Identifying Bacterial from Viral Infections with Certainty at the Point of Care: A New Assay That May Help :

If you ask any pediatrician what would be on their wish list for making their jobs easier, it would be a finding a biomarker assay that determines a bacterial versus viral infection in a child better than the tools we have now including history and physical, CBC, C-reactive protein, procalcitonin and other laboratory values. Srugo et al. (10.1542/peds.2016-3453) decided to look into this possibility by performing a double-blind multicenter evaluation of a new assay that integrates measurements of blood-borne host-response proteins to then use these measurements to differentiate between bacteria and viruses.  Collecting data in five emergency department and two inpatient wards on 361 children ages 3 months to 18 years, who were febrile with symptoms of an infection less than a week old, the assay used was able to distinguish bacterial and viral causes with 93.8% sensitivity and 89.8% specificity with 11.7% showing equivocal findings.  Is it perfect?  No, but in this study the investigators’ assay outperformed CRP and procalcitonin in regard to their sensitivity and specificity.  How important is this study and what does it mean for moving this assay into common practice?  We asked Infectious Disease specialists Drs. David Kimberlin and Claudette Poole (10.1542/peds.2017-1210) to put the findings into perspective and they do just that in an important accompanying commentary.  You’ll find both the study and commentary to be infectious when it comes to giving us a glimpse of improving the accuracy of our diagnoses, and in turn worth sharing with colleagues.