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Genetic Roadmap May Assist with Identifying Lower Respiratory Tract Infections

Acute respiratory infections still pose a significant clinical challenge in patients of all ages, carrying with them significant mortality and potentially contributing to the overuse of antibiotics as a result of misdiagnosis.

Now, researchers from the University of Rochester (NY) School of Medicine believe they have developed an effective genetic roadmap to assist in the identification and characterization of infections in the lower respiratory tract. Their findings were published on July 26, 2017 in Scientific Reports.

Despite the advent of novel diagnostics, “we still see a number of individuals who, in our minds, appear to be at pretty low risk for bacterial infection—with a clear chest x-ray and low white blood cell count—in whom doctors are prescribing antibiotics,” study coauthor Ann R. Falsey, MD, Interim Chief, Department of Medicine—Infectious Diseases at the University of Rochester Medical Center told Contagion®. “Clearly, the need to rule out bacterial infection with some degree of certainty is very important. And to be clear, I’m not disparaging clinicians. A chest x-ray and lab tests aren’t always definitive, and when you have somebody ill enough to be in the hospital you don’t want to miss a bacterial infection.”

As Dr. Falsey and her colleagues note in their introduction, lower respiratory tract infections (LRTIs) are difficult to properly treat because “the precise microbial etiology is [often] unknown.” And, they write, although technologies such as polymerase chain reaction (PCR) enable the accurate diagnosis of respiratory viruses, they have not always led to a reduction in antibiotic use because clinicians remain concerned about bacterial coinfection. In fact, earlier research from the University of Rochester group suggests that as many as 30% of hospitalized adults with viral LRTI “have evidence of concomitant bacterial infection.”

For this more recent study, Dr. Falsey and her colleagues screened daily admissions logs at the University of Rochester Medical Center for a 6-month period in 2013 for adults with diagnoses of acute exacerbation of chronic obstructive pulmonary disease (COPD), bronchitis, asthma, influenza, viral syndrome, respiratory failure and congestive heart failure with infection, pneumonia or symptoms of wheezing, dyspnea, cough, sputum production, nasal congestion, sore throat, and/or hoarseness. Eligible patients were enrolled in the study within 24 hours of hospital admission, and researchers collected nose and throat swabs, sputum, urine, and blood for analysis. Only subjects with a microbiologic diagnosis and complete diagnostic testing were included in the study.

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