43 - Using MeMed BV® to Reduce Antibiotic Use for Low Risk CAP

In the United States, pediatric community acquired pneumonia (CAP) remains one of the most prevalent and costly indications for pediatric evaluation in a medical setting. Respiratory viruses are the most isolated source in pre-school aged children diagnosed with CAP, but because of the difficulties differentiating its etiology, most children are still treated with antibiotics. Various serum markers have been trialed to aid in this dilemma without consistent success. The MeMed BV™ test is an immunoassay that intends to aid in the differentiation between bacterial and viral infection.  The test generates a single numeric score with predefined cut-offs of < 35 for viral disease and > 65 for bacterial disease. The test has a sensitivity and specificity of 94% and 90% respectively with a positive predictive value of 82% and a negative predictive value of 95%. MeMed BV™ has been approved for clinical use in the EU, Switzerland, and Israel. FDA approval for use in the United States was granted in September of 2021. 

 

Objective:

We aimed to use MeMed BV™ to aid in the reduction of inappropriate antibiotic treatment in children with low risk, uncomplicated CAP in a pediatric emergency department.

 

Design/Methods:

This was a two-part prospective, single site study. In the first phase, a baseline frequency of antibiotic administration by our ED providers was evaluated. In the second phase, we used MeMed BV™ to determine which patients should receive antibiotic therapy. The inclusion criteria for both phases were: children with concerns for radiographic pneumonia, discharged home or admitted to the general medicine floor, age > 6mo to < 5 years, and having received at least 2 vaccines against both HiB and pneumococcus. Exclusion criteria: received any antibiotics in the past 14 days, a history of aspiration pneumonia or chronic complex conditions, complicated pneumonia as defined by the IDSA guidelines, any other indication for antibiotics, or prior enrollment in the study.

 

Results:

Of the 54 patients enrolled in phase one, 49 (91%) received antibiotics. There were 8 failure events, which was defined as initiation of antibiotics within 7 days of enrollment for worsening respiratory symptoms or unplanned visit to a medical provider due to worsening respiratory symptoms. Of the 38 patients enrolled in phase two, 21 (55%) received antibiotics with 5 failure events (p < 0.001 for antibiotic reduction).

 

Conclusion(s):

These data suggest that using a serum biomarker for differentiating bacterial from viral pneumonia in young children may reduce unnecessary antibiotic prescriptions without an increase in adverse events.