A novel host-protein assay outperforms routine parameters for distinguishing between bacterial and viral lower respiratory tract infections

Publication date: Available online 24 November 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Michal Stein, Shelly Lipman-Arens, Kfir Oved, Asi Cohen, Ellen Bamberger, Roy Navon, Olga Boico, Tom Friedman, Liat Etshtein, Meital Paz, Tanya M. Gottlieb, Or Kriger, Yura Fonar, Ester Pri-Or, Renata Yacobov, Yaniv Dotan, Amit Hochberg, Moti Grupper, Irina Chistyakov, Israel Potasman, Isaac Srugo, Eran Eden, Adi Klein
Bacterial and viral lower respiratory tract infections (LRTIs) are often clinically indistinguishable, leading to antibiotic overuse. We compared the diagnostic accuracy of a new assay that combines three host-biomarkers (TRAIL, IP-10, CRP) with parameters in routine use to distinguish bacterial from viral LRTIs. Study cohort included 184 potentially eligible pediatric and adult patients. Reference standard diagnosis was based on adjudication by an expert panel following comprehensive clinical and laboratory investigation (including respiratory PCRs). Experts were blinded to assay results and assay performers were blinded to reference standard outcomes. Evaluated cohort included 88 bacterial and 36 viral patients (23 did not fulfill inclusion criteria; 37 had indeterminate reference standard outcome). Assay distinguished bacterial from viral LRTI patients with sensitivity of 0.93±0.06 and specificity of 0.91±0.09, outperforming routine parameters, including WBC, CRP and chest x-ray signs. These findings support the assay's potential to help clinicians avoid missing bacterial LRTIs or overusing antibiotics.



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