A novel diagnostic approach may reduce inappropriate antibiotic use for acute respiratory infections

Abstract

Respiratory infections can be due to a multitude of etiologies and are common throughout the world. Most are viral and self-limited, yet these infections are commonly treated with antibiotics thus contributing to the increase in resistance. Historically, infectious disease diagnostics have focused on identification of the microbial culprit at the site of infection but the specificity of host response as measured by the host transcriptome, now enables us to classify the etiology of infection agnostic to pathogen class. The ability to rapidly determine whether a similar set of symptoms is due to a virus, bacteria, or other agent from a common specimen (blood) will have far-reaching public health benefits, and further research is warranted to transfer this technology into the clinical setting.

Keywords::

• acute respiratory infection
• bacterial resistance
• diagnostic devices
• gene expression
• host-based diagnostics

Financial & competing interests disclosure

GS Ginsburg and C Woods have patents pending on host-based diagnostics for pathogen identification. They also receive funding from Novartis to develop novel biomarkers for infectious disease. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Acute respiratory tract infections caused by viruses and bacteria may be clinically indistinguishable, and diagnostic methods are often not used to make treatment decisions.

• Inappropriate use and overprescribing of antibiotics is common and has led to an alarming increase in multidrug-resistant organisms.

• Existing infectious disease diagnostics (approved and in development) are based upon a prior knowledge of the organism and thus must be tailored to detect novel pathogens.

• Improved approaches to diagnose respiratory tract infections are needed as new antibiotics in development are insufficient to overcome current resistance issues.

• The host response to infection, assayed by a multigene RNA profile in peripheral blood, represents a novel approach to guiding appropriate antibiotic therapy.