Title : Evaluation of the clinical effectiveness of an early marker system for differentiating between viral or bacterial respiratory infections or febrile infections in a children's hospital during the first post-pandemic season
Abstract:
The aim of the study is the clinical evaluation of an diagnostic marker system that is able to distinguish between bacterial and viral infection, with focus on the influences on therapeutic regimes in primary care and inpatient care.
Material and Method: The MeMed- BV® Scores (Diasorin) measures the three non-microbial proteins TRAIL, IP-10 and CRP using CLIA technology on the LiaisonXL. The test result is determined as a score, while a low score indicates a viral and a high score a bacterial infection.
The study included children presenting to emergency departments, as well as inpatients from the children's hospital with suspected acute bacterial or viral infections. The results of the MeMed-BV are compared with the results from cultural and molecular biological routine diagnostics including multiplex PCR systems (MAGPIX-System, Diasorin). A total of 49 patients were included.
For the clinical evaluation, a score was developed that describes whether the various aspects of diagnostics and therapy correlate with the results of the MeMed-BV test and whether options for optimizing the use of antibiotics can be derived from this.
Results: After the patients were discharged, the test results were compared with the case data and the score was applied. All cases were evaluated together with the treating physicians.
The majority of patients showed respiratory symptoms with and without fever. In 30 cases, 34 viral respiratory pathogens were detected and in 8 cases bacterial infectious agents. Gastroenteritis occurred in 12 patients (5 x viral pathogens, 1x bacterial pathogen) Urinary tract infections, appendicitis, otitis and tonsillitis also occurred.
The assignment to bacterial or viral infection was possible in almost all patients; in only 2 cases the result was not clear. The self-developed evaluation score was also able to differentiate well for the majority of patients (Fig. 1) and shows the potential for improvement.
Analyzing the cases we eliminated gastroenteritis, appendicitis and urinary tract infections, due to bad concordance. The new evaluation was additionally stratified according to “bacterial” and “viral”.
We found a good concordance between the MeMed-BV and the clinical picture respectively the diagnostic results. Only the laboratory findings for “bacterial” didn’t matched well, caused by a lack of cultural examinations. Checking the antibiotic therapy, the MeMed BV gave the best results for bacterial infections and viral diseases with high CPR. Viral diseases with low CRP therefore have the highest potential for adaptation to antibiotic therapy.
Conclusions: The MeMed BV assay is a powerful tool in clinical practice when used for respiratory diseases with and without fever. Especially in the case of viral respiratory diseases, despite the use of multiplex PCR systems and the associated improved pathogen detection in clinical management, there is still uncertainty about the assessment of the results and the potential of bacterial superinfections. The MeMed assay has proven to be very helpful and can therefore become an important tool for antibiotic stewardship in pediatrics.
