title: Adults hospitalised with acute respiratory illness rarely have detectable bacteria in the absence of COPD or pneumonia; viral infection predominates in a large prospective UK sample.
abstract: OBJECTIVE
  Many adult patients hospitalised with acute respiratory illness have viruses detected but the overall importance of viral infection compared to bacterial infection is unclear.
  
  
  METHODS
  Patients were recruited from two acute hospital sites in Leicester (UK) over 3 successive winters. Samples were taken for viral and bacterial testing.
  
  
  RESULTS
  Of the 780 patients hospitalised with acute respiratory illness 345 (44%) had a respiratory virus detected. Picornaviruses were the most commonly isolated viruses (detected in 23% of all patients). Virus detection rates exceeded 50% in patients with exacerbation of asthma (58%), acute bronchitis and Influenza-like-illness (64%), and ranged from 30 to 50% in patients with an exacerbation of COPD (38%), community acquired pneumonia (36%) and congestive cardiac failure (31%). Bacterial detection was relatively frequent in patients with exacerbation of COPD and pneumonia (25% and 33% respectively) but was uncommon in all other groups. Antibiotic use was high across all clinical groups (76% overall) and only 21% of all antibiotic use occurred in patients with detectable bacteria.
  
  
  CONCLUSIONS
  Respiratory viruses are the predominant detectable aetiological agents in most hospitalised adults with acute respiratory illness. Antibiotic usage in hospital remains excessive including in clinical conditions associated with low rates of bacterial detection. Efforts at reducing excess antibiotic use should focus on these groups as a priority. Registered International Standard Controlled Trial Number: 21521552.
authors.affiliation: Department of Clinical and Experimental Sciences and Respiratory Biomedical Research Unit, University of Southampton, UK; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK. Electronic address: t.w.clark@soton.ac.uk.
authors.forename: Tristan W
authors.initials: TW
authors.lastname: Clark
authors.affiliation: Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.
authors.forename: Marie-jo
authors.initials: MJ
authors.lastname: Medina
authors.affiliation: Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Batham
authors.affiliation: Public Health England Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Curran
authors.affiliation: Public Health England Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Surendra
authors.initials: S
authors.lastname: Parmar
authors.affiliation: Department of Clinical and Experimental Sciences and Respiratory Biomedical Research Unit, University of Southampton, UK; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.
authors.forename: Karl G
authors.initials: KG
authors.lastname: Nicholson
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001249:Asthma / Q000382:microbiology / Q000821:virology; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D017714:Community-Acquired Infections / Q000188:drug therapy; D018450:Disease Progression; D004363:Drug Utilization; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000382:microbiology / Q000821:virology; D029424:Pulmonary Disease, Chronic Obstructive / Q000382:microbiology / Q000821:virology; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000821:virology; D006113:United Kingdom; D014777:Virus Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D014780:Viruses / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute respiratory illness; Adults; Antibiotics; Hospitalisation; Respiratory viruses
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