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. 2025 Jun;53(3):883-891.
doi: 10.1007/s15010-024-02384-w. Epub 2024 Sep 9.

Evaluation of a host-protein signature score for differentiating between bacterial and viral infections: real-life evidence from a German tertiary hospital

Laura Wagner  1 , Heike Schneider  2 , Peter B Luppa  2 , Kathrin Schröder  3 , Nina Wantia  3 , Christiane Querbach  4 , Samuel D Jeske  5 , Tobias Lahmer  6 , Kathrin Rothe  3 , Miriam Dibos  6 , Florian Voit  6 , Johanna Erber  6 , Christoph D Spinner  6 , Jochen Schneider  6 , Julian Triebelhorn  6
Affiliations

Evaluation of a host-protein signature score for differentiating between bacterial and viral infections: real-life evidence from a German tertiary hospital

Laura Wagner et al. Infection. 2025 Jun.

Abstract

Purpose: A host-protein signature score, consisting of serum-concentrations of C-reactive protein, tumour necrosis factor-related apoptosis-inducing ligand, and interferon gamma-induced protein 10, was validated for distinguishing between bacterial and viral infections as an antimicrobial stewardship measure for routine clinical practice among adult patients in a German tertiary hospital.

Methods: This single-centre, explorative study prospectively assessed the host-protein signature score, comparing it with serum procalcitonin (PCT) in patients with blood stream infections (BSI) and evaluating its efficacy in patients with viral infections against the standard of care (SOC) to assess the need for antibiotics due to suspected bacterial super/coinfection. Manufacturer-specified threshold scores were used to differentiate viral (< 35) and bacterial (> 65) infections.

Results: Ninety-seven patients (BSI [n = 56]; viral infections [n = 41]) were included. The score (cut-off score > 65) tended to detect BSI with higher sensitivity than did PCT (cut-off > 0.5 ng/mL) (87.5% vs. 76.6%). Three patients (5.4%) with BSI had a score < 35. One patient with BSI did not receive antibiotic treatment following SOC prior to positive blood culture results. Among patients with viral infections, 29 (70.7%) had scores > 65, indicating bacterial superinfections. Additionally, 11 patients (26.8%) had scores < 35, indicating no bacterial superinfections. In total, the antibiotic treatment discrepancy in the viral group between the SOC and a host-protein signature score guided approach was 2/41 patients (4.9%).

Conclusion: The score tended towards a higher sensitivity in detecting BSI than that with PCT. However, its impact on reducing antibiotic use in viral infections was minor compared with that of SOC.

Keywords: Antibiotics; Blood stream infections; C-reactive protein; Infection; Procalcitonin.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. CDS received grants and personal fees from AbbVie; grants, fees, and non-financial support from Gilead Sciences; grants and personal fees from Janssen-Cilag; grants and personal fees from MSD; grants from Cepheid; personal fees from GSK; grants and personal fees from ViiV Healthcare, during the conduct of the study; fees from AstraZeneca and Apeiron; grants, personal fees, and non-financial support from B. Braun Melsungen; grants and personal fees from BioNtech; personal fees from Eli Lilly, Formycon, Moderna, Molecular partners, Novartis, Roche, SOBI, Shionogi, and Pfizer; and grants and personal fees from Eli Lilly. JE received non-financial support from Gilead Sciences, ViiV Healthcare, and Pfizer. FV received personal fees and non-financial support from Gilead Sciences and ViiV Healthcare and grants from MSD and B. Braun Melsungen AG outside of the submitted work.

Figures

Fig. 1
Fig. 1
Overview of the study cohort. BSI, blood stream infection
Fig. 2
Fig. 2
Graphical overview of the total cohort with host-protein signature score results
See this image and copyright information in PMC

References

    1. Erbay A, Colpan A, Bodur H, et al. Evaluation of antibiotic use in a hospital with an antibiotic restriction policy. Int J Antimicrob Agents. 2003;21:308–12. 10.1016/s0924-8579(02)00392-8. - PubMed
    1. Pulcini C, Cua E, Lieutier F, et al. Antibiotic misuse: a prospective clinical audit in a French university hospital. Eur J Clin Microbiol Infect Dis. 2007;26:277–80. 10.1007/s10096-007-0277-5. - PubMed
    1. Ewig S, Kolditz K, Pletz M, et al. Management of Adult Community-Acquired Pneumonia and Prevention - Update 2021 - Guideline of the German respiratory society (DGP), the Paul-Ehrlich-Society for Chemotherapy (PEG), the German Society for Infectious Diseases (DGI), the German Society of Medical Intensive Care and Emergency Medicine (DGIIN), the German Viological Society (DGV), the competence Network CAPNETZ, the German College of General Practitioneers and Family Physicians (DEGAM), the German Society for Geriatric Medicine (DGG), the German Palliative Society (DGP), the Austrian Society of Pneumology Society (ÖGP), the Austrian Society for Infectious and Tropical Diseases (ÖGIT), the Swiss respiratory society (SGP) and the Swiss Society for Infectious Diseases Society (SSI). Pneumologie. 2021;75:665–729. 10.1055/a-1497-0693. - PubMed
    1. Hoeboer SH, van der Geest PJ, Nieboer D, et al. The diagnostic accuracy of procalcitonin for bacteraemia: a systematic review and meta-analysis. Clin Microbiol Infect. 2015;21:474–81. 10.1016/j.cmi.2014.12.026. - PubMed
    1. Yo CH, Hsieh PS, Lee SH, et al. Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: a systematic review and meta-analysis. Ann Emerg Med. 2012;60:591–600. 10.1016/j.annemergmed.2012.05.027. - PubMed

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