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UBE2D1 and COX7C as Potential Biomarkers of Diabetes-Related Sepsis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9463717. [PMID: 35445133 PMCID: PMC9015863 DOI: 10.1155/2022/9463717] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/05/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022]
Abstract
Patients with diabetes are physiologically frail and more likely to suffer from infections and even life-threatening sepsis. This study aimed to identify and verify potential biomarkers of diabetes-related sepsis (DRS). Datasets GSE7014, GSE57065, and GSE95233 from the Gene Expression Omnibus were used to explore diabetes- and sepsis-related differentially expressed genes (DEGs). Gene set enrichment analysis (GSEA) and functional analyses were performed to explore potential functions and pathways associated with sepsis and diabetes. Weighted gene co-expression network analysis (WGCNA) was performed to identify diabetes- and sepsis-related modules. Functional enrichment analysis was performed to determine the characteristics and pathways of key modules. Intersecting DEGs that were also present in key modules were considered as common DEGs. Protein-protein interaction (PPI) network and key genes were analyzed to screen hub genes involved in DRS development. A mouse C57 BL/6J-DRS model and a neural network prediction model were constructed to verify the relationship between hub genes and DRS. In total, 7457 diabetes-related DEGs and 2606 sepsis-related DEGs were identified. GSEA indicated that gene datasets associated with diabetes and sepsis were mainly enriched in metabolic processes linked to inflammatory responses and reactive oxygen species, respectively. WGCNA indicated that grey60 and brown modules were diabetes- and sepsis-related key modules, respectively. Functional analysis showed that grey60 module genes were mainly enriched in cell morphogenesis, heart development, and the PI3K-Akt signaling pathway, whereas genes from the brown module were mainly enriched in organelle inner membrane, mitochondrion organization, and oxidative phosphorylation. UBE2D1, IDH1, DLD, ATP5C1, COX6C, and COX7C were identified as hub genes in the PPI network. Animal DRS and neural network prediction models indicated that the expression levels of UBE2D1 and COX7C in DRS models and samples were higher than control mice. UBE2D1 and COX7C were identified as potential biomarkers of DRS. These findings may help develop treatment strategies for DRS.
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2
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Rojas-Garcia P, van der Pol S, van Asselt ADI, Postma MJ, Rodríguez-Ibeas R, Juárez-Castelló CA, González M, Antoñanzas F. Diagnostic Testing for Sepsis: A Systematic Review of Economic Evaluations. Antibiotics (Basel) 2021; 11:antibiotics11010027. [PMID: 35052904 PMCID: PMC8773030 DOI: 10.3390/antibiotics11010027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/10/2021] [Accepted: 12/23/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction: Sepsis is a serious and expensive healthcare problem, when caused by a multidrug-resistant (MDR) bacteria mortality and costs increase. A reduction in the time until the start of treatment improves clinical results. The objective is to perform a systematic review of economic evaluations to analyze the cost-effectiveness of diagnostic methods in sepsis and to draw lessons on the methods used to incorporate antimicrobial resistance (AMR) in these studies. Material and Methods: the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the Consolidated Health Economic Evaluation Reporting standards (CHEERS) checklist was used to extract the information from the texts. Results: A total of 16 articles were found. A decision model was performed in 14. We found two ways to handle resistance while modelling: the test could identify infections caused by a resistant pathogen or resistance-related inputs, or outcomes were included (the incidence of AMR in sepsis patients, antibiotic use, and infection caused by resistant bacterial pathogens). Conclusion: Using a diagnostic technique to detect sepsis early on is more cost-effective than standard care. Setting a direct relationship between the implementation of a testing strategy and the reduction of AMR cases, we made several assumptions about the efficacy of antibiotics and the length-of-stay of patients.
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Affiliation(s)
- Paula Rojas-Garcia
- Department of Economics and Business, University of La Rioja, 26004 Logroño, Spain; (R.R.-I.); (C.A.J.-C.); (M.G.); (F.A.)
- Correspondence:
| | - Simon van der Pol
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, 9713 GZ, P.O. Box 30.001 Groningen, The Netherlands; (S.v.d.P.); (A.D.I.v.A.); (M.J.P.)
| | - Antoinette D. I. van Asselt
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, 9713 GZ, P.O. Box 30.001 Groningen, The Netherlands; (S.v.d.P.); (A.D.I.v.A.); (M.J.P.)
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9713 GZ, P.O. Box 30.001 Groningen, The Netherlands
| | - Maarten J. Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, 9713 GZ, P.O. Box 30.001 Groningen, The Netherlands; (S.v.d.P.); (A.D.I.v.A.); (M.J.P.)
- Department of Economics, Econometrics and Finance, University of Groningen, 9747 AE Groningen, The Netherlands
| | - Roberto Rodríguez-Ibeas
- Department of Economics and Business, University of La Rioja, 26004 Logroño, Spain; (R.R.-I.); (C.A.J.-C.); (M.G.); (F.A.)
| | - Carmelo A. Juárez-Castelló
- Department of Economics and Business, University of La Rioja, 26004 Logroño, Spain; (R.R.-I.); (C.A.J.-C.); (M.G.); (F.A.)
| | - Marino González
- Department of Economics and Business, University of La Rioja, 26004 Logroño, Spain; (R.R.-I.); (C.A.J.-C.); (M.G.); (F.A.)
| | - Fernando Antoñanzas
- Department of Economics and Business, University of La Rioja, 26004 Logroño, Spain; (R.R.-I.); (C.A.J.-C.); (M.G.); (F.A.)
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3
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D'Onofrio V, Salimans L, Bedenić B, Cartuyvels R, Barišić I, Gyssens IC. The Clinical Impact of Rapid Molecular Microbiological Diagnostics for Pathogen and Resistance Gene Identification in Patients With Sepsis: A Systematic Review. Open Forum Infect Dis 2020; 7:ofaa352. [PMID: 33033730 PMCID: PMC7528559 DOI: 10.1093/ofid/ofaa352] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022] Open
Abstract
Fast microbiological diagnostics (MDx) are needed to ensure early targeted antimicrobial treatment in sepsis. This systematic review focuses on the impact on antimicrobial management and patient outcomes of MDx for pathogen and resistance gene identification compared with blood cultures. PubMed was searched for clinical studies using either whole blood directly or after short-term incubation. Twenty-five articles were retrieved describing the outcomes of 8 different MDx. Three interventional studies showed a significant increase in appropriateness of antimicrobial therapy and a nonsignificant change in time to appropriate therapy. Impact on mortality was conflicting. Length of stay was significantly lower in 2 studies. A significant decrease in antimicrobial cost was demonstrated in 6 studies. The limitations of this systematic review include the low number and observed heterogeneity of clinical studies. In conclusion, potential benefits of MDx regarding antimicrobial management and some patient outcomes were reported. More rigorous intervention studies are needed focusing on the direct benefits for patients.
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Affiliation(s)
- Valentino D'Onofrio
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.,Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lene Salimans
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Branka Bedenić
- Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Ivan Barišić
- Molecular diagnostics, Austrian Institute of Technology, Vienna, Austria
| | - Inge C Gyssens
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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4
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Tassinari M, Zannoli S, Farabegoli P, Pedna MF, Pierro A, Mastroianni A, Fontan R, Luongo L, Sarnataro G, Menegatti E, Caruso A, Sambri V. Rapid diagnosis of bloodstream infections in the critically ill: Evaluation of the broad-range PCR/ESI-MS technology. PLoS One 2018; 13:e0197436. [PMID: 29763469 PMCID: PMC5953471 DOI: 10.1371/journal.pone.0197436] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/02/2018] [Indexed: 12/30/2022] Open
Abstract
Bloodstream infection (BSI) and associated sepsis represent a major source of mortality in industrialized countries. Prompt treatment with targeted antibiotics affects both the financial impact and the clinical outcome of BSI: every hour gained in initiating the correct antimicrobial therapy significantly increases the probability of patient survival. However, the current standard-of-care, which depends on blood culture-based diagnosis, are often unable to provide such a fast response. Fast and sensitive molecular techniques for the detection of sepsis-related pathogens from primary blood samples are strongly needed. The aim of this study was to assess the usefulness of the IRIDICA BAC BSI Assay, a PCR/ESI-MS-based technology for the early diagnosis of bloodstream infections from primary blood samples in critical patients. This evaluation has been performed by comparison with the traditional culture-based methods. The study was performed on a total of 300 prospective whole blood specimens obtained from patients suspected of sepsis, admitted to enrolling ER units from The Greater Romagna Area. The overall concordance between the two techniques was of 86%, with a calculated sensitivity of 76% and an assay specificity of 90%. The clinical significance of discrepant results was evaluated reviewing the patients’ clinical records and the results of additional relevant microbiological tests. The data here obtained support the ability of the IRIDICA BAC BSI Assay to identify a broad range of bacteria directly from primary whole blood samples, within eight hours. This might allow a timely administration of a suitable treatment.
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Affiliation(s)
- Martina Tassinari
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, Pievesestina, Italy
- * E-mail: (MT); (SZ)
| | - Silvia Zannoli
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, Pievesestina, Italy
- * E-mail: (MT); (SZ)
| | - Patrizia Farabegoli
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, Pievesestina, Italy
| | - Maria Federica Pedna
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, Pievesestina, Italy
| | - Anna Pierro
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, Pievesestina, Italy
| | | | | | | | | | | | | | - Vittorio Sambri
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, Pievesestina, Italy
- DIMES, University of Bologna, Bologna, Italy
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5
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Stevenson M, Pandor A, Martyn-St James M, Rafia R, Uttley L, Stevens J, Sanderson J, Wong R, Perkins GD, McMullan R, Dark P. Sepsis: the LightCycler SeptiFast Test MGRADE®, SepsiTest™ and IRIDICA BAC BSI assay for rapidly identifying bloodstream bacteria and fungi - a systematic review and economic evaluation. Health Technol Assess 2018; 20:1-246. [PMID: 27355222 DOI: 10.3310/hta20460] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sepsis can lead to multiple organ failure and death. Timely and appropriate treatment can reduce in-hospital mortality and morbidity. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of three tests [LightCycler SeptiFast Test MGRADE(®) (Roche Diagnostics, Risch-Rotkreuz, Switzerland); SepsiTest(TM) (Molzym Molecular Diagnostics, Bremen, Germany); and the IRIDICA BAC BSI assay (Abbott Diagnostics, Lake Forest, IL, USA)] for the rapid identification of bloodstream bacteria and fungi in patients with suspected sepsis compared with standard practice (blood culture with or without matrix-absorbed laser desorption/ionisation time-of-flight mass spectrometry). DATA SOURCES Thirteen electronic databases (including MEDLINE, EMBASE and The Cochrane Library) were searched from January 2006 to May 2015 and supplemented by hand-searching relevant articles. REVIEW METHODS A systematic review and meta-analysis of effectiveness studies were conducted. A review of published economic analyses was undertaken and a de novo health economic model was constructed. A decision tree was used to estimate the costs and quality-adjusted life-years (QALYs) associated with each test; all other parameters were estimated from published sources. The model was populated with evidence from the systematic review or individual studies, if this was considered more appropriate (base case 1). In a secondary analysis, estimates (based on experience and opinion) from seven clinicians regarding the benefits of earlier test results were sought (base case 2). A NHS and Personal Social Services perspective was taken, and costs and benefits were discounted at 3.5% per annum. Scenario analyses were used to assess uncertainty. RESULTS For the review of diagnostic test accuracy, 62 studies of varying methodological quality were included. A meta-analysis of 54 studies comparing SeptiFast with blood culture found that SeptiFast had an estimated summary specificity of 0.86 [95% credible interval (CrI) 0.84 to 0.89] and sensitivity of 0.65 (95% CrI 0.60 to 0.71). Four studies comparing SepsiTest with blood culture found that SepsiTest had an estimated summary specificity of 0.86 (95% CrI 0.78 to 0.92) and sensitivity of 0.48 (95% CrI 0.21 to 0.74), and four studies comparing IRIDICA with blood culture found that IRIDICA had an estimated summary specificity of 0.84 (95% CrI 0.71 to 0.92) and sensitivity of 0.81 (95% CrI 0.69 to 0.90). Owing to the deficiencies in study quality for all interventions, diagnostic accuracy data should be treated with caution. No randomised clinical trial evidence was identified that indicated that any of the tests significantly improved key patient outcomes, such as mortality or duration in an intensive care unit or hospital. Base case 1 estimated that none of the three tests provided a benefit to patients compared with standard practice and thus all tests were dominated. In contrast, in base case 2 it was estimated that all cost per QALY-gained values were below £20,000; the IRIDICA BAC BSI assay had the highest estimated incremental net benefit, but results from base case 2 should be treated with caution as these are not evidence based. LIMITATIONS Robust data to accurately assess the clinical effectiveness and cost-effectiveness of the interventions are currently unavailable. CONCLUSIONS The clinical effectiveness and cost-effectiveness of the interventions cannot be reliably determined with the current evidence base. Appropriate studies, which allow information from the tests to be implemented in clinical practice, are required. STUDY REGISTRATION This study is registered as PROSPERO CRD42015016724. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Matt Stevenson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Abdullah Pandor
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Rachid Rafia
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lesley Uttley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jean Sanderson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ruth Wong
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.,Heart of England NHS Foundation Trust, Coventry, UK
| | - Ronan McMullan
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK.,Belfast Health and Social Care Trust, The Royal Hospitals, Belfast, UK
| | - Paul Dark
- Institute of Inflammation and Repair, University of Manchester, Manchester, UK.,Salford Royal NHS Foundation Trust, Salford, UK
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6
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Greco R, Barbanti MC, Mancini N, Crucitti L, Oltolini C, Forcina A, Lorentino F, Vago L, Messina C, Clerici D, Morelli M, Giglio F, Lupo Stanghellini MT, Infurnari L, Carrabba MG, Marktel S, Assanelli A, Scarpellini P, Bernardi M, Peccatori J, Corti C, Clementi M, Ciceri F. Adjuvant role of SeptiFast to improve the diagnosis of sepsis in a large cohort of hematological patients. Bone Marrow Transplant 2018; 53:410-416. [PMID: 29330406 DOI: 10.1038/s41409-017-0039-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 10/23/2017] [Accepted: 10/29/2017] [Indexed: 11/09/2022]
Abstract
Febrile neutropenia and sepsis are common and life-threatening complications in hematological diseases. This study was performed retrospectively in 514 patients treated for febrile neutropenia at our institute, to investigate the clinical usefulness of a molecular tool, LightCycler® SeptiFast test (SF), to promptly recognize pathogens causing sepsis in hematological patients. We collected 1837 blood samples of 514 consecutive hematological patients. The time of processing is short. Overall, 757 microorganisms in 663 episodes were detected by molecular test and standard blood cultures (BC): 73.6% Gram-positive bacteria, 23.9% Gram-negative bacteria, and 2.5% fungal species. This large analysis demonstrated a significant episode-to episode agreement (71.9%) between the two methods, higher in negative samples (89.14%), and a specificity of 75.89%. Clinical variables that gave a statistically significant contribution to their concordance were absolute neutrophil count, ongoing antimicrobial therapy, timing of test execution, and organ localization of infection. The large analysis highlights the potential of molecular-based assays directly performed on blood samples, especially if implementing the detection of antibiotic resistance genes, which was lacking in the used study.
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Affiliation(s)
- Raffaella Greco
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | - Maria Chiara Barbanti
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | - Nicasio Mancini
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Lara Crucitti
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy.,Università degli Studi di Milano, Milano, MI, Italy
| | - Chiara Oltolini
- Infectious Disease Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Alessandra Forcina
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | - Francesca Lorentino
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | - Luca Vago
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy.,Unit of Immunogenetics, Leukemia Genomics and Immunobiology IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Carlo Messina
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | - Daniela Clerici
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | - Mara Morelli
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | - Fabio Giglio
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | | | - Laura Infurnari
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Matteo G Carrabba
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | - Sarah Marktel
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | - Andrea Assanelli
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | - Paolo Scarpellini
- Unit of Immunogenetics, Leukemia Genomics and Immunobiology IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Massimo Bernardi
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | - Jacopo Peccatori
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | - Consuelo Corti
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy
| | - Massimo Clementi
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milano, Italy.,University Vita-Salute, via Olgettina 48, 20132, Milano, Italy
| | - Fabio Ciceri
- Hematology and BMT Unit, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milano, Italy. .,University Vita-Salute, via Olgettina 48, 20132, Milano, Italy.
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7
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Escadafal C, Nsanzabana C, Archer J, Chihota V, Rodriguez W, Dittrich S. New Biomarkers and Diagnostic Tools for the Management of Fever in Low- and Middle-Income Countries: An Overview of the Challenges. Diagnostics (Basel) 2017; 7:E44. [PMID: 28753985 PMCID: PMC5617944 DOI: 10.3390/diagnostics7030044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/10/2017] [Accepted: 07/18/2017] [Indexed: 11/16/2022] Open
Abstract
A lack of simple, inexpensive, and rapid diagnostic tests for febrile illnesses other than malaria leads to overtreatment with antibiotics for those who test negative for malaria, and contributes to the global rise in antimicrobial resistance. New tests for the detection of host biomarkers provide promising tools to differentiate bacterial from non-bacterial infections in febrile patients. However, most available biomarker tests are not currently used in resource-limited settings, and very few evaluations have been performed in low- and middle-income country populations with non-severe febrile illness. As a result, our knowledge of the performance of these tests in settings with high prevalence of infectious and poverty-related diseases such as malaria, HIV, malnutrition and intestinal parasites is poor. This paper describes challenges faced during the process of getting to an approved test, including difficulties in selecting the most appropriate fever biomarkers; suitable study designs and sites for test evaluations; lack of available reference tests to evaluate the performance of new tests; and lack of clear regulatory pathways to introduce such tests. As many new biomarker assays are in development, understanding these challenges will better enable those working in this area to address them during product development.
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Affiliation(s)
- Camille Escadafal
- FIND (Foundation for Innovative New Diagnostics), 1202 Geneva, Switzerland.
| | | | - Julie Archer
- FIND (Foundation for Innovative New Diagnostics), 1202 Geneva, Switzerland.
| | - Violet Chihota
- FIND (Foundation for Innovative New Diagnostics), 1202 Geneva, Switzerland.
| | - William Rodriguez
- FIND (Foundation for Innovative New Diagnostics), 1202 Geneva, Switzerland.
| | - Sabine Dittrich
- FIND (Foundation for Innovative New Diagnostics), 1202 Geneva, Switzerland.
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