Cihan Papan (Germany)
Saarland University Center for Infectious DiseasesPresenter of 4 Presentations
How to Make the Most out of the Technology During WMW (ID 1833)
Introduction (ID 2332)
A HOST-BASED ASSAY COMPRISING TRAIL, IP-10 AND CRP CAN IMPROVE ANTIBIOTIC TREATMENT DECISIONS FOR VIRAL PCR POSITIVE CHILDREN BY ACCURATELY RULING OUT CO-INFECTION (ID 1360)
Abstract
Background
Identifying infectious disease etiology is essential for appropriate patient management, including antibiotic use. A known limitation of viral detection is that it does not rule out bacterial co-infection. Previous studies showed that a host assay comprising TNF-related apoptosis induced ligand (TRAIL), interferon gamma induced protein-10 (IP-10) and C-reactive protein (CRP) accurately differentiates bacterial from viral infections with negative predictive value >98%.
Methods
Children aged >90 days with fever without source or respiratory tract infection were prospectively recruited at pediatric emergency departments in Germany and Italy (AutoPilot-Dx; grant #701088; NCT03052088). Infection etiology was adjudicated by three independent experts based on clinical, laboratory, radiological and follow-up data. Viruses were detected using multiplex PCR on nasopharyngeal swabs. The host assay was conducted, giving three possible outcomes: viral, bacterial or equivocal.
Results
Out of 1,140 children recruited, 530 met inclusion criteria and had at least one viral detection. 483 of the viral PCR positive children were adjudicated as viral (blue circle) and 47 as bacterial (red dot). Children with bacterial infections were older (mean 3.9 years (SD 2.3) vs. 2.9 (3.0); p<0.001), had higher fever (mean 39.6°C (SD 0.7) vs. 39.2 (0.8); p=0.001), and were more likely to be admitted (93.6%) vs. 70.2%); p<0.001). To estimate the assay’s impact on antibiotic misuse, the observed treatment was considered the current practice, and a contraindicative assay result was assumed to trigger a change in practice, with current practice occurring in cases of equivocal results. In this model, the host assay potentially reduces antibiotic treatment of viral infections 3.75-fold (from 143 to 38 children; p<0.001), while also slightly reducing underuse (p=0.5).
Conclusions
The TRAIL/IP-10/CRP assay has the potential to improve antibiotic stewardship practices.
Clinical Trial Registration
Clinical trial registration: ClinicalTrials.gov NCT03052088
Live Discussion (ID 1860)
Moderator of 2 Sessions
