Samuel A. Rhedin (Sweden)
Karolinska Institutet Department of Medical Epidemiology and BiostatisticsAuthor Of 1 Presentation
MYXOVIRUS RESISTANCE PROTEIN A FOR DISCRIMINATING BETWEEN VIRAL AND BACTERIAL LOWER RESPIRATORY TRACT INFECTIONS IN CHILDREN – THE TREND STUDY
Abstract
Backgrounds:
Discriminating between viral and bacterial lower respiratory tract infection (LRTI) in children is challenging, leading to an excessive use of antibiotics. Myxovirus resistance protein A (MxA) is a promising biomarker for viral infections. The aim of the study was to assess the difference in blood MxA levels between children with viral and bacterial LRTI and to assess MxA levels in relation to specific respiratory viruses.
Methods
Children with lower respiratory tract infection (LRTI) were enrolled as cases at Sachs’ Children and Youth Hospital, Stockholm, Sweden. Nasopharyngeal aspirates (for respiratory PCR analysis) and blood samples (for analysis of MxA and CRP) were systematically collected from all study subjects in addition to standard laboratory/radiology assessment. Aetiology was defined according to an algorithm based on laboratory and radiological findings. The diagnostic accuracy of MxA was assessed by calculating sensitivity, specificity and area under the curve (AUC) in receiving operator characterstic (ROC) curves.
Results:
Of the 326 cases, 242 had viral aetiology, 11 had mixed viral-bacterial aetiology, 5 had bacterial aetiology, 2 had atypical bacterial aetiology, and 66 cases had undetermined aetiology. MxA levels were higher in children with viral LRTI as compared with bacterial LRTI (p<0.01, AUC 0.92). In the subgroup of children with pneumonia diagnosis, a cut-off of MxA 430µg/l discriminated between viral and bacterial aetiology with 93% sensitivity and 100% specificity (AUC 0.98). The highest MxA levels were seen in cases PCR positive for adenovirus and respiratory syncytial virus (median MxA 1961µg/l and 1226µg/l respectively).
Conclusions/Learning Points:
MxA accurately discriminated between viral and bacterial etiology in children with LRTI, in particular in the group of children with pneumonia diagnosis. Thus, MxA determination might improve rational use of antibiotics in this patient group.
Presenter of 1 Presentation
MYXOVIRUS RESISTANCE PROTEIN A FOR DISCRIMINATING BETWEEN VIRAL AND BACTERIAL LOWER RESPIRATORY TRACT INFECTIONS IN CHILDREN – THE TREND STUDY
Abstract
Backgrounds:
Discriminating between viral and bacterial lower respiratory tract infection (LRTI) in children is challenging, leading to an excessive use of antibiotics. Myxovirus resistance protein A (MxA) is a promising biomarker for viral infections. The aim of the study was to assess the difference in blood MxA levels between children with viral and bacterial LRTI and to assess MxA levels in relation to specific respiratory viruses.
Methods
Children with lower respiratory tract infection (LRTI) were enrolled as cases at Sachs’ Children and Youth Hospital, Stockholm, Sweden. Nasopharyngeal aspirates (for respiratory PCR analysis) and blood samples (for analysis of MxA and CRP) were systematically collected from all study subjects in addition to standard laboratory/radiology assessment. Aetiology was defined according to an algorithm based on laboratory and radiological findings. The diagnostic accuracy of MxA was assessed by calculating sensitivity, specificity and area under the curve (AUC) in receiving operator characterstic (ROC) curves.
Results:
Of the 326 cases, 242 had viral aetiology, 11 had mixed viral-bacterial aetiology, 5 had bacterial aetiology, 2 had atypical bacterial aetiology, and 66 cases had undetermined aetiology. MxA levels were higher in children with viral LRTI as compared with bacterial LRTI (p<0.01, AUC 0.92). In the subgroup of children with pneumonia diagnosis, a cut-off of MxA 430µg/l discriminated between viral and bacterial aetiology with 93% sensitivity and 100% specificity (AUC 0.98). The highest MxA levels were seen in cases PCR positive for adenovirus and respiratory syncytial virus (median MxA 1961µg/l and 1226µg/l respectively).
Conclusions/Learning Points:
MxA accurately discriminated between viral and bacterial etiology in children with LRTI, in particular in the group of children with pneumonia diagnosis. Thus, MxA determination might improve rational use of antibiotics in this patient group.