1
|
Wilcox CR, Odeh N, Clark TW, Muller I, Becque T, Todd A, Islam N, Little P, Davies F, McGavin J, Francis N. Use of the FebriDx® host-response point-of-care test may reduce antibiotic use for respiratory tract infections in primary care: a mixed-methods feasibility study. J Antimicrob Chemother 2024; 79:1441-1449. [PMID: 38708643 PMCID: PMC11144485 DOI: 10.1093/jac/dkae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION FebriDx® is a CE-marked, single-use point-of-care test with markers for bacterial [C-reactive protein (CRP)] and viral [myxovirus resistance protein A (MxA)] infection, using finger-prick blood samples. Results are available after 10-12 min. We explored the usability and potential impact of FebriDx® in reducing antibiotic prescriptions for lower respiratory tract infection (LRTI) in primary care, and the feasibility of conducting a randomized controlled trial (RCT). METHODS Patients (aged ≥1 year) with LRTI deemed likely to receive antibiotic prescription were recruited at nine general practices and underwent FebriDx® testing. Data collection included FebriDx® results, antibiotic prescribing plan (before and after testing) and re-consultation rates. Staff completed System Usability Scale questionnaires. RESULTS From 31 January 2023 to 9 June 2023, 162 participants participated (median age 57 years), with a median symptom duration of 7 days (IQR 5-14). A valid FebriDx® result was obtained in 97% (157/162). Of 155 patients with available results, 103 (66%) had no detectable CRP or MxA, 28 (18%) had CRP only, 5 (3%) had MxA only, and 19 (12%) had both CRP and MxA. The clinicians' stated management plan was to prescribe antibiotics for 86% (134/155) before testing and 45% (69/155) after testing, meaning a 41% (95% CI: 31%, 51%) difference after testing, without evidence of increased re-consultation rates. Ease-of-use questionnaires showed 'good' user-friendliness. CONCLUSIONS Use of FebriDx® to guide antibiotic prescribing for LRTI in primary care was associated with a substantial reduction in prescribing intentions. These results support a fully powered RCT to confirm its impact and safety.
Collapse
Affiliation(s)
- Christopher R Wilcox
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Nour Odeh
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Tristan W Clark
- School of Clinical and Experimental Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Ingrid Muller
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Taeko Becque
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Alexander Todd
- Lilliput Surgery, Shore Medical Group, Elms Avenue, Poole BH14 8EE, UK
| | - Nazrul Islam
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Paul Little
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Firoza Davies
- Patient and Public Involvement Representative, Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - John McGavin
- Patient and Public Involvement Representative, Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Nick Francis
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| |
Collapse
|
2
|
de la Matta Farrando P, Suay Torres MT, Sabater Sabate A, Trenchs Sainz de la Maza V, Luaces Cubells C, Hernández Bou S. Evaluation of FebriDx® for the management of children with acute febrile respiratory infection. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:313-316. [PMID: 38688819 DOI: 10.1016/j.eimce.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/25/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Acute respiratory infections (ARI) are a common cause of inappropriate antibiotic prescription (ATB) in pediatrics. FebriDx® is a rapid diagnostic test that differentiates between viral and bacterial infections. The objective is to analyse the impact of FebriDx® on ATB prescription when managing febrile ARI. METHODS Prospective study carried out in patients aged 1-<18 years with febrile ARI in the emergency department. FebriDx® was performed and the impact on management was evaluated at follow-up. RESULTS A total of 216 patients were included. Clinical assessment and FebriDx® result coincided coincided in 174 (80.5%) cases. A modification of the initial therapeutic plan was made in 22 (52.4%) of the 42 discordant ones (10.2% of the overall patients). In pneumonia the impact was 34.5%; in all cases it involved not prescribing ATB. CONCLUSIONS FebriDx® could be a useful tool in the management of pediatric patients with febrile ARI to optimize ATB prescription.
Collapse
Affiliation(s)
| | - Maria Teresa Suay Torres
- Área de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
| | - Anna Sabater Sabate
- Área de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain
| | - Victoria Trenchs Sainz de la Maza
- Área de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain; Influencia del entorno en el bienestar del niño y del adolescente, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Universidad de Barcelona, Barcelona, Spain.
| | - Carles Luaces Cubells
- Área de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain; Influencia del entorno en el bienestar del niño y del adolescente, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Universidad de Barcelona, Barcelona, Spain
| | - Susanna Hernández Bou
- Área de Urgencias, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona, Spain; Influencia del entorno en el bienestar del niño y del adolescente, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Enfermedades Infecciosas y Microbioma, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| |
Collapse
|
3
|
Sapozhnikov J, Albarillo FS, Pulia MS. Optimizing Antimicrobial Stewardship in the Emergency Department. Emerg Med Clin North Am 2024; 42:443-459. [PMID: 38641398 DOI: 10.1016/j.emc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Antibiotic stewardship is a core component of emergency department (ED) practice and impacts patient safety, clinical outcomes, and public health. The unique characteristics of ED practice, including crowding, time pressure, and diagnostic uncertainty, need to be considered when implementing antibiotic stewardship interventions in this setting. Rapid advances in pathogen detection and host response biomarkers promise to revolutionize the diagnosis of infectious diseases in the ED, but such tests are not yet considered standard of care. Presently, clinical decision support embedded in the electronic health record and pharmacist-led interventions are the most effective ways to improve antibiotic prescribing in the ED.
Collapse
Affiliation(s)
- Julia Sapozhnikov
- Medical Science Liaison, Karius Inc, 975 Island Drive, Redwood City, CA 94065, USA
| | - Fritzie S Albarillo
- Department of Medicine, Infectious Diseases Division, Loyola University Medical Center, Loyola University Medical Center is 2160 South First Avenue, Maywood, IL 60153, USA
| | - Michael S Pulia
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 300, Madison, WI 53705, USA.
| |
Collapse
|
4
|
Iliopoulou K, Koufargyris P, Doulou S, Tasouli E, Katopodis S, Chachali SP, Schinas G, Karachalios C, Astriti M, Katsaounou P, Chrysos G, Seferlis T, Dimopoulou E, Kollia M, Poulakou G, Gerakari S, Papanikolaou IC, Milionis H, Dalekos GN, Tzavara V, Kontopoulou T, Giamarellos-Bourboulis EJ. Developing a Tool for Differentiation Between Bacterial and Viral Respiratory Infections Using Myxovirus Resistance Protein A and C-Reactive Protein. Infect Dis Ther 2024; 13:105-119. [PMID: 38112973 PMCID: PMC10828347 DOI: 10.1007/s40121-023-00901-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION The aim was to assess the performance of a blood assay combining measurements of MxA (myxovirus resistance protein A) and CRP (C-reactive protein) to differentiate viral from bacterial respiratory infections. METHODS In a prospective study, MxA and CRP were measured in the blood by the AFIAS panel in adults admitted with respiratory infection. Patients were split into discovery and validation cohorts. Final diagnosis was adjudicated by a panel of experts. Microbiology-confirmed cases comprised the discovery cohort, and infections adjudicated as highly probable viral or bacterial comprised the validation cohort. RESULTS A total of 537 patients were analyzed: 136 patients were adjudicated with definitive viral infections and 131 patients with definitive bacterial infections. Using logistic regression analysis, an equation was developed to calculate the probability for bacterial infection using the absolute value of MxA and CRP. Calculated probability ≥ 0.5 and/or MxA to CRP ratio less than 2 applied as the diagnostic rule for bacterial infections. This rule provided 91.6% sensitivity and 90.4% negative predictive value for the diagnosis of bacterial infections. This diagnostic sensitivity was confirmed in the validation cohort. A MxA/CRP ratio less than 0.15 was associated with unfavorable outcome. CONCLUSION The calculation of the probability for bacterial infection using MxA and CRP may efficiently discriminate between viral and bacterial respiratory infections.
Collapse
Affiliation(s)
- Konstantina Iliopoulou
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Panagiotis Koufargyris
- Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Sarantia Doulou
- Fifth Department of Internal Medicine, Evangelismos Athens General Hospital, Athens, Greece
| | - Elisavet Tasouli
- First Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Sokratis Katopodis
- Second Department of Propedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula-Porphyria Chachali
- Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Georgios Schinas
- Depertment of Internal Medicine, University of Patras, Rion, Greece
| | - Charalampos Karachalios
- Third Department of Internal Medicine and Infectious Diseases Unit, Korgialeneio-Benakeio General Hospital, Athens, Greece
| | - Myrto Astriti
- First Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Paraskevi Katsaounou
- First Department of Critical Care and Pulmonary Medicine, Medical School, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Chrysos
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Theodoros Seferlis
- Second Department of Internal Medicine, Konstantopouleio General Hospital, Athens, Greece
| | | | - Myrto Kollia
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Garyphalia Poulakou
- Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Styliani Gerakari
- Emergency Department, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Ilias C Papanikolaou
- Department of Pulmonary Medicine, General Hospital of Corfu "Agia Eirini", Kontokali, Greece
| | - Haralampos Milionis
- First Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, 41110, Larissa, Greece
| | - Vasiliki Tzavara
- First Department of Internal Medicine, Korgialeneio-Benakeio General Hospital, Athens, Greece
| | - Theano Kontopoulou
- Fifth Department of Internal Medicine, Evangelismos Athens General Hospital, Athens, Greece
- First Department of Internal Medicine, Evangelismos Athens General Hospital, Athens, Greece
| | - Evangelos J Giamarellos-Bourboulis
- Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece.
- Hellenic Institute for the Study of Sepsis, Athens, Greece.
| |
Collapse
|
5
|
Nainu F, Ophinni Y, Shiratsuchi A, Nakanishi Y. Apoptosis and Phagocytosis as Antiviral Mechanisms. Subcell Biochem 2023; 106:77-112. [PMID: 38159224 DOI: 10.1007/978-3-031-40086-5_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Viruses are infectious entities that make use of the replication machinery of their hosts to produce more progenies, causing disease and sometimes death. To counter viral infection, metazoan hosts are equipped with various defense mechanisms, from the rapid-evoking innate immune responses to the most advanced adaptive immune responses. Previous research demonstrated that cells in fruit flies and mice infected with Drosophila C virus and influenza, respectively, undergo apoptosis, which triggers the engulfment of apoptotic virus-infected cells by phagocytes. This process involves the recognition of eat-me signals on the surface of virus-infected cells by receptors of specialized phagocytes, such as macrophages and neutrophils in mice and hemocytes in fruit flies, to facilitate the phagocytic elimination of virus-infected cells. Inhibition of phagocytosis led to severe pathologies and death in both species, indicating that apoptosis-dependent phagocytosis of virus-infected cells is a conserved antiviral mechanism in multicellular organisms. Indeed, our understanding of the mechanisms underlying apoptosis-dependent phagocytosis of virus-infected cells has shed a new perspective on how hosts defend themselves against viral infection. This chapter explores the mechanisms of this process and its potential for developing new treatments for viral diseases.
Collapse
Affiliation(s)
- Firzan Nainu
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia.
| | - Youdiil Ophinni
- Division of Clinical Virology, Center for Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan
- Laboratory of Host Defense, Immunology Frontier Research Center, Osaka University, Osaka, Japan
| | - Akiko Shiratsuchi
- Center for Medical Education, Sapporo Medical University, Sapporo, Japan
- Division of Biological Function and Regulation, Graduate School of Medicine, Sapporo Medical University, Sapporo, Japan
| | | |
Collapse
|