Promising blood test to distinguish between viral and bacterial infections, help antibiotic misuse

Rapid blood test could help antibiotic misuse in patients

In cases of severe illness, antibiotics are usually prescribed while waiting for the results, and this can contribute to antibiotic resistance. A new blood test was good at distinguishing between viral and bacterial infections, and separating people with and without an infectious disease. This opens the potential to improve management of patients with acute infections and reduce antibiotic misuse.

blood-in-tubes image
A new blood test helped researchers from several institutes and medical centres in Israel tease out whether an infection is caused by a virus or bacteria within two hours.

2015 Study Abstract

Bacterial and viral infections are often clinically indistinguishable, leading to inappropriate patient management and antibiotic misuse. Bacterial-induced host proteins such as procalcitonin, C-reactive protein (CRP), and Interleukin-6, are routinely used to support diagnosis of infection. However, their performance is negatively affected by inter-patient variability, including time from symptom onset, clinical syndrome, and pathogens. Our aim was to identify novel viral-induced host proteins that can complement bacterial-induced proteins to increase diagnostic accuracy. Initially, we conducted a bioinformatic screen to identify putative circulating host immune response proteins. The resulting 600 candidates were then quantitatively screened for diagnostic potential using blood samples from 1002 prospectively recruited patients with suspected acute infectious disease and controls with no apparent infection. For each patient, three independent physicians assigned a diagnosis based on comprehensive clinical and laboratory investigation including PCR for 21 pathogens yielding 319 bacterial, 334 viral, 112 control and 98 indeterminate diagnoses; 139 patients were excluded based on predetermined criteria. The best performing host-protein was TNF-related apoptosis-inducing ligand (TRAIL) (area under the curve [AUC] of 0.89; 95% confidence interval [CI], 0.86 to 0.91), which was consistently up-regulated in viral infected patients. We further developed a multi-protein signature using logistic-regression on half of the patients and validated it on the remaining half. The signature with the highest precision included both viral- and bacterial-induced proteins: TRAIL, Interferon gamma-induced protein-10, and CRP (AUC of 0.94; 95% CI, 0.92 to 0.96). The signature was superior to any of the individual proteins (P<0.001), as well as routinely used clinical parameters and their combinations (P<0.001). It remained robust across different physiological systems, times from symptom onset, and pathogens (AUCs 0.87-1.0). The accurate differential diagnosis provided by this novel combination of viral- and bacterial-induced proteins has the potential to improve management of patients with acute infections and reduce antibiotic misuse.

Sources and more information
  • A Novel Host-Proteome Signature for Distinguishing between Acute Bacterial and Viral Infections, PLOS one, DOI: 10.1371/journal.pone.0120012, March 18, 2015.
  • Rapid blood test to ‘cut antibiotic use’, BBC News Health, 19 March 2015.
  • New blood test could help prevent antibiotic misuse, NHS Choice, March 19 2015.

Author: DES Daughter

Activist, blogger and social media addict committed to shedding light on a global health scandal and dedicated to raise DES awareness.

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