was more frequent,
the body temperature and the number of breaths per minute were higher, the systolic blood pressure was lower,
the frequency of sputum, infiltrate, chest pain, muscle ache, confusion/disorientation, diarrhoea, pneumonia and
exacerbations of COPD was more frequent, EQ-5D index and VAS scale were lower, the number of visits to the GP, of
working days lost and of days patients needed assistance were higher.
Conclusions:SP was responsible for approximately 5 % of SLRTIs observed in primary care in Belgium. Pneumococcal
infection was associated with a significant increase in morbidity. Sixty-eight percent of serotypes causing SLRTI were
potentially preventable by PCV13.
Keywords:Lower respiratory tract infection (LRTI), Primary care, General practitioner,Streptococcus pneumoniae,
Pneumonia, Belgium, BinaxNOW assay, Serotype-specific urine antigen detection assay