TY - JOUR T1 - Clinical relevance of bacterial resistance in lower respiratory tract infection in primary care: secondary analysis of a multicentre European trial JF - British Journal of General Practice JO - Br J Gen Pract DO - 10.3399/bjgp18X698333 SP - bjgp18X698333 AU - Jolien Teepe AU - Berna DL Broekhuizen AU - Herman Goossens AU - Patricia Marinka Hordijk AU - Katherine Loens AU - Christine Lammens AU - Margareta Ieven AU - Paul Little AU - Chris C Butler AU - Samuel Coenen AU - Maciek Godycki-Cwirko AU - Birgitta Henriques-Normark AU - Theo JM Verheij AU - on behalf of the GRACE consortium Y1 - 2018/07/31 UR - http://bjgp.org/content/early/2018/07/30/bjgp18X698333.abstract N2 - Background The impact of antimicrobial resistance on clinical outcomes in patients with lower respiratory tract infection in primary care is largely unknown.Aim To determine the illness course of infections with resistant bacteria in adults presenting to primary care with acute cough.Design and setting Secondary analysis of a multicentre European trial in primary care.Method A total of 2061 adults with acute cough (lasting ≤28 days) were recruited from primary care and randomised to amoxicillin or placebo. To reflect the natural course of disease, only patients in the placebo group (n = 1021) were eligible. Nasopharyngeal flocked swabs and/or sputa (when available) were analysed at baseline and Streptococcus pneumoniae and Haemophilus influenzae isolates underwent susceptibility testing. Patients recorded their symptoms in a diary every day for 4 weeks. Patients with and without resistant bacterial infection were compared with regards to symptom severity, duration of symptoms, worsening of illness, and duration of interference with normal activities or work.Results Of the 834 patients with diary records, 104 showed S. pneumoniae and/or H. influenzae infection. Of this number, 54 (52%) were resistant to antibiotics, while seven (7%) were resistant to penicillin. For the duration of symptoms rated ‘moderately bad or worse’ (hazard ratio 1.27, 95% confidence interval [CI] = 0.67 to 2.44), mean symptom severity (difference −0.48, 95% CI = −1.17 to 0.21), and worsening of illness (odds ratio 0.31, 95% CI = 0.07 to 1.41), there was no statistically significant difference between the antibiotic-resistant and antibiotic-sensitive groups.Conclusion The illness course of antibiotic-resistant lower respiratory tract infection does not differ from that caused by antibiotic-sensitive bacteria. ER -