When patients complain of coughing, runny nose, sneezing and fever, doctors are often at a loss because they do not have a basic tool to identify the cause of the respiratory symptoms and to guide appropriate treatments.
This tool could finally be on the way. In a proof-of-concept study, Duke Health researchers showed that their testing technology can accurately differentiate between viral and bacterial infections in respiratory diseases – a critical difference in determining whether antibiotics are warranted. Most importantly, the test delivered results in less than an hour.
This is exciting progress. We have been working on this for over a decade. We knew our test would work in research in 2016, but it has always been our goal to have a test that can produce results quickly while patients are in their doctor’s office. It is important that the distinction can be made quickly to ensure that antibiotics are not inappropriately prescribed. “
Ephraim Tsalik, Director of Studies, Associate Professor, Departments of Medicine and Molecular Genetics and Microbiology, Duke University School of Medicine
Tsalik and colleagues published the results of their study in the journal Critical Care Medicine, confirming the accuracy of the test with results available in less than an hour.
Researchers have developed a gene expression method that deviates from current diagnostic strategies and focuses on identifying specific pathogens. The current tests are time-consuming and can only identify a pathogen if it is primarily treated in a targeted manner by the test.
However, host gene expression looks for a specific immune signal that is unique to the type of infection the body is fighting. The immune system activates one set of genes to fight bacterial infections and another set of genes in response to a viral infection. After discovering these gene expression signatures for bacterial and viral infections, the team worked with BioFire Diagnostics, a company specializing in molecular diagnostics, to develop this unique test.
In a multisite study of more than 600 patients presenting to hospital emergency rooms with respiratory infections, the tests identified bacterial infections with an accuracy of 80% and viral infections with an accuracy of nearly 87%. The current standard tests have an accuracy of about 69 percent. Tests gave results in less than an hour and their accuracy was confirmed retrospectively by two different methods.
“Acute respiratory disease is the most common reason people see a doctor when they feel sick,” said Tsalik. “Far too often, patients with these symptoms are inappropriately treated with antibiotics because it is difficult to differentiate the cause of the disease and to promote antibiotic resistance. Our study shows that a rapid test can be used to differentiate these two sources of disease and improve clinical care could. “”
Tsalik said additional studies are ongoing to validate this approach in additional groups of patients. Researchers are also working to adapt the technology to get more specific information, including whether the disease-causing virus is influenza or SARS-CoV-2.
Source:
Duke University Medical Center
Journal reference:
Tsalik, EL, et al. (2021) Differentiating bacterial and viral infections using a host’s rapid gene expression test. Intensive care. doi.org/10.1097/CCM.0000000000005085.
