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Tannous E, Lipman-Arens S, Cohen R. Should a minimum Daptomycin AUC24h of 666 mg/L/h be the target in Staphylococcus aureus infections? Clin Infect Dis 2024:ciae086. [PMID: 38446985 DOI: 10.1093/cid/ciae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/14/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
- Elias Tannous
- Pharmacy Services, Hillel Yaffe Medical Centre, Hadera, Israel
- Department of clinical biochemistry and pharmacology, Faculty of health sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Shelly Lipman-Arens
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Regev Cohen
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
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2
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Lipman-Arens S, Finn T, Istomin V, Cohen R, Reisfeld S. The Prognostic Value of Serology in Persistent Q Fever Infection. Vector Borne Zoonotic Dis 2024. [PMID: 38306181 DOI: 10.1089/vbz.2023.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024] Open
Abstract
Background: Q fever has significant consequences for patients with persistent localized infection. A combination of doxycycline with hydroxychloroquine, for at least 18-24 months, is the first-line therapy. The use of serology as a prognostic marker during therapy is controversial. Methods: A retrospective, observational cohort study in two outpatient clinics in northern Israel. All adults with persistent Q fever (2015-2021) were included in the study. Clinical failure was defined as relapse or death related to Q fever after end of treatment (EOT). Serological cure was defined as phase 1 IgG ≤800 or a four-fold decrease at EOT. Results: Twenty-two patients were included in the study, with a median follow up of 40 months (IQR = 28.5-63.5), and median treatment duration of 28.5 months (IQR = 21.8-50.5). Clinical cure occurred in 18 patients (82%), serological cure in 10 (45%). Phase 1 IgG at presentation was significantly higher in the clinical failure group (median 9600 vs. 3200 in the clinical cure group, p = 0.019), and at 6-12 months after EOT (median 6400 vs. 800 respectively, p = 0.03). Phase 1 IgG levels at 1 year and EOT were similar in both groups. Positive phase 2 IgM after one year of therapy correlated with clinical failure (p = 0.038), but not at EOT or after EOT. Conclusion: Phase 1 IgG levels at presentation, phase 2 IgM at 1 year, and Phase 1 IgG 6-12 months after EOT were associated with clinical failure in patients with persistent Q fever.
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Affiliation(s)
- Shelly Lipman-Arens
- Infectious Diseases Unit, Hillel Yaffe Medical Center, Hadera, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Talya Finn
- Infectious Diseases Unit, Sanz Medical Center, Netanya, Israel
| | - Valery Istomin
- Internal Medicine Department C, Hillel Yaffe Medical Center, Hadera, Israel
| | - Regev Cohen
- Infectious Diseases Unit, Hillel Yaffe Medical Center, Hadera, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Sharon Reisfeld
- Infectious Diseases Unit, Hillel Yaffe Medical Center, Hadera, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Cohen R, Tannous E, Natan OB, Vaknin A, Ganayem M, Reisfeld S, Lipman-Arens S, Mahamid L, Ishay L, Karisi E, Melnik N, Leibel M, Ashkar J, Freimann S. An emergency department intervention to improve earlier detection of community-onset bloodstream infection among hospitalized patients. Am J Infect Control 2024:S0196-6553(24)00003-8. [PMID: 38232901 DOI: 10.1016/j.ajic.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Blood cultures (BCs) are essential microbiologic tests, but blood culturing diagnostic stewardship is frequently poor. We aimed to study the process-related failures and to evaluate the effect of an emergency department (ED) intervention on BCs collection practices and yield. METHODS We implemented an ED-quality improvement intervention including educational sessions, phlebotomists addition, promoting single-site strategy for BC-collection and preanalytical data feedback. BC-bottles collected, positive BCs, blood volumes and documentation of collection times were measured, before (December 2021-August 2022) and after (September 2022-July 2023) intervention. Results were corrected to hospitalizations admissions or days. We used interrupted-time series analyses for comparisons. RESULTS A total of 64,295 BC bottles were evaluated, 26,261 before and 38,034 postintervention. The median ED-BCs collected and week increased from 88 to 105 BCs (P < .0001), resulting from increased early sampling (P = .0001). Solitary BCs decreased (95%-28%), documented times increased (2.8%-25%), and average blood volume increased (3 mL to 4.5 mL) postintervention. Community-onset Bloodstream infections (BSIs) increased (39.6-52 bottles/1,000 admissions, P = .0001), while Health care-associated BSIs decreased (39-27 bottles/10,000 days, P = .0042). Contamination rates did not change. CONCLUSIONS An ED-focused intervention based on the education sessions and single-site strategy improved culturing stewardship and facilitated the early identification of BSI without an increase in contamination.
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Affiliation(s)
- Regev Cohen
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Elias Tannous
- Pharmacy Department, Hillel Yaffe Medical Centre, Hadera, Israel; Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Orna Ben Natan
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Aliza Vaknin
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Mohammed Ganayem
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Sharon Reisfeld
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shelly Lipman-Arens
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lamis Mahamid
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Linor Ishay
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Erez Karisi
- Information Technology Department, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Noa Melnik
- Information Technology Department, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Mira Leibel
- Emergency Department, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Jalal Ashkar
- Emergency Department, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Sarit Freimann
- Department of Laboratories, Clinical Microbiology Laboratory, Hillel Yaffe Medical Centre, Hadera, Israel
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Klein A, Shapira M, Lipman-Arens S, Bamberger E, Srugo I, Chistyakov I, Stein M. Diagnostic Accuracy of a Real-Time Host-Protein Test for Infection. Pediatrics 2023; 152:e2022060441. [PMID: 37916266 DOI: 10.1542/peds.2022-060441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Determining infection etiology can be difficult because viral and bacterial diseases often manifest similarly. A host protein test that computationally integrates the circulating levels of TNF-related apoptosis-induced ligand, interferon γ-induced protein-10, and C-reactive protein to differentiate between bacterial and viral infection (called MMBV) demonstrated high performance in multiple prospective clinical validation studies. Here, MMBV's diagnostic accuracy is evaluated in febrile children for whom physicians were uncertain about etiology when applied at the physician's discretion. METHODS Patients aged 3 months to 18 years were retrospectively recruited (NCT03075111; SPIRIT study; 2014-2017). Emergency department physician's etiological suspicion and certainty level were recorded in a questionnaire at blood-draw. MMBV results are based on predefined score thresholds: viral/non-bacterial etiology (0 ≤ score <35), equivocal (35 ≤ score ≤65), and bacterial or coinfection (65 < score ≤100). Reference standard etiology (bacterial/viral/indeterminate) was adjudicated by 3 independent experts based on all available patient data. Experts were blinded to MMBV. MMBV and physician's etiological suspicion were assessed against the reference standard. RESULTS Of 3003 potentially eligible patients, the physicians were uncertain about infection etiology for 736 of the cases assigned a reference standard (128 bacterial, 608 viral). MMBV performed with sensitivity 89.7% (96/107; 95% confidence interval 82.4-94.3) and specificity 92.6% (498/538; 95% confidence interval 90.0-94.5), significantly outperforming physician's etiological suspicion (sensitivity 49/74 = 66.2%, specificity 265/368 = 72.0%; P < .0001). MMBV equivocal rate was 12.4% (91/736). CONCLUSIONS MMBV was more accurate in determining etiology compared with physician's suspicion and had high sensitivity and specificity according to the reference standard.
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Affiliation(s)
- Adi Klein
- Pediatrics Department
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ma'anit Shapira
- Laboratory Division
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shelly Lipman-Arens
- Infectious Diseases, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ellen Bamberger
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Pediatrics Department
| | | | | | - Michal Stein
- Pediatric Infectious Diseases Unit, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Tel-Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Brosh-Nissimov T, Hussein K, Wiener-Well Y, Orenbuch-Harroch E, Elbaz M, Lipman-Arens S, Maor Y, Yagel Y, Chazan B, Hershman-Sarafov M, Rahav G, Zimhony O, Shimshovitz AZ, Chowers M. Hospitalized Patients With Severe Coronavirus Disease 2019 During the Omicron Wave in Israel: Benefits of a Fourth Vaccine Dose. Clin Infect Dis 2022; 76:e234-e239. [PMID: 35724127 PMCID: PMC9278185 DOI: 10.1093/cid/ciac501] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Waning immunity and an increased incidence of coronavirus disease 2019 (COVID-19) during the Omicron outbreak led the Israeli Ministry of Health to recommend a fourth vaccine dose for high-risk individuals. In this study, we assessed its effect for hospitalized patients with severe breakthrough COVID-19. METHODS In this multicenter cohort study of hospitalized adults with severe COVID-19 in Israel, from 15 to 31 January 2022, cases were divided according to the number of vaccinations received. Poor outcome was defined as mechanical ventilation or in-hospital death and was compared between 3- and 4-dose vaccinees using logistic regression. RESULTS Included were 1049 patients, median age 80 years. Among them, 394 were unvaccinated, 386 and 88 had received 3 or 4 doses, respectively. The 3-dose group was older, included more males, and immunosuppressed patients but with similar outcomes, 49% vs 51% compared with unvaccinated patients (P = .72). Patients who received 4 doses were similarly older and immunosuppressed but had better outcomes compared with unvaccinated patients, 34% vs 51% (P < .01). We examined independent predictors for poor outcome in patients who received either 3 or 4 doses a median of 161 days or 14 days before diagnosis, respectively. Receipt of the fourth dose was associated with protection (odds ratio, 0.51; 95% confidence interval, .3-.87), as was remdesivir. Male sex, chronic renal failure, and dementia were associated with poor outcomes. CONCLUSIONS Among hospitalized patients with severe breakthrough COVID-19, a recent fourth dose was associated with significant protection against mechanical ventilation or death compared with 3 doses.
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Affiliation(s)
- Tal Brosh-Nissimov
- Corresponding author: Dr. Tal Brosh-Nissimov Head of infectious Diseases Unit Samson Assuta-Ashdod University Hospital Harefua St. 7 Ashdod 7747629, Israel ;
| | - Khetam Hussein
- Rambam Health Care Campus, Haifa, Israel,Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
| | - Yonit Wiener-Well
- Shaare Zedek Medical Center, Jerusalem, Israel,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Efrat Orenbuch-Harroch
- Division of Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Meital Elbaz
- Department of Infectious Diseases, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Lipman-Arens
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel,Infectious disease and Infection Control Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yasmin Maor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Infectious Disease Unit, Wolfson Medical Center, Holon, Israel
| | - Yael Yagel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel,Infectious Disease Institute, Soroka Medical Center, Beer Sheba, Israel
| | - Bibiana Chazan
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel,Infectious Diseases Unit, Emek Medical Center, Afula, Israel
| | - Mirit Hershman-Sarafov
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel,Bnai Zion Medical Center, Haifa, Israel
| | - Galia Rahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Oren Zimhony
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel,Infectious Diseases Unit, Kaplan Medical Center, Rehovot, Israel
| | - Adi Zaidman Shimshovitz
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel,Infectious Disease Unit, The Baruch Padeh Medical Center, Tiberias, Israel
| | - Michal Chowers
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Meir Medical Center, Kfar Saba, Israel
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Brosh-Nissimov T, Maor Y, Elbaz M, Lipman-Arens S, Wiener-Well Y, Hussein K, Orenbuch-Harroch E, Cohen R, Zimhony O, Chazan B, Nesher L, Rahav G, Zayyad H, Hershman-Sarafov M, Weinberger M, Najjar-Debbiny R, Chowers M. Hospitalised patients with breakthrough COVID-19 following vaccination during two distinct waves in Israel, January to August 2021: a multicentre comparative cohort study. Euro Surveill 2022; 27. [PMID: 35593161 PMCID: PMC9121662 DOI: 10.2807/1560-7917.es.2022.27.20.2101026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Changing patterns of vaccine breakthrough can clarify vaccine effectiveness. Aim To compare breakthrough infections during a SARS-CoV-2 Delta wave vs unvaccinated inpatients, and an earlier Alpha wave. Methods In an observational multicentre cohort study in Israel, hospitalised COVID-19 patients were divided into three cohorts: breakthrough infections in Comirnaty-vaccinated patients (VD; Jun–Aug 2021) and unvaccinated cases during the Delta wave (ND) and breakthrough infections during an earlier Alpha wave (VA; Jan–Apr 2021). Primary outcome was death or ventilation. Results We included 343 VD, 162 ND and 172 VA patients. VD were more likely older (OR: 1.06; 95% CI: 1.05–1.08), men (OR: 1.6; 95% CI: 1.0–2.5) and immunosuppressed (OR: 2.5; 95% CI: 1.1–5.5) vs ND. Median time between second vaccine dose and admission was 179 days (IQR: 166–187) in VD vs 41 days (IQR: 28–57.5) in VA. VD patients were less likely to be men (OR: 0.6; 95% CI: 0.4–0.9), immunosuppressed (OR: 0.3; 95% CI: 0.2–0.5) or have congestive heart failure (OR: 0.6; 95% CI: 0.3–0.9) vs VA. The outcome was similar between all cohorts and affected by age and immunosuppression and not by vaccination, variant or time from vaccination. Conclusions Vaccination was protective during the Delta variant wave, as suggested by older age and greater immunosuppression in vaccinated breakthrough vs unvaccinated inpatients. Nevertheless, compared with an earlier post-vaccination period, breakthrough infections 6 months post-vaccination occurred in healthier patients. Thus, waning immunity increased vulnerability during the Delta wave, which suggests boosters as a countermeasure.
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Affiliation(s)
- Tal Brosh-Nissimov
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel.,Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Yasmin Maor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Disease Unit, Wolfson Medical Center, Holon, Israel
| | - Meital Elbaz
- Department of Infectious Diseases, Tel Aviv Sourasky Medical Center.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Lipman-Arens
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Infectious Disease and Infection Control Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yonit Wiener-Well
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Shaare Zedek Medical Center, Jerusalem, Israel
| | - Khetam Hussein
- Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Efrat Orenbuch-Harroch
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Regev Cohen
- Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Oren Zimhony
- Infectious Diseases Unit, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Bibiana Chazan
- Infectious Diseases Unit, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lior Nesher
- Infectious Disease Institute, Soroka Medical Center, Beer Sheba, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Galia Rahav
- Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hiba Zayyad
- The Azrieli Faculty of Medicine in the Galilee, Bar Ilan university, Safed, Israel.,Infectious Disease Unit, The Baruch Padeh Medical Center, Tiberias, Israel
| | - Mirit Hershman-Sarafov
- Bnai Zion Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Miriam Weinberger
- Shamir (Assaf Harofe) Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronza Najjar-Debbiny
- Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michal Chowers
- Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Stein M, Lipman-Arens S, Oved K, Cohen A, Bamberger E, Navon R, Boico O, Friedman T, Etshtein L, Paz M, Gottlieb TM, Kriger O, Fonar Y, Pri-Or E, Yacobov R, Dotan Y, Hochberg A, Grupper M, Chistyakov I, Potasman I, Srugo I, Eden E, Klein A. A novel host-protein assay outperforms routine parameters for distinguishing between bacterial and viral lower respiratory tract infections. Diagn Microbiol Infect Dis 2017; 90:206-213. [PMID: 29273482 DOI: 10.1016/j.diagmicrobio.2017.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/16/2017] [Accepted: 11/18/2017] [Indexed: 01/12/2023]
Abstract
Bacterial and viral lower respiratory tract infections (LRTIs) are often clinically indistinguishable, leading to antibiotic overuse. We compared the diagnostic accuracy of a new assay that combines 3 host-biomarkers (TRAIL, IP-10, CRP) with parameters in routine use to distinguish bacterial from viral LRTIs. Study cohort included 184 potentially eligible pediatric and adult patients. Reference standard diagnosis was based on adjudication by an expert panel following comprehensive clinical and laboratory investigation (including respiratory PCRs). Experts were blinded to assay results and assay performers were blinded to reference standard outcomes. Evaluated cohort included 88 bacterial and 36 viral patients (23 did not fulfill inclusion criteria; 37 had indeterminate reference standard outcome). Assay distinguished bacterial from viral LRTI patients with sensitivity of 0.93±0.06 and specificity of 0.91±0.09, outperforming routine parameters, including WBC, CRP and chest x-ray signs. These findings support the assay's potential to help clinicians avoid missing bacterial LRTIs or overusing antibiotics.
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Affiliation(s)
- Michal Stein
- Infectious Diseases Unit, Hillel Yaffe Medical Center, Hadera, Israel.
| | | | - Kfir Oved
- MeMed Diagnostics, Tirat Carmel, Israel
| | - Asi Cohen
- MeMed Diagnostics, Tirat Carmel, Israel
| | - Ellen Bamberger
- MeMed Diagnostics, Tirat Carmel, Israel; Bnai Zion Medical Center, Haifa, Israel; Technion-Israel Institute of Technology, Haifa, Israel
| | - Roy Navon
- MeMed Diagnostics, Tirat Carmel, Israel
| | | | - Tom Friedman
- MeMed Diagnostics, Tirat Carmel, Israel; Rambam Medical Center, Haifa, Israel
| | | | | | | | - Or Kriger
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yura Fonar
- Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Renata Yacobov
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yaniv Dotan
- Bnai Zion Medical Center, Haifa, Israel; Technion-Israel Institute of Technology, Haifa, Israel
| | - Amit Hochberg
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Moti Grupper
- Bnai Zion Medical Center, Haifa, Israel; Technion-Israel Institute of Technology, Haifa, Israel
| | - Irina Chistyakov
- Bnai Zion Medical Center, Haifa, Israel; Technion-Israel Institute of Technology, Haifa, Israel
| | - Israel Potasman
- Bnai Zion Medical Center, Haifa, Israel; Technion-Israel Institute of Technology, Haifa, Israel
| | - Isaac Srugo
- Bnai Zion Medical Center, Haifa, Israel; Technion-Israel Institute of Technology, Haifa, Israel
| | - Eran Eden
- MeMed Diagnostics, Tirat Carmel, Israel
| | - Adi Klein
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
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