Evaluation of C-reactive protein and myxovirus resistance protein A to guide the rational use of antibiotics among acute febrile adult patients in Northwest Ethiopia

Abstract

In low-resource settings, treatment is often given empirically without knowledge of the aetiology due to a lack of diagnostics. In the search for reliable rapid tests to guide treatment work-up, this study was performed to determine whether two biomarkers could differentiate bacterial from nonbacterial infections in acute febrile patients. Methods: Adults with acute fever were recruited at a referral hospital in Ethiopia. The QuikRead Go test was used to quantify C-reactive protein (qCRP) and the FebriDx test was used for combined qualitative detection of the bacterial CRP marker with myxovirus resistance protein A (MxA), a viral biomarker. Results: Of the 200 patients included in this study, most presented with 2-3 days of fever, headache, and joint pain. Antibiotics were prescribed for 83.5% and antimalarials for 36.5%, while a bacterial infection was only confirmed in 5% and malaria in 11%. The median qCRP level for confirmed bacterial infections was 128 mg/l. The FebriDx and QuikRead Go test had an overall agreement of 72.0%. Conclusions: An over-prescription of antibiotics for febrile patients was observed, even for those with low CRP levels and without a confirmed bacterial infection. The added value of the FebriDx was limited, while the combined use of rapid tests for qCRP and malaria should be considered for the management of acute febrile illness and antibiotic stewardship.

Aetiologies of acute undifferentiated febrile illness at the emergency ward of the University of Gondar Hospital, Ethiopia

“…A cross-sectional study was conducted at the emergency ward of UoGCSH in Amhara region in northwest Ethiopia as described before [11]. The ward has 50 beds, serving a population of about 7 million.…”

“…Study-related sample collection was performed after routine clinical work-up as described previously [11] and consequent procedures are shown in Figure 1. All samples were tested by RDT, ELISA and PCR (study procedures), malaria microscopy (routine procedure) was only performed for a selection of patients, when requested by the treating physician.…”

“…One hundred and fifty-five (77.5%) participants were living in Gondar town, five (2.5%) in other towns and 40 (20.0%) patients came from rural areas. Clinical data of the participants were described before [11]. Among all AFI cases, the aetiology of the acute infection was identified for 41 (20.5%) patients.…”

Differences in diagnosis, management, and outcomes of acute febrile illness by health facility level in southern Ethiopia

“…For fever without clinical evidence of bacterial infection, guidelines recommend withholding antibacterial treatment unless patients have signs of severe illness 10 . Nevertheless, in the absence of reliable diagnostics to explain the cause of the fever in patients with negative malaria tests, health workers may not adhere to guidelines and unnecessarily prescribe antimalarials [11][12][13] and antibacterials 14,15 , which may lead to the development of drug resistance 16,17 .We recently reported a low proportion of malaria (3.2%) 18 , a lack of adherence to guidelines in prescribing antimicrobials (antibacterials and antimalarials), and substantial proportions of hospitalization (38.1%) and in-hospital fatality ratio (5.9%) in febrile children aged under 13 years presenting at the largest tertiary hospital in southern Ethiopia 19 . To determine how the pattern of childhood febrile illness, health workers' adherence to guidelines for the initiation of antimicrobials, and outcomes may differ in other health settings, we extended our investigation to lower-level health facilities in the catchment areas of the hospital.…”

“…For fever without clinical evidence of bacterial infection, guidelines recommend withholding antibacterial treatment unless patients have signs of severe illness 10 . Nevertheless, in the absence of reliable diagnostics to explain the cause of the fever in patients with negative malaria tests, health workers may not adhere to guidelines and unnecessarily prescribe antimalarials [11][12][13] and antibacterials 14,15 , which may lead to the development of drug resistance 16,17 .…”