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Host Transcriptional Signatures Predict Etiology in Community-Acquired Pneumonia: Potential Antibiotic Stewardship

William W Siljan1, Dhanasekaran Sivakumaran2,3, Christian Ritz2,4

  • 1Department of Pulmonary Medicine, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.

Biomarker Insights
|June 13, 2022
PubMed
Abstract

Insights

Accurate pathogen identification in community-acquired pneumonia (CAP) is crucial. Host transcriptional signatures in blood show promise for differentiating bacterial from viral CAP, aiding antibiotic stewardship.

Area of Science:

  • Medical diagnostics
  • Molecular biology
  • Infectious disease

Background:

  • Current methods for identifying pathogens in community-acquired pneumonia (CAP) are insufficient, leading to a lack of diagnosis for most patients.
  • Improved diagnostic tools are needed to distinguish between viral and bacterial CAP, thereby reducing unnecessary antibiotic use in viral cases.

Purpose of the Study:

  • To identify host transcriptional signatures in peripheral blood that can differentiate between bacterial, viral, and mixed viral-bacterial infections in hospitalized CAP patients.
  • To evaluate the diagnostic accuracy of these signatures using Dual-color-Reverse-Transcriptase-Multiplex-Ligation-dependent-Probe-Amplification (dc-RT MLPA).

Main Methods:

  • 156 adult CAP patients were analyzed.
  • Peripheral blood samples were collected at hospital admission.
  • Dual-color-Reverse-Transcriptase-Multiplex-Ligation-dependent-Probe-Amplification (dc-RT MLPA) was used to identify host transcriptional signatures.

Main Results:

  • A 9-transcript signature accurately discriminated bacterial from viral CAP (AUC 0.91) when patients were classified by microbiological testing.
  • A 13-transcript signature showed perfect accuracy (AUC 1.00) in discriminating bacterial from viral CAP when patients were classified by microbiological testing and procalcitonin (PCT) levels.
  • Signatures also effectively differentiated mixed viral-bacterial from viral CAP.

Conclusions:

  • Host transcriptional signatures in peripheral blood are a promising tool for diagnosing CAP etiology.
  • These signatures can guide clinical decisions and support antibiotic stewardship efforts in managing CAP.
Keywords:
Pneumoniaantimicrobial stewardshipbacteriaclinical decision-makinggene expression signaturesviruses

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