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Bauer W, Gläser S, Thiemig D, Wanner K, Peric A, Behrens S, Bialas J, Behrens A, Galtung N, Liesenfeld O, Sun L, May L, Mace S, Ott S, Vesenbeckh S. Detection of Viral Infection and Bacterial Coinfection and Superinfection in Coronavirus Disease 2019 Patients Presenting to the Emergency Department Using the 29-mRNA Host Response Classifier IMX-BVN-3: A Multicenter Study. Open Forum Infect Dis 2022; 9:ofac437. [PMID: 36111173 PMCID: PMC9452140 DOI: 10.1093/ofid/ofac437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background Identification of bacterial coinfection in patients with coronavirus disease 2019 (COVID-19) facilitates appropriate initiation or withholding of antibiotics. The Inflammatix Bacterial Viral Noninfected (IMX-BVN) classifier determines the likelihood of bacterial and viral infections. In a multicenter study, we investigated whether IMX-BVN version 3 (IMX-BVN-3) identifies patients with COVID-19 and bacterial coinfections or superinfections. Methods Patients with polymerase chain reaction-confirmed COVID-19 were enrolled in Berlin, Germany; Basel, Switzerland; and Cleveland, Ohio upon emergency department or hospital admission. PAXgene Blood RNA was extracted and 29 host mRNAs were quantified. IMX-BVN-3 categorized patients into very unlikely, unlikely, possible, and very likely bacterial and viral interpretation bands. IMX-BVN-3 results were compared with clinically adjudicated infection status. Results IMX-BVN-3 categorized 102 of 111 (91.9%) COVID-19 patients into very likely or possible, 7 (6.3%) into unlikely, and 2 (1.8%) into very unlikely viral bands. Approximately 94% of patients had IMX-BVN-3 unlikely or very unlikely bacterial results. Among 7 (6.3%) patients with possible (n = 4) or very likely (n = 3) bacterial results, 6 (85.7%) had clinically adjudicated bacterial coinfection or superinfection. Overall, 19 of 111 subjects for whom adjudication was performed had a bacterial infection; 7 of these showed a very likely or likely bacterial result in IMX-BVN-3. Conclusions IMX-BVN-3 identified COVID-19 patients as virally infected and identified bacterial coinfections and superinfections. Future studies will determine whether a point-of-care version of the classifier may improve the management of COVID-19 patients, including appropriate antibiotic use.
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Affiliation(s)
- Wolfgang Bauer
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Emergency Medicine, Berlin, Germany
| | - Sven Gläser
- Klinik für Innere Medizin–Pneumologie, Vivantes Klinikum Spandau und Klinik für Innere Medizin–Pneumologie und Infektiologie, Vivantes Klinikum Neukölln, Berlin, Germany
- Klinik für Innere Medizin–Pneumologie und Infektiologie, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Dorina Thiemig
- Klinik für Innere Medizin–Pneumologie und Infektiologie, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Katrin Wanner
- Klinik für Innere Medizin–Pneumologie, Vivantes Klinikum Spandau und Klinik für Innere Medizin–Pneumologie und Infektiologie, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Alexander Peric
- Klinik für Innere Medizin–Pneumologie und Infektiologie, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Steffen Behrens
- Klinik für Innere Medizin–Kardiologie, Vivantes–Netzwerk für Gesundheit/Vivantes Humboldt-Klinikum and Klinik für Innere Medizin–Kardiologie und konservative Intensivmedizin, Vivantes–Netzwerk für Gesundheit/Vivantes Klinikum Spandau, Berlin, Germany
| | - Johanna Bialas
- Labor Berlin–Charité Vivantes Services GmbH, Berlin, Germany
| | - Angelika Behrens
- Klinik für Innere Medizin, Gastroenterologie und Pneumologie, Evangelische Elisabeth Klinik Krankenhausbetriebs gGmbH, Berlin, Germany
| | - Noa Galtung
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Emergency Medicine, Berlin, Germany
| | | | - Lisa Sun
- Inflammatix Inc, Burlingame, California, USA
| | - Larissa May
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Sharron Mace
- Department of Emergency Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sebastian Ott
- Department of Pulmonary Medicine, St Claraspital AG, Basel, Switzerland
- University of Bern, Bern, Switzerland
| | - Silvan Vesenbeckh
- Department of Pulmonary Medicine, St Claraspital AG, Basel, Switzerland
- Department of Pulmonology, University Hospital Zürich, Zürich, Switzerland
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