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A Host-Protein Test for Differentiating Bacterial From Viral Infection: Diagnostic Accuracy in Elderly Patients
Tanya M Gottlieb1, Yaly Orr1, Hagai Hamami1
1MeMed Diagnostics, Tirat Carmel, Israel.
Objectives:
Older adults are vulnerable to infection and are difficult to diagnose. This study assessed the performance of MeMed BV (MMBV), a host-protein test for differentiating bacterial from viral infection, in adults ≥65 years.
Methods:
Post hoc pooled and meta-analysis of adults with suspected acute infections enrolled in 3 prospective studies. MMBV results were interpreted as bacterial/viral/equivocal per manufacturer's instructions. Reference standard infection etiology was adjudicated by experienced physicians who were blinded to MMBV. Diagnostic accuracy for bacterial infection was calculated for MMBV results (area under the receiver operating characteristic curve [AUC], bin analysis) and for unequivocal MMBV results (sensitivity/specificity). MMBV's potential impact on antibiotic use was estimated by comparing MMBV-guided decisions to actual practice.
Results:
A total of 754 younger (18-64 years) and 248 older (≥65 years) adults were included. Among older adults, the median age was 75.0 years (IQR, 69.0, 82.0), 53.2% were male, 68.1% were hospitalized, and 79.0% had ≥3 comorbidities. Respiratory tract infections were common (76.2%), and 85.1% were prescribed antibiotics. A total of 111 patients were assigned a bacterial reference standard infection etiology, 77 a viral etiology, and 60 an indeterminate etiology. In pooled analysis, MMBV attained comparable AUC in older (0.95; 95% CI, 0.92-0.98) vs younger adults (0.95; 0.93-0.97). Focusing on older adults, 96.2% (90.3-98.8) sensitivity and 85.7% (74.8-92.5) specificity with 10.6% equivocal results were observed. MMBV could reduce potentially unwarranted antibiotic prescriptions 2.5-fold (from 62.3% to 24.7%; P < .0001). Using a bivariate model, MMBV similarly attained AUC 0.92 (0.81-0.97).
Conclusions:
MMBV demonstrated high diagnostic accuracy in older adults, supporting its potential to optimize antibiotic use in this population. Further studies are needed to evaluate real-world utility.
Insights
The MeMed BV (MMBV) test accurately differentiates bacterial from viral infections in older adults, showing potential to reduce unnecessary antibiotic prescriptions. This host-protein test aids in diagnosing infections in this vulnerable population.
Area of Science:
- Infectious Diseases
- Clinical Diagnostics
- Geriatrics
Background:
- Older adults are susceptible to infections with diagnostic challenges.
- Accurate differentiation between bacterial and viral infections is crucial for appropriate treatment in the elderly.
Purpose of the Study:
- To evaluate the diagnostic performance of the MeMed BV (MMBV) host-protein test in adults aged 65 years and older.
- To assess the potential impact of MMBV on antibiotic prescribing practices in older adults.
Main Methods:
- A post hoc pooled analysis and meta-analysis of three prospective studies involving adults with suspected acute infections.
- MMBV results were categorized as bacterial, viral, or equivocal. Infection etiology was determined by physicians blinded to MMBV results.
- Diagnostic accuracy (AUC, sensitivity, specificity) was calculated, and the impact on antibiotic use was estimated.
Main Results:
- The study included 248 older adults (≥65 years) with a median age of 75.0 years.
- MMBV demonstrated high diagnostic accuracy in older adults, with an AUC of 0.95, comparable to younger adults.
- The test achieved 96.2% sensitivity and 85.7% specificity for bacterial infections, with 10.6% equivocal results. MMBV could potentially reduce antibiotic prescriptions by 2.5-fold.
Conclusions:
- The MeMed BV (MMBV) test exhibits high diagnostic accuracy in older adults for differentiating bacterial from viral infections.
- MMBV shows promise in optimizing antibiotic use in the elderly population.
- Further research is warranted to confirm the real-world clinical utility of MMBV.
