An adjunct bio-array that rapidly differentiates viral from bacterial sources can improve quality of care in Oncology patients presenting to Emergency Departments (EDs) with respiratory illnesses

Abstract

Background

Oncology patients presenting to EDs with acute respiratory illnesses (ARI) require a broad workup and early treatment due to risk of underlying infection and immunocompromised status. Early antibiotic administration is often required as determining a nonbacterial source is time consuming. A novel host bio-array developed to rapidly differentiate bacterial from viral sources could improve ED resource utilization, reduce unnecessary antibiotics, and increase healthcare quality.

Methods

An IRB approved subject on multiple immunosuppressants presents with ARI and positive SIRS criteria. The MeMed BV® (BV) is an FDA approved rapid immunoassay that reports a computationally integrated score (0-100) of three host proteins (TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein 10 (IP-10), and C-reactive protein (CRP). The BV score and ED standard of care tests were obtained in a modified ED sepsis protocol (mEDSP). Scores above 65 are associated with bacterial infections, while scores below 10 are associated with viral infections. Cost of laboratory, radiology, professional and facilities fees (room charges, nursing, and ancillaries) were summed for the admission. Investigators received three surveys to: (1) establish pretest probability of disease, (2) determine posttest probability after receiving BV results, (3) query what resources might be withheld or changed if presented with the BV test results early.

Results

The BV reported a ‘0’ value (viral source) within 20 minutes. Further testing confirmed no bacterial source of infection. An adjudicated cost and resource review of the mEDSP and admission revealed a potential reduction of unnecessary antibiotics by 59%, lab testing by 24.2%, and overall costs by 23.2%. Admission time could have been reduced by 24 hours (43%). Furthermore, the ED physician was amenable to changing care based on this test.

Conclusion

Significant improvement in resource utilization and greater quality was identified with early identification of nonbacterial sources in ARI in the ED. Adjunct biomarkers differentiating viral from other sources can improve quality and resource utilization when deployed early in the ED. Further trials in the Emergency Oncology realm are necessary.