![0556-01-10 Pediatrics](https://farm3.static.flickr.com/2935/14136133512_e75fee8f56_b.jpg)
0556-01-10 Pediatrics
Project Lead(s): Ngweina Magitta
Issue
Bacterial infection of the blood is a major cause of death and morbidity among children less than five years old, particularly in resource-limited settings.
Blood culture is the gold standard for diagnosis of bacterial sepsis – a technique that is virtually absent in resource-limited settings.
In order to reduce mortality, antibiotic therapy is normally initiated without adequate evidence.
Solution
The investigators for this pilot project hypothesized that a combination of biomarkers with moderate diagnostic threshold could result in an improved ‘multistix’ for diagnosis of bloodstream bacterial infection.
The pilot study attempted to generate preliminary evidence for an innovative strategy to identify the potential biomarkers for bacterial sepsis that could be used to develop a rapid, point-of-care test for bacterial sepsis.
The design of this test could then be combined with the existing malaria rapid diagnostic test (mRDT) into a single rapid test for diagnosis of both malaria and bacterial sepsis at a single setting.
The tool could guide rational use of antibiotics in non-malarial fevers, thereby reducing antibiotic resistance.
The investigators analyzed four predetermined biomarkers for bloodstream bacterial infection in children and evaluated their potential for a rapid diagnostic test.
Outcome
The preliminary findings indicate improved diagnostic value for lipoteichoic acid (LTA), as compared to other biomarkers.
However, using a subset analysis with polymerase chain reaction (PCR) as the reference, it was observed that LTA performed similar to procalcitonin (PCT) and lipopolysaccharide (LPS) in the diagnosis of bloodstream bacterial infection, while C-Reactive Protein (CRP) consistently performed poorly in both analyses. Hence, no conclusion could be drawn.
Large-powered studies are required for validation of these markers, prior to further attempts to design of a randomized controlled trial (RCT).
The team intends to apply for Phase II Transition To Scale funding, which they anticipate would provide an opportunity to search for additional biomarkers and to validate sensitive markers, using a large sample size of diverse strata of children with bloodstream bacterial infection and other forms of non-malarial fevers.