Wagner Laura, Schneider Heike, Luppa Peter B, Schröder Kathrin, Wantia Nina, Querbach Christiane, Jeske Samuel D, Lahmer Tobias, Rothe Kathrin, Dibos Miriam, Voit Florian, Erber Johanna, Spinner Christoph D, Schneider Jochen, Triebelhorn Julian
TUM School of Medicine and Health, Department of Clinical Medicine, Clinical Department for Internal Medicine II, University Medical Center, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
TUM School of Medicine and Health, Department of Clinical Chemistry and Pathobiochemistry, University Medical Center, Technical University of Munich, Munich, Germany.
Infection. 2024 Sep 9. doi: 10.1007/s15010-024-02384-w.
A host-protein signature score, consisting of serum-concentrations of C-reactive protein, tumour necrosis factor-related apoptosis-inducing ligand, and interferon gamma-induced protein 10, was validated for distinguishing between bacterial and viral infections as an antimicrobial stewardship measure for routine clinical practice among adult patients in a German tertiary hospital.
This single-centre, explorative study prospectively assessed the host-protein signature score, comparing it with serum procalcitonin (PCT) in patients with blood stream infections (BSI) and evaluating its efficacy in patients with viral infections against the standard of care (SOC) to assess the need for antibiotics due to suspected bacterial super/coinfection. Manufacturer-specified threshold scores were used to differentiate viral (< 35) and bacterial (> 65) infections.
Ninety-seven patients (BSI [n = 56]; viral infections [n = 41]) were included. The score (cut-off score > 65) tended to detect BSI with higher sensitivity than did PCT (cut-off > 0.5 ng/mL) (87.5% vs. 76.6%). Three patients (5.4%) with BSI had a score < 35. One patient with BSI did not receive antibiotic treatment following SOC prior to positive blood culture results. Among patients with viral infections, 29 (70.7%) had scores > 65, indicating bacterial superinfections. Additionally, 11 patients (26.8%) had scores < 35, indicating no bacterial superinfections. In total, the antibiotic treatment discrepancy in the viral group between the SOC and a host-protein signature score guided approach was 2/41 patients (4.9%).
The score tended towards a higher sensitivity in detecting BSI than that with PCT. However, its impact on reducing antibiotic use in viral infections was minor compared with that of SOC.
一种宿主蛋白特征评分，由血清中C反应蛋白、肿瘤坏死因子相关凋亡诱导配体和干扰素γ诱导蛋白10的浓度组成，作为德国一家三级医院成年患者常规临床实践中的抗菌管理措施，用于区分细菌感染和病毒感染。
这项单中心探索性研究前瞻性评估了宿主蛋白特征评分，并将其与血流感染（BSI）患者的血清降钙素原（PCT）进行比较，评估其在病毒感染患者中相对于标准治疗（SOC）的疗效，以评估因疑似细菌重叠/合并感染而使用抗生素的必要性。使用制造商指定的阈值评分来区分病毒感染（<35）和细菌感染（>65）。
纳入了97例患者（BSI [n = 56]；病毒感染 [n = 41]）。该评分（临界值评分>65）检测BSI的敏感性倾向于高于PCT（临界值>0.5 ng/mL）（87.5% 对 76.6%）。3例（5.4%）BSI患者的评分<35。1例BSI患者在血培养结果呈阳性之前，按照SOC未接受抗生素治疗。在病毒感染患者中，29例（70.7%）的评分>65，表明存在细菌重叠感染。此外，11例（26.8%）患者的评分<35，表明不存在细菌重叠感染。总体而言，病毒感染组中SOC与宿主蛋白特征评分指导方法之间的抗生素治疗差异为2/41例患者（4.9%）。
该评分在检测BSI方面的敏感性倾向于高于PCT。然而，与SOC相比，其对减少病毒感染中抗生素使用的影响较小。
