Dedeoglu Bilge Eylem, Tanner Alex R, Brendish Nathan J, Moyses Helen E, Clark Tristan W
NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
J Infect. 2024 Dec;89(6):106360. doi: 10.1016/j.jinf.2024.106360. Epub 2024 Nov 22.
Distinguishing bacterial from viral acute respiratory infection (ARI) is challenging, leading to inappropriate antimicrobial use and antimicrobial resistance. We evaluated the accuracy of two host-response tests to differentiate bacterial and viral infection.
This study used patient blood samples previously collected during a randomised controlled trial of adults hospitalised with ARI. The aetiology for each patient was clinically adjudicated. PAXgene blood RNA samples were tested using the TriVerity test (which measures 29 mRNAs) and serum samples were tested using the MeMed BV test (which measures 3 proteins). Diagnostic accuracy was calculated against adjudicated aetiology.
169 patients were tested. Median age was 60 (45-74) years and 152 (90%) received antibiotics. 60 (36%) were adjudicated as bacterial, 54 (32%) as viral, 26 (15%) as viral/bacterial co-infection, and 29 (17%) as non-infected. For bacterial (including bacterial/viral co-infection) versus non-bacterial infection, the TriVerity bacterial score had a Positive Percentage Agreement (PPA) of 81% (95%CI 70-89) and a Negative Percentage Agreement (NPA) of 66% (95%CI 55-79) and the MeMed BV score had a PPA of 96% (95%CI 90-99) and NPA of 34% (95%CI 23-47). The AUROC for the two tests was 0.77 (95%CI 0.70-0.84) and 0.81 (95%CI 0.74-0.87) respectively, p = 0.388.
Both tests demonstrated similar overall accuracy for distinguishing bacterial infection with the Triverity test missing some bacterial infections and MeMed BV misclassifying most viral infections as bacterial. Prospective impact studies evaluating antibiotic use, safety and cost effectiveness are now required.
区分细菌感染与病毒感染所致的急性呼吸道感染（ARI）具有挑战性，这会导致抗菌药物使用不当及产生耐药性。我们评估了两种宿主反应检测方法鉴别细菌和病毒感染的准确性。
本研究使用了先前在一项针对ARI住院成人的随机对照试验中采集的患者血样。对每位患者的病因进行临床判定。使用TriVerity检测（检测29种信使核糖核酸）对PAXgene血液RNA样本进行检测，使用MeMed BV检测（检测3种蛋白质）对血清样本进行检测。根据判定的病因计算诊断准确性。
对169例患者进行了检测。中位年龄为60（45 - 74）岁，152例（90%）接受了抗生素治疗。60例（36%）被判定为细菌感染，54例（32%）为病毒感染，26例（15%）为病毒/细菌混合感染，29例（17%）为非感染。对于细菌感染（包括细菌/病毒混合感染）与非细菌感染，TriVerity细菌评分的阳性百分比一致性（PPA）为81%（95%CI 70 - 89），阴性百分比一致性（NPA）为66%（95%CI 55 - 79）；MeMed BV评分的PPA为96%（95%CI 90 - 99），NPA为34%（95%CI 23 - 47）。两种检测方法的受试者工作特征曲线下面积（AUROC）分别为0.77（95%CI 0.70 - 0.84）和0.81（95%CI 0.74 - 0.87），p = 0.388。
两种检测方法在区分细菌感染方面总体准确性相似，TriVerity检测遗漏了一些细菌感染，而MeMed BV检测将大多数病毒感染误分类为细菌感染。现在需要进行评估抗生素使用、安全性和成本效益的前瞻性影响研究。
