Identification and Differentiation of Viral and Bacterial Respiratory Infection to Guide Antibiotic Stewardship
Identification and Differentiation of Viral and Bacterial Respiratory Infection to Guide Antibiotic Stewardship
The development of point-of-care testing is critical in the identification and differentiation between bacterial and viral respiratory infections. Defining the indications of infection to improve antibiotic stewardship, ensures that patients are protected from unnecessary antibiotic use and antibiotic resistance. It has been shown that particular protein biomarkers, such as myxovirus resistance protein (MxA) and C-reactive protein (CRP), differentiate infections between bacterial and viral. Using point-of-care platforms, such as Randox’s VeraSTAT, for detection of these protein biomarkers may provide more rapid and cost-effective discriminating tools.
The treatment of bacterial and viral infections can differ significantly, however people are often treated with empirical antibiotics due to a lack of paid and accurate testing. Although early intervention of infection is urgent, current diagnostic methods are either time intensive or inaccurate. The challenges clinicians are faced with in the differentiation of viral or bacterial respiratory infection can lead to delayed diagnosis, misappropriation of antibiotics and increased healthcare costs.
MxA protein has the potential to greatly enhance the rapid detection of viral respiratory infections as it increases significantly when there is actuate viral infection. CRP is the dominant acute phase protein often used to guide treatment of a bacterial infection or inflammation associated with tissue injury, inflammatory disorders, and associated diseases.
CRP & MxA together, allow clinicians to make appropriate decisions in supporting antimicrobial stewardship and guide the appropriate use of antibiotics, saving time performing unnecessary tests, providing unnecessary treatment which missing the opportunity to provide the right treatment in a timely manner.
The Randox VeraSTAT is a simple, accurate, portable point of care device which delivers rapid results via the use of patented cathodic electrochemiluminescence technology (C-ECL). Designed with the aim of offering users the next generation of rapid diagnosis, the VeraSTAT eliminates the requirement to send samples to a laboratory and instead returns results in as little as 6 minutes.
- Eliminates delays in sending samples to the lab and facilitate immediate decision making at the point of care.
- Lightweight, portable and convenient, the Randox VeraSTAT can be used in a variety of locations to deliver results as required, such as a GP surgery or Emergency Department.
- Intuitive user interface guides the operator through the entire testing process.
- All necessary reagents are conveniently included in each single use, sealed cassette with no preparation required. All necessary consumables are supplied with the kit.
- The Randox VeraSTAT allows for results to be exported via Bluetooth connectivity.
- Flexible test menu comprising of a range of immunoassay, protein, inflammatory, diabetes & infectious disease markers.
Novel testing approaches identifying the type of infection at the point of care are essential in accurately guiding appropriate antibiotic treatment. Although these tests can’t determine what type of viral or bacterial infection a patient has, it will determine whether the infection is viral or bacterial, further testing is then carried out to determine what type of pathogen the patient has via PCR – the gold standard. The ability to distinguish between viral and bacterial infections is the most effective guide for clinical decision making and is an innovative tool for antibiotic stewardship.
1 – Fleming-Dutra K.E., Hersh A.L., Shapiro D.J. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA. 2016;315:1864–1873. doi: 10.1001/jama.2016.4151.
2 – Cals JW, Hopstaken RM, Butler CC, Hood K, Severens JL, Dinant GJ. Improving management of patients with acute cough by C-reactive protein point of care testing and communication training (IMPAC3T): study protocol of a cluster randomised controlled trial. BMC Fam Pract. 2007;8:15.
3- New report calls for urgent action to avert antimicrobial resistance crisis [Internet]. World Health Organization. World Health Organization; 2019
4 – Hutchings MI, Truman AW, Wilkinson B. Antibiotics: past, present and future. Curr Opin Microbiol. (2019) 51:72–80. doi: 10.1016/j.mib.2019.10.008
What is syphilis?
Syphilis is caused by the bacterium Treponema pallidum. Although spread through sexual contact, it is frequently passed to an unborn child by its infected mother, where it can cause congenital syphilis resulting in high rates of stillbirth and increased risk of infant mortality.
Primary syphilis is when sores appear at the point where the bacteria entered the body. These sores can appear anywhere such as: around the opening of the urethra, penis, foreskin and anus in men; the vulva, clitoris, cervix, urethra and anus in women.
Secondary syphilis occurs when untreated sores have appeared and healed. It is still infectious and maintains its ability to be passed on.Tertiary syphilis is a progression from untreated secondary forms of the infection. Left untreated, after many years, the infection can cause serious damage to the heart, brain, eyes, internal organs and nervous system, which can ultimately lead to death.
Below are some statistics that have been published: about syphilis in recent years.
- In 2017, there were approximately 422,000 diagnoses of sexually transmitted infections (STIs) made in England, around the same number that was reported in 2016.
- There were 7,137 diagnoses of syphilis reported in 2017, a 20% increase (from 5,955) relative to the year prior and a 148% increase relative to 2008.
- The impact of STIs remains greatest in young heterosexuals 15 to 24 years; black ethnic minorities; and gay, bisexual and other MSM
- The increase in syphilis follows a 10-year trend, with 78% of diagnoses in gay, bisexual and other men who have sex with men (MSM).
How is the infection passed on?
Syphilis is passed on from one person to another through sex (vaginal, anal and oral) and also by direct skin contact with syphilis sores or rashes. Symptoms do not have to be visible for it to be passed on. It can still be transmitted before sores appear or after they have disappeared. Pregnant women can also pass syphilis onto their unborn baby.
What are the complications?
If syphilis is not treated effectively, it can spread to other parts of the body. This can result in long term complications, such as damage to the heart, brain, eyes and other organs. Ultimately, this damage can even lead to death.
Confidante avoids any embarrassing examinations, allowing you to take a test in the privacy of your own home. The Confidante test is made to be quick and easy to use, with no technical jargon, making it extremely convenient.
Confidante is now only £40 with free postage and packaging (RRP £85). Your results will be delivered discreetly via post within 7 days and will not appear on your medical record.
When you have an infection, it’s important to receive the correct diagnosis in order to access appropriate treatments. Misdiagnosis can not only lead to the prolonging of the infection, but could also prove detrimental to your long-term health, such as if you become resistant to certain anti-biotic strains through mistaken prescription.
Throughout this month, we’ve been highlighting how the Randox clinical product range can assess the impact of infection. The RX series’ dedicated testing panel comprises of IgA, hsCRP and ASO which are also available for third-party use. The extensive QC range caters for assessment of infectious disease testing in both liquid and lyophilised formats.
The Randox range of third-party reagents enables the clinical analysis of 113 different analytes with comprehensive range measurements and excellent correlations to reference methods.
IgG (the most abundant antibody) and IgM (the first antibody made in response to infection) can be used in the diagnosis of Dengue Fever. This is significant as more than 40 % of the global population, in more than 100 countries, are at risk of the Dengue Virus.
IgA is an antibody that lines the mucous membranes lining the mouth, airways and digestive tract. A deficiency in IgA is common in patients with bronchitis, conjunctivitis and otitis media.
Other Randox assays that may be used to detect differing infections include: albumin, ferritin, alpha-1-antitrypsin (AAT), complement C3, complement C4, haptoglobin, CRP, alpha-1-acid glycoprotein (AGP) and anti-streptolysin (ASO).
The RX series range offers the most comprehensive testing profile for assessing infectious diseases within an individual. The RX series test menu possesses the most extensive infectious disease testing panel available to give an expansive picture of an individual’s health. The RX series zinc test will assess the levels of zinc in an individual, Zinc plays a significant role in an individual’s health s it’s functions include cell and enzyme production as well as wound healing.
To view the full RX series test menu click here.
Internal Quality Control
Randox has partnered with Qnostics to provide a wide range of molecular controls for infectious disease testing. Designed to meet the demand of today’s molecular diagnostics laboratory and laboratories carrying out Nucleic Acid Testing (NAT), the Qnostics Molecular Infectious Disease range comprises hundreds of characterised viral, bacterial and fungal targets covering a wide range of Transplant Associated Diseases, Respiratory Infections, Blood Borne Viruses, Sexually Transmitted Infections, Gastrointestinal Diseases and Central Nervous System Diseases.
External Quality Control
Randox have also partnered up with QCMD to offer a vast array of molecular EQA programmes for infectious disease testing. With an extensive database of over 2000 participants in over 100 countries, QCMD is one of the largest providers of molecular EQA in the field of molecular diagnostics.
Frequent challenges, comprehensive reports and international accreditation ensures the best assessment of test system performance.
For more information on how Randox is helping to diagnose infection accurately and effectively, visit www.randox.com.
Throughout the month of September, we will be highlighting on our social media channels how the Randox clinical range can help combat infections and infectious diseases through accurate and swift diagnosis, allowing the necessary steps to be taken in order to improve individual health.
What is infection?
Infection is the infiltration of an organism’s body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to the infectious agents and toxins they produce. Infectious disease can also be known as communicable disease and transmissible disease.
How is the Randox helping to diagnose infection?
The Randox portfolio comprises of a wide range of products to combat infections including the RX series’ dedicated infectious disease testing panel, diagnostic reagents such as copper, potassium and sTfR and an extensive QC range catering for infectious disease testing in both liquid and lyophilised formats.
How can I limit my risk of contracting infection?
- The most important way to reduce the spread of infection is to wash your hands regularly with soap and water
- If you have an infection, get the appropriate vaccine and do not take antibiotics when they are not needed. This will only increase antibiotic-resistance
- Stay at home if you are sick to limit the spread of infection
- Use single-use tissues and dispose of them immediately after use
- Do not share cups, glasses or cutlery
- Do not touch your eyes, nose or mouth as viruses can transfer from your hands and in to the body
How can my workplace limit the spread of infection?
- Have an infection control plan
- Provide clean hand washing facilities
- Offer alcohol-based hand sanitisers when regular facilities are not available
- Provide boxes of single-use tissues and encourage their use
- Remind staff not to share cups, glasses or cutlery
- Remove newspapers and magazines from waiting areas
- Encourage staff to regularly disinfect their workspaces
- Make sure ventilation systems are working properly
For more information on how Randox is helping to diagnose infection, visit www.randox.com/infections.
Today, Northern Ireland’s Chief Medical Officer Dr. Michael McBride has stated that antibiotic resistance is now the greatest risk to human health and medicines worldwide. Dr. McBride said; “Currently 700,000 people die worldwide each year from drug resistant infections and this figure is forecasted to reach 10 million deaths by 2050, if the problem is ignored.”
It is rather alarming therefore that 70% of GPs admit that they prescribe antibiotics when they are unsure if they are treating a viral or bacterial infection. By prescribing antibiotics for viral infections, which can’t be combatted with antibiotics, patients are being exposed to antibiotics which are of no benefit.
John Lamont, Lead Scientist at Randox Laboratories, said that “Current diagnostic testing for respiratory infections takes at least 36 hours to confirm the nature of an infection, and they cannot name and categorise infections as bacterial or viral is the way our new respiratory test can.”
At Randox, our pioneering R&D teams have developed a revolutionary swab test for respiratory infections which indicates the cause of the infection and whether a patient needs antibiotics or not. This helps to limit the amount of patients who are prescribed antibiotics, reducing antibiotic resistance.
The Randox test, which can rapidly detect and identify the cause of 21 respiratory infections in just 5 hours, can also subsequently determine the appropriate antibiotic drug treatment for patients.
This test, if adopted by GP surgeries, could allow medical practitioners to make the correct treatment choice on the same day as examination and before patients have already begun a precautionary course of inefficient antibiotics. It would also have additional efficiency savings for the NHS, by eliminating the need for lengthy microbiology lab tests and unnecessarily prescribing drugs which are not needed. This new rapid and accurate test will give the GP confidence in their diagnosis of respiratory infections and will allow for quicker treatment if necessary, which benefits patient outcomes.
The test is also available as a Randox Health Cough, Cold & Flu offering, and can be carried out by booking an appointment with Randox Health at our clinics in Crumlin, Holywood or London, or by arranging the mobile clinic to visit you at your home or place of work.
So what action can we take to limit the looming antibiotic resistance crisis?
- Ask your GP if tests will be performed to make sure you even need antibiotics and that the correct antibiotic is prescribed.
- Take the antibiotics as prescribed. Make sure you complete the prescribed course, even when you start feeling better. This makes sure that all bacteria from your current infection are eradicated, leaving none behind that could potentially develop resistance to your antibiotic.
- Only take antibiotics prescribed for you; do not share or use leftover antibiotics. Taking the wrong medication will delay correct treatment and allow bacteria to multiply, and potentially develop a resistance to the antibiotic you are using incorrectly.
Find out more about the Cough, Cold & Flu Respiratory test here.
Book an appointment with one of our clinics, or arrange the mobile clinic, by phoning 0800 2545 130 or by clicking here.
For further information please contact the Randox PR team by email: firstname.lastname@example.org or phone 028 9442 2413