Session Type: 1,5-hour Oral Session
Session Title: 1,5-hour Oral Session
Authors(s): H. Salim (1), S. Shiber (2), M. Paz (3), T.M. Gottlieb (3), T. Ilan Ber (3), E. Moscoviz (3), L. Shani (3), G. Kronenfeld (3), N. Petersiel (4), O. Bioco (3), M. Grupper (4), E. Simon (3), D. Kirshner (4), N. Avni (3), D. Haber (4), M. Stein (3), Y. Maor (5), C. Guetta (2), M. Ben Ari (1), Y. Lishtzinsky (2), S. Yanai (2), M.J. Dresher (2), K. Oved (3), E. Eden (3), A. Neuberger (4)
Authors Affiliations(s): (1) Carmel Medical Center, Israel, (2) Rabin Medical Center, Israel, (3) MeMed, Israel, (4) Rambam Health Care Campus, Israel, (5) Wolfson Medical Center, Israel
Third Party Affiliation: The study was funded by the European Commission; grant #684589
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:Adults aged >18 years with suspicion of lower respiratory tract infection were prospectively recruited at three medical sites (OBSERVER; grant #684589; NCT003011515). 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 (immunoXpert™, MeMed) was conducted, giving three possible outcomes, viral, bacterial or equivocal.
Results:Out of 583 adults recruited, 186 met inclusion criteria and had at least one viral detection, of whom 159 patients were adjudicated as viral (left panel, blue dots) and 27 as bacterial (left panel, red dots). Patients with bacterial infections were older [mean 63.26 years (SD 19.36) vs. 53.37 (SD 20.58); p=0.01] and were more likely to be admitted (81.5% vs. 17.0%; p<0.001). To estimate the assay’s impact on antibiotic use, 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 3.4-fold (right panel, p-value < 0.001), from 59.7% (95%CI 52.0-67.1) to 17.6% (CI: 12.4-24.3), without significantly impacting underuse (p-value 1).
Conclusions:The TRAIL/IP-10/CRP assay has the potential to improve antibiotic stewardship practices.
Keyword(s): Host response, TRAIL; IP-10; CRP, Viral detectionCOI Institutional Grants: Yes COI Stock Options: Yes
Session Type: 1,5-hour Oral Session
Session Title: 1,5-hour Oral Session
Authors(s): H. Salim (1), S. Shiber (2), M. Paz (3), T.M. Gottlieb (3), T. Ilan Ber (3), E. Moscoviz (3), L. Shani (3), G. Kronenfeld (3), N. Petersiel (4), O. Bioco (3), M. Grupper (4), E. Simon (3), D. Kirshner (4), N. Avni (3), D. Haber (4), M. Stein (3), Y. Maor (5), C. Guetta (2), M. Ben Ari (1), Y. Lishtzinsky (2), S. Yanai (2), M.J. Dresher (2), K. Oved (3), E. Eden (3), A. Neuberger (4)
Authors Affiliations(s): (1) Carmel Medical Center, Israel, (2) Rabin Medical Center, Israel, (3) MeMed, Israel, (4) Rambam Health Care Campus, Israel, (5) Wolfson Medical Center, Israel
Third Party Affiliation: The study was funded by the European Commission; grant #684589
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:Adults aged >18 years with suspicion of lower respiratory tract infection were prospectively recruited at three medical sites (OBSERVER; grant #684589; NCT003011515). 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 (immunoXpert™, MeMed) was conducted, giving three possible outcomes, viral, bacterial or equivocal.
Results:Out of 583 adults recruited, 186 met inclusion criteria and had at least one viral detection, of whom 159 patients were adjudicated as viral (left panel, blue dots) and 27 as bacterial (left panel, red dots). Patients with bacterial infections were older [mean 63.26 years (SD 19.36) vs. 53.37 (SD 20.58); p=0.01] and were more likely to be admitted (81.5% vs. 17.0%; p<0.001). To estimate the assay’s impact on antibiotic use, 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 3.4-fold (right panel, p-value < 0.001), from 59.7% (95%CI 52.0-67.1) to 17.6% (CI: 12.4-24.3), without significantly impacting underuse (p-value 1).
Conclusions:The TRAIL/IP-10/CRP assay has the potential to improve antibiotic stewardship practices.
Keyword(s): Host response, TRAIL; IP-10; CRP, Viral detectionCOI Institutional Grants: Yes COI Stock Options: Yes
Session Type: 1,5-hour Oral Session
Session Title: 1,5-hour Oral Session
Authors(s): H. Salim (1), S. Shiber (2), M. Paz (3), T.M. Gottlieb (3), T. Ilan Ber (3), E. Moscoviz (3), L. Shani (3), G. Kronenfeld (3), N. Petersiel (4), O. Bioco (3), M. Grupper (4), E. Simon (3), D. Kirshner (4), N. Avni (3), D. Haber (4), M. Stein (3), Y. Maor (5), C. Guetta (2), M. Ben Ari (1), Y. Lishtzinsky (2), S. Yanai (2), M.J. Dresher (2), K. Oved (3), E. Eden (3), A. Neuberger (4)
Authors Affiliations(s): (1) Carmel Medical Center, Israel, (2) Rabin Medical Center, Israel, (3) MeMed, Israel, (4) Rambam Health Care Campus, Israel, (5) Wolfson Medical Center, Israel
Third Party Affiliation: The study was funded by the European Commission; grant #684589
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:Adults aged >18 years with suspicion of lower respiratory tract infection were prospectively recruited at three medical sites (OBSERVER; grant #684589; NCT003011515). 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 (immunoXpert™, MeMed) was conducted, giving three possible outcomes, viral, bacterial or equivocal.
Results:Out of 583 adults recruited, 186 met inclusion criteria and had at least one viral detection, of whom 159 patients were adjudicated as viral (left panel, blue dots) and 27 as bacterial (left panel, red dots). Patients with bacterial infections were older [mean 63.26 years (SD 19.36) vs. 53.37 (SD 20.58); p=0.01] and were more likely to be admitted (81.5% vs. 17.0%; p<0.001). To estimate the assay’s impact on antibiotic use, 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 3.4-fold (right panel, p-value < 0.001), from 59.7% (95%CI 52.0-67.1) to 17.6% (CI: 12.4-24.3), without significantly impacting underuse (p-value 1).
Conclusions:The TRAIL/IP-10/CRP assay has the potential to improve antibiotic stewardship practices.
Keyword(s): Host response, TRAIL; IP-10; CRP, Viral detectionCOI Institutional Grants: Yes COI Stock Options: Yes
Session Type: 1,5-hour Oral Session
Session Title: 1,5-hour Oral Session
Authors(s): H. Salim (1), S. Shiber (2), M. Paz (3), T.M. Gottlieb (3), T. Ilan Ber (3), E. Moscoviz (3), L. Shani (3), G. Kronenfeld (3), N. Petersiel (4), O. Bioco (3), M. Grupper (4), E. Simon (3), D. Kirshner (4), N. Avni (3), D. Haber (4), M. Stein (3), Y. Maor (5), C. Guetta (2), M. Ben Ari (1), Y. Lishtzinsky (2), S. Yanai (2), M.J. Dresher (2), K. Oved (3), E. Eden (3), A. Neuberger (4)
Authors Affiliations(s): (1) Carmel Medical Center, Israel, (2) Rabin Medical Center, Israel, (3) MeMed, Israel, (4) Rambam Health Care Campus, Israel, (5) Wolfson Medical Center, Israel
Third Party Affiliation: The study was funded by the European Commission; grant #684589
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:Adults aged >18 years with suspicion of lower respiratory tract infection were prospectively recruited at three medical sites (OBSERVER; grant #684589; NCT003011515). 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 (immunoXpert™, MeMed) was conducted, giving three possible outcomes, viral, bacterial or equivocal.
Results:Out of 583 adults recruited, 186 met inclusion criteria and had at least one viral detection, of whom 159 patients were adjudicated as viral (left panel, blue dots) and 27 as bacterial (left panel, red dots). Patients with bacterial infections were older [mean 63.26 years (SD 19.36) vs. 53.37 (SD 20.58); p=0.01] and were more likely to be admitted (81.5% vs. 17.0%; p<0.001). To estimate the assay’s impact on antibiotic use, 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 3.4-fold (right panel, p-value < 0.001), from 59.7% (95%CI 52.0-67.1) to 17.6% (CI: 12.4-24.3), without significantly impacting underuse (p-value 1).
Conclusions:The TRAIL/IP-10/CRP assay has the potential to improve antibiotic stewardship practices.
Keyword(s): Host response, TRAIL; IP-10; CRP, Viral detectionCOI Institutional Grants: Yes COI Stock Options: Yes