1948. A Host-response Assay Distinguishes Between Simple Influenza Patients and Influenza Patients with Bacterial Coinfection
Session: Poster Abstract Session: Clinical Trials
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • ID week 2018 Influenza poster final.pdf (653.7 kB)
  • Background:

    Identifying bacterial coinfection in influenza patients can be difficult as the symptoms of simple influenza versus mixed infections are often similar, leading to antibiotic overuse. A new host-response assay (ImmunoXpert™) that integrates the levels of three proteins (TRAIL, IP-10, and CRP) was shown to exhibit high performance in distinguishing between bacterial and viral disease in two double-blind validation studies. Here we sought to evaluate its ability to differentiate between simple influenza and influenza with bacterial coinfection.

    Methods:

    The study population included 653 febrile pediatric and adult patients prospectively recruited in the “Curiosity” study. Patient etiology (simple viral versus mixed infection) was determined by unanimous expert adjudication based on comprehensive clinical, laboratory and radiological assessment. Influenza strains (A or B) were detected using multiplex PCR applied to nasal swabs (Seeplex-RV15). We compared the expert panel diagnosis with the assay that gives three possible outcomes: viral, bacterial (including viral with bacterial coinfection) or equivocal. An equivocal outcome does not provide diagnostic information and is observed in ~10% of cases.

    Results:

    Out of 653 patients, 51 had positive influenza detection and unanimous expert diagnosis: 44 simple viral infections and 7 influenza with bacterial coinfections (Figure 1). Antibiotics were prescribed to all 7 cases of influenza with bacterial coinfection and to 20/44 cases adjudicated as simple viral infections, indicating an overuse rate of 45%. The assay correctly classified 40 of the 44 simple viral cases (out of the remaining 4, 2 were assigned viral with bacterial coinfection and 2 received equivocal outcomes) as well as 5 of the 7 viral with bacterial coinfection cases (the remaining 2 received equivocal outcomes) supporting the assay’s potential to reduce antibiotic overuse 5-fold (from 45% to 4/44=9%, P<0.001).

    Conclusion:

    The host-response assay can differentiate between simple influenza and influenza patients with bacterial coinfection, with potential to reduce antibiotic overuse. Utility studies are warranted to demonstrate that the assay can safely assist physicians in correct management of influenza patients

     

    Meital Paz, BSc1, Kfir Oved, PhD1, Tanya Gottlieb, PhD1, Asi Cohen, PhD1, Roy Navon, MSc1, Niv Mastboim, BSc1, Ellen Bamberger, MD1,2,3, Tom Friedman, MD1,4, Liat Etshtein, MD1,4, Olga Boico, PhD1, Isaac Srugo, MD2,3, Irina Chistyakov, MD2,3, Adi Klein, MD3,5, Israel Potasman, MD, FIDSA3,6, Eran Eden, PhD1 and Liran Shani, MD1, (1)MeMed Diagnostics, Tirat Carmel, Israel, (2)Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel, (3)Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel, (4)Rambam Health Care Campus, Haifa, Israel, (5)Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel, (6)Infectious Diseases, Bnai Zion Medical Center, Haifa, Israel

    Disclosures:

    M. Paz, MeMed Diagnostics: Employee , Salary .

    K. Oved, MeMed Diagnostics: Board Member , Employee and Shareholder , Salary .

    T. Gottlieb, MeMed Diagnostics: Employee , Salary .

    A. Cohen, MeMed Diagnostics: Employee , Salary .

    R. Navon, MeMed Diagnostics: Employee , Salary .

    N. Mastboim, MeMed Diagnostics: Employee , Salary .

    E. Bamberger, MeMed Diagnostics: Employee , Salary .

    T. Friedman, MeMed Diagnostics: Employee , Salary .

    L. Etshtein, MeMed Diagnostics: Employee , Salary .

    O. Boico, MeMed Diagnostics: Employee , Salary .

    I. Srugo, None

    I. Chistyakov, None

    A. Klein, None

    I. Potasman, MeMed Diagnostics: Holding stock options , Stock options .

    E. Eden, MeMed Diagnostics: Board Member , Employee and Shareholder , Salary .

    L. Shani, MeMed Diagnostics: Employee , Salary .

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