title: A rapid flow cytometric method for distinguishing between febrile bacterial and viral infections.
abstract: Antibiotic resistance due to the inappropriate use of antimicrobials is one of the most critical public health problems worldwide. A major factor underlying the unnecessary use of antibiotics is the lack of rapid and accurate diagnostic tests. Therefore, we aimed to develop a novel rapid flow cytometric method for distinguishing between febrile bacterial and viral infections. In this prospective comparative study, quantitative flow cytometric analysis of FcγRII/CD32, CR1/CD35, MHC Class I receptor (MHCI), and C5aR/CD88 on human phagocytes was performed in 286 hospitalized febrile patients with suspected infection. After using microbiological and serological detection methods, or clinical diagnosis, 205 patients were identified with either bacterial (n=136) or viral (n=69) infection. Receptor data from patients were compared to those of 50 healthy controls. We developed a flow cytometric marker of local and systemic bacterial infections designated "bacterial infection score (BIS)" incorporating the quantitative analysis of FcγRII/CD32, CR1/CD35, C5aR/CD88 and MHCI on neutrophils and/or monocytes, which displays 91% sensitivity and 92% specificity in distinguishing between microbiologically confirmed bacterial (n=77) and serologically confirmed viral infections (n=61) within 1h. The BIS method was effectively applied to distinguish between bacterial and viral (pandemic H1N1 influenza) pneumonia cases with 96% sensitivity and 92% specificity. We propose that the rapid BIS test can assist physicians in deciding whether antibiotic treatment is necessary, thus reducing unnecessary antimicrobial use.
authors.affiliation: Department of Biochemistry, University of Turku, Turku, Finland. jarnuu@utu.fi
authors.forename: Jari
authors.initials: J
authors.lastname: Nuutila
authors.forename: Päivi
authors.initials: P
authors.lastname: Jalava-Karvinen
authors.forename: Ulla
authors.initials: U
authors.lastname: Hohenthal
authors.forename: Pirkko
authors.initials: P
authors.lastname: Kotilainen
authors.forename: Tarja-Terttu
authors.initials: TT
authors.lastname: Pelliniemi
authors.forename: Jukka
authors.initials: J
authors.lastname: Nikoskelainen
authors.forename: Esa-Matti
authors.initials: EM
authors.lastname: Lilius
mesh_terms: D000328:Adult; D000954:Antigens, Surface / Q000032:analysis; D001424:Bacterial Infections / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood*; D019411:Clinical Laboratory Techniques / Q000379:methods*; D005260:Female; D005334:Fever / Q000209:etiology*; D005434:Flow Cytometry / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010586:Phagocytes / Q000737:chemistry; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014777:Virus Diseases / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D000954:Antigens, Surface; D015415:Biomarkers