Background The management of patients with suspected infections requires identification of the infectious etiology to determine appropriate use of antibiotics. However, differentiating viral from bacterial infection (and co-infection) is often challenging as clinical presentations can be similar and existing diagnostics sometimes fail to identify a clinically relevant pathogen. A host-response test (MeMed BV®, MMBV) that relies on computational integration of three proteins (TRAIL, IP-10 and CRP) measured from blood or serum has demonstrated high diagnostic performance for differentiating bacterial from viral infections, with a negative predictive value >95% across multiple studies. This report evaluates real-world use of MMBV at a micro-hospital Emergency Department (ED) and associated antibiotic prescribing. Methods The study is a retrospective analysis of real-world data collected between January and June 2023. MMBV was ordered by providers at a micro-hospital ED in Tucson, AZ at provider discretion as part of routine care. Prescription among cases with MMBV score <35 was analyzed. This cutoff is indicated by the manufacturer to indicate a viral or other non-bacterial etiology. If an antibiotic was prescribed, the authors conducted a chart review to adjudicate whether the prescription was warranted. Results Data was evaluated between January and June 2023; 116 MMBV tests were ordered by six providers. Most tests (81.9% (95%CI: ±7.0%)) had an MMBV score <35 (mean score 11.3 with standard deviation 10.8). Among these, 92.6% (95%CI: ±5.3%) of cases with viral results were not prescribed antibiotics. MMBV use increased throughout the study period from 12 tests in the first month to 25 in the last month (r = 0.88; p<0.001). There were seven cases where providers chose to prescribe despite a viral MMBV result. Upon chart review, 2/7 were unwarranted prescriptions. Conclusions In the emergency settings, integrating MMBV can effectively guide clinical decision-making, potentially reducing unnecessary antibiotic use. Further research in diverse healthcare settings is needed to validate these findings.

中文翻译：

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B-047 快速宿主反应检测支持微型医院急诊科的抗菌药物管理


背景 疑似感染患者的管理需要确定感染病因，以确定抗生素的适当使用。然而，区分病毒与细菌感染（和混合感染）通常具有挑战性，因为临床表现可能相似，并且现有诊断有时无法识别临床相关的病原体。依赖于从血液或血清中测量的三种蛋白质（TRAIL、IP-10 和 CRP）的计算整合的宿主反应测试（MeMed BV®、MMBV）已证明在区分细菌和病毒感染方面具有很高的诊断性能，在多项研究中具有阴性预测值 >95%。本报告评估了微型医院急诊科 （ED） 和 相关抗生素处方 MMBV 的实际使用情况。方法 该研究是对 2023 年 1 月至 6 月期间收集的真实世界数据的回顾性分析。MMBV 是由亚利桑那州图森市一家微型医院急诊科的提供者根据提供者的判断订购的，作为常规护理的一部分。分析 MMBV 评分为 <35 的病例的处方。制造商指示此临界值，以表明病毒或其他非细菌病因。如果开了抗生素，作者会进行图表审查，以确定是否有必要开处方。结果 数据在 2023 年 1 月至 6 月期间进行评估;6 家提供商订购了 116 次 MMBV 检测。大多数测试 （81.9% （95%CI： ±7.0%）） 的 MMBV 评分为 <35 （平均评分 11.3，标准差 10.8）。其中，92.6% （95% CI： ±5.3%） 的病毒结果病例没有开具抗生素。在整个研究期间，MMBV 的使用从第一个月的 12 次测试增加到最后一个月的 25 次 （r = 0.88;p<0.001）。 有 7 例提供者选择开处方，尽管有病毒性 MMBV 结果。在图表审查时，2/7 是毫无根据的处方。结论 在紧急情况下，整合 MMBV 可以有效地指导临床决策，可能减少不必要的抗生素使用。需要在不同的医疗保健环境中进行进一步研究来验证这些发现。