Point of care biomarkers to guide antibiotic prescription for acute febrile illness in sub-Saharan Africa: promises and caveats

Griensven, Johan van; Cnops, Lieselotte; Weggheleire, Anja De; Declercq, Steven; Bottieau, Emmanuel

doi:10.1093/ofid/ofaa260

Cited by 21 publications

(18 citation statements)

References 45 publications

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“…Plots of sensitivity and specificity for each test in all participants and each subgroup are shown in the appendix (pp [56][57][58][59][60][61]. Indirect comparisons between each test and W4SS in all participants are shown in table 3 and each subgroup are shown in the appendix (pp 12-16).…”

Section: Resultsmentioning

confidence: 99%

“…Indirect comparisons by ART status are shown in the appendix (pp [12][13][57][58]. Most tests, except chest x-ray and haemoglobin, had lower sensitivity and higher specificity in outpatients on ART than in outpatients not on ART.…”

Section: Number Of Participantsmentioning

confidence: 99%

“…In outpatients not on ART, sensitivities for C-reactive protein (≥10 mg/L) alone (83% [95% CI 79-86]) and a sequential strategy of W4SS then C-reactive protein (≥5 mg/L; 84% [75-90]) were similar to the sensitivity of W4SS alone (85% [76-91]), but their specificities were higher (67% [60][61][62][63][64][65][66][67][68][69][70][71][72][73] for C-reactive protein alone; 64% [57][58][59][60][61][62][63][64][65][66][67][68][69][70][71] for sequential strategy) than with W4SS alone (37% ; appendix p 13). In a hypothetical cohort of 1000 outpatients not on ART with 10% tuberculosis prevalence, compared with use of W4SS alone, use of C-reactive protein (≥10 mg/L) would reduce the number of rapid diagnostic tests needed by 272 but miss two additional tuberculosis cases, and use of the sequential strategy of W4SS then C-reactive protein (≥5 mg/L) would reduce the number of rapid diagnostic tests needed by 244 but miss one additional tuberculosis case (figure 3; appendix pp [35][36][37].…”

Section: Table 3: Indirect Comparisons Between Each Test and W4ss For The Detection Of Tuberculosis In All Participants (Using Culture Asmentioning

confidence: 99%

See 2 more Smart Citations

Tuberculosis screening among ambulatory people living with HIV: a systematic review and individual participant data meta-analysis

Dhana

Hamada

Kengne

et al. 2022

The Lancet Infectious Diseases

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Section: Resultsmentioning

confidence: 99%

Section: Number Of Participantsmentioning

confidence: 99%

Section: Table 3: Indirect Comparisons Between Each Test and W4ss For The Detection Of Tuberculosis In All Participants (Using Culture Asmentioning

confidence: 99%

See 1 more Smart Citation

Tuberculosis screening among ambulatory people living with HIV: a systematic review and individual participant data meta-analysis

Dhana

Hamada

Kengne

et al. 2022

The Lancet Infectious Diseases

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“…Overall, PCT has shown promising results, though the lack of high-quality data does not allow for decisive conclusions or recommendations yet. Similarly, studies in low-income countries, where availability and relative cost of PCT testing may differ, report encouraging results, but these findings are also based on little data [ 113 , 114 ].…”

Section: Medical Wardmentioning

confidence: 99%

Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19

Wolfisberg

Gregoriano

Schuetz

2021

Critical Reviews in Clinical Laboratory Sciences

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Procalcitonin (PCT) is useful for differentiating between viral and bacterial infections and for reducing the unnecessary use of antibiotics. As the rise of antimicrobial resistance reaches “alarming” levels according to the World Health Organization, the importance of using biomarkers, such as PCT to limit unnecessary antibiotic exposure has further increased. Randomized trials in patients with respiratory tract infections have shown that PCT has prognostic implications and its use, embedded in stewardship protocols, leads to reductions in the use of antibiotics in different clinical settings without compromising clinical outcomes. However, available data are heterogeneous and recent trials found no significant benefit. Still, from these trials, we have learned several key considerations for the optimal use of PCT, which depend on the clinical setting, severity of presentation, and pretest probability for bacterial infection. For patients with respiratory infections and sepsis, PCT can be used to determine whether to initiate antimicrobial therapy in low-risk settings and, together with clinical data, whether to discontinue antimicrobial therapy in certain high-risk settings. There is also increasing evidence regarding PCT-guided therapy in patients with coronavirus disease 2019 (COVID-19). This review provides an up-to-date overview of the use of PCT in different clinical settings and diseases, including a discussion about its potential to improve the care of patients with COVID-19.

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“…Immediate access to CRP results could be valuable to identify patients who require antibiotic treatment and those for whom antibiotics can be safely withheld (van Griensven et al, 2020).…”

Section: Biomarkers To Guide Patient Managementmentioning

confidence: 99%

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

Akelew

Derbew

Lemma

et al. 2020

International Journal of Infectious Diseases

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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.

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Point of care biomarkers to guide antibiotic prescription for acute febrile illness in sub-Saharan Africa: promises and caveats

Abstract: Abstract

Cited by 21 publications

References 45 publications

Tuberculosis screening among ambulatory people living with HIV: a systematic review and individual participant data meta-analysis

Tuberculosis screening among ambulatory people living with HIV: a systematic review and individual participant data meta-analysis

Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19

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

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