Please select the eligibility criteria that correspond to the clinical trial below.
Title: Viral Testing and Biomarkers to Reduce Antibiotic Use for Respiratory Infections
Brief Summary: This trial is a pilot study to determine the feasibility of a randomized clinical trial comparing a treatment algorithm consisting of a limited number of clinical parameters, rapid molecular viral diagnostics, and serum procalcitonin testing to standard of care for directing antibiotic use in patients with non-pneumonic lower respiratory tract infection. The reduction in antibiotic use in those subjects randomized to the treatment algorithm compared to those randomized to standard care will be determined.


Options:
A: Inclusion Criteria:

1. Patients 18 years of age or older, admitted from the community or a nursing home with acute (i.e., at least 1 day but less than 28 days) LRTI as the main diagnosis consisting of having at least two of the following:

   * new or increased respiratory signs or symptoms (i.e., cough, sputum production, dyspnea, auscultatory findings of abnormal breath sounds and rales, pleuritic chest pain) with or without inflammatory signs (core body temperature \> 38.0° C, leukocyte count \> 10 or \< 4 x 10\^9 cells L-1).
   * CAP is defined by the presence of LRTI along with a new or increased infiltrate on chest radiograph. Severity scores of CAP (pneumonia severity index \[PSI\] and CURB-65) will be calculated.
   * COPD is defined by post-bronchodilator spirometric criteria according to the GOLD-guidelines as a FEV1/FVC ratio below 70% and the severity categorized into mild (FEV1 \<= 80% of predicted), moderate (50% \>= FEV1 \< 80%), severe (30% \>= FEV1 \< 50%) and very severe (FEV1 \< 30%), respectively. Severity of acute exacerbations of COPD will be graded as proposed. Acute bronchitis is defined as LRTI in the absence of an underlying lung disease or focal chest signs and infiltrates on chest X-ray, respectively. Patients who are on admission judged as having an LRTI but have another final diagnosis, will be classified as "others".
2. Ability to understand verbal and written instructions and informed consent.

Exclusion Criteria:

1. Patients unable to give written informed consent, e.g. with severe dementia or patients not understanding German (or other local language) and no translation (e.g. family members) available.
2. Patients with active intravenous drug use.
3. Severe immunosuppression (e.g. patients infected with human immunodeficiency virus infection and a CD4 count below 350 x 10\^9/L, patients on immunosuppressive therapy after solid organ transplantation and neutropenic patients with present neutrophil count \< 500 x 10\^9/L and patients under chemotherapy with neutrophils 500-1000 x 10\^9/L with an expected decrease to values \< 500 x 10\^9/L); patients with cystic fibrosis, infection with M. tuberculosis, L. pneumophila, Listeria spp. hospital stay within 14 days of inclusion.
4. Accompanying chronic (e.g. osteomyelitis), abscess (e.g. brain, pleural empyema) infection or endocarditis.
5. Terminal and very severe medical co-morbidity where death is imminent or has to be expected in the current hospitalization (e.g. due to malignancy, cardiac, renal or hepatic failure, comfort therapy).
B: Inclusion Criteria:

* written informed consent
* all types of respiratory tract infection according to investigator´s diagnosis

Exclusion Criteria:

* pretreatment with antibiotics in the past 2 weeks
* portal hypertension
* Major surgeries or multiple trauma which require hospitalization, in previous 4 weeks
* Autoimmune disease and systemic diseases (lupus erythematodes, wegener´s disease)
* Peritoneal dialysis
* Acute treated or recently operated medullary c-cell-carcinoma, SCLC, carcinoid
* Other inflammatory diseases (e.g. urinary tract infection, pyelonephritis, pancreatitis
C: Inclusion Criteria:

1. Patients with clinically suspected or microbiologically confirmed bacterial sepsis
2. Informed consent

Exclusion Criteria:

1. Patients with microbiologically documented infections caused by the following microorganisms: Listeria spp, Legionella pneumophilia, Mycobacterium tuberculosis, Staphylococcus aureus
2. Patients with fungal infections
3. Patients with severe infections due to viruses or parasites (e.g. hemorrhagic fever, malaria)
4. Patients with suspected or confirmed bacterial meningitis or endocarditis
5. Patients with localized, deep-seated abscesses (e.g. brain abscess) without systemic sepsis
6. Patients with chronic, localized infections (e.g. chronic osteomyelitis) without systemic sepsis
7. Neutropenic and other severely immuno-compromised patients (patients infected with human immunodeficiency virus and a CD4 count \< 200; patients on immuno-suppressive therapy after solid organ transplantation; patients with cystic fibrosis)
8. Withholding of life-support
9. Early discharge or death (\< 24 hours after admission)
10. Complete absence of antimicrobial treatment despite suspicion of sepsis
D: Inclusion Criteria:

* Hospitalized with symptoms of a respiratory infection
* Age \> 21 years
* Systolic Blood Pressure \> 90mm Hg
* Patient or health care designee can provide written informed consent

Exclusion Criteria:

* Intensive Care Requirement
* Antibiotics received prior to admission
* More than 24 hours of antibiotics received prior to enrollment
* Active chemotherapy or pulmonary radiation therapy
* Immunosuppressive conditions
* Conditions know to increase PCT values
* Definite infiltrate on CXR •% of band forms in peripheral blood \> 15

Answer: D