Bacterial Infection

细菌感染
  • 文章类型: Journal Article
    由致病菌引起的传染病在全球范围内的传播引起了公众的极大关注,以及敏感的方法,选择性,和细菌的轻松诊断可以有效地防止感染的恶化和进一步传播。纳米酶的出现扩大了诊断细菌感染的替代方案的范围。与天然酶相比,纳米酶表现出相同的酶学特性,但提供更大的经济效率,增强耐用性,和可调尺寸。介绍了细菌感染早期诊断和常规诊断方法的重要性。随后,审查阐明了定义,属性,和纳米酶的催化机理。最终,探索了纳米酶在细菌检测中的详细应用,强调它们作为生物传感器的利用,可以加速和高度敏感地识别细菌感染,并反映基于纳米酶的细菌检测作为即时检测(POCT)工具的潜力。本综述的结论简要介绍了该领域的障碍和未来前景。
    The global spread of infectious diseases caused by pathogenic bacteria significantly poses public health concerns, and methods for sensitive, selective, and facile diagnosis of bacteria can efficiently prevent deterioration and further spreading of the infections. The advent of nanozymes has broadened the spectrum of alternatives for diagnosing bacterial infections. Compared to natural enzymes, nanozymes exhibit the same enzymatic characteristics but offer greater economic efficiency, enhanced durability, and adjustable dimensions. The importance of early diagnosis of bacterial infection and conventional diagnostic approaches is introduced. Subsequently, the review elucidates the definition, properties, and catalytic mechanism of nanozymes. Eventually, the detailed application of nanozymes in detecting bacteria is explored, highlighting their utilization as biosensors that allow for accelerated and highly sensitive identification of bacterial infections and reflecting on the potential of nanozyme-based bacterial detection as a point-of-care testing (POCT) tool. A brief summary of obstacles and future perspectives in this field is presented at the conclusion of this review.
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  • 文章类型: Journal Article
    伤口易于感染,这可能对患者的生命是致命的。抗生素的使用对于控制伤口中的细菌感染至关重要,但是长期使用高剂量的抗生素可能会导致细菌耐药性,甚至产生超级细菌。因此,制定针对性的抗菌治疗策略和减少抗生素的使用是当务之急.在这项研究中,通过Zn2+的自组装合成了一种用于治疗抑菌感染的多功能纳米药物递送系统(Cef-rhEGF@ZIF-8@ConA),头孢拉定(Cef)和重组人表皮生长因子(rhEGF),然后与伴刀豆球蛋白(ConA)缀合,其经历pH响应性降解以释放药物。首先,ConA能与细菌特异性结合,抑制Zn2+离子的快速释放,从而达到长效抗菌效果。Cef通过抑制细菌膜蛋白的合成发挥其抗菌作用。最后,从Zn-金属-有机骨架(MOF)释放的Zn2离子通过增强细菌细胞膜的渗透性而表现出抑菌特性。此外,rhEGF上调血管生成相关基因,从而促进血管生成,上皮再生和伤口愈合过程。结果表明,Cef-rhEGF@ZIF-8@ConA具有良好的生物相容性,对金黄色葡萄球菌和大肠杆菌的抗菌效果分别为99.61%和99.75%,分别。这些纳米材料可以抑制炎症细胞因子的释放,促进抗炎细胞因子的释放,同时还刺激成纤维细胞的增殖以促进伤口愈合。一起来看,Cef-rhEGF@ZIF-8@ConA纳米系统是抑菌感染和伤口愈合的临床治疗的优秀候选者。
    Wounds are prone to infection which may be fatal to the life of the patient. The use of antibiotics is essential for managing bacterial infections in wounds, but the long-term use of high doses of antibiotics may lead to bacterial drug resistance and even to creation of superbacteria. Therefore, the development of targeted antimicrobial treatment strategies and the reduction in antibiotic usage are of utmost urgency. In this study, a multifunctional nanodrug delivery system (Cef-rhEGF@ZIF-8@ConA) for the treatment of bacteriostatic infection was synthesized through self-assembly of Zn2+, cefradine (Cef) and recombinant human epidermal growth factor (rhEGF), then conjugated with concanavalin (ConA), which undergoes pH-responsive degradation to release the drugs. First, ConA can specifically combine with bacteria and inhibit the rapid release of Zn2+ ions, thus achieving a long-acting antibacterial effect. Cef exerts its antibacterial effect by inhibiting the synthesis of bacterial membrane proteins. Finally, Zn2+ ions released from the Zn-metal-organic framework (MOF) demonstrate bacteriostatic properties by enhancing the permeability of the bacterial cell membrane. Furthermore, rhEGF upregulates angiogenesis-associated genes, thereby promoting angiogenesis, re-epithelialization and wound healing processes. The results showed that Cef-rhEGF@ZIF-8@ConA has good biocompatibility, with antibacterial efficacy against Staphylococcus aureus and Escherichia coli of 99.61 % and 99.75 %, respectively. These nanomaterials can inhibit the release of inflammatory cytokines and promote the release of anti-inflammatory cytokines, while also stimulating the proliferation of fibroblasts to facilitate wound healing. Taken together, the Cef-rhEGF@ZIF-8@ConA nanosystem is an excellent candidate in clinical therapeutics for bacteriostatic infection and wound healing.
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  • 文章类型: Journal Article
    细菌的快速增殖和感染,尤其是多重耐药细菌,已经成为全球公共卫生的巨大威胁。重点关注抗生素滥用引起的"超级耐药菌"的出现,细菌性疾病的早期诊断不足和延误,开发新的技术和方法对细菌感染的早期针对性检测和治疗具有重要的研究意义。金属纳米颗粒基于其独特的物理和化学性质的特殊效果使得这种系统非常适合在体外和体内检测和治疗细菌感染。金属纳米粒子由于其抗菌谱广,也具有令人钦佩的临床应用前景,各种抗菌机制和优异的生物相容性。在这里,综述了金属纳米粒子在抗菌活性和细菌检测方面的作用机制的研究进展。选择代表性的成就来说明体外和体内应用的概念验证。基于这些观察,我们还简要讨论了金属纳米颗粒在细菌感染诊断和治疗中存在的问题和前景。
    The rapid proliferation and infection of bacteria, especially multidrug-resistant bacteria, have become a great threat to global public health. Focusing on the emergence of \"super drug-resistant bacteria\" caused by the abuse of antibiotics and the insufficient and delayed early diagnosis of bacterial diseases, it is of great research significance to develop new technologies and methods for early targeted detection and treatment of bacterial infection. The exceptional effects of metal nanoparticles based on their unique physical and chemical properties make such systems ideal for the detection and treatment of bacterial infection both in vitro and in vivo. Metal nanoparticles also have admirable clinical application prospects due to their broad antibacterial spectrum, various antibacterial mechanisms and excellent biocompatibility. Herein, we summarized the research progress concerning the mechanism of metal nanoparticles in terms of antibacterial activity together with the detection of bacterial. Representative achievements are selected to illustrate the proof-of-concept in vitro and in vivo applications. Based on these observations, we also give a brief discussion on the current problems and perspective outlook of metal nanoparticles in the diagnosis and treatment of bacterial infection.
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  • 文章类型: Journal Article
    鱼的皮肤粘液装有免疫和抗微生物肽,可提供针对入侵病原体的保护。已经在鱼类中研究了皮肤粘液,但是有关其在细菌感染中的免疫作用的信息很少。这项研究强调了默默无闻的河豚Takifuguobscurus的皮肤粘液中的蛋白质和肽,这些蛋白质和肽对嗜水气单胞菌的感染产生了定量变化。我们通过浸泡浴缸感染了鱼,内心,然后使用液相色谱-串联质谱(LC-MS/MS)分析比较各组中皮肤粘液中的蛋白质水平。基于串联质量标签(TMT)的定量显示,4896种蛋白质是优选定量的蛋白质(DQP),基于19,751种独特的肽。其中170个被耗尽(丰度降低),69个在浴处理(BT)与对照(C)组的比较中是丰富的。同样,与治疗组(T)和BT组相比,76个DQP被耗尽,70个丰富。Further,126DQP耗尽,与T组和C组相比,有34个是丰富的。我们报告的DQP主要是免疫学的,并且涉及独特的生物学功能和途径。我们报道的有趣的蛋白质,其中一些蛋白质首次出现在鱼类中,显示了鱼粘液的富含蛋白质的结构,它可以作为生物标志物,用于鱼类的细菌性疾病治疗,并最终暗示了鱼类对细菌性病原体产生抗性的方法。
    The skin mucus of fish is equipped with immunological and antimicrobial peptides that confer protection against invading pathogens. The skin mucus has been studied in fish however information regarding its immunological roles in bacterial infection is rare. This study highlighted the proteins and peptides in the skin mucus of Obscure puffer Takifugu obscurus that quantitatively altered against Aeromonas hydrophila infection. We infected the fish through bath immersion, intraperitonially, and treated with PBS (control) then compared the level of proteins in the skin mucus among the groups using liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. The Tandem Mass Tag (TMT) based quantification showed that 4896 proteins were Deferentially Quantified Proteins (DQPs), based on 19,751 unique peptides. Of which 170 were depleted (decreased in abundance) and 69 were abundant in comparison of Bath Treated (BT) vs Control (C) groups. Similarly, 76 DQPs were depleted and 70 were abundant in comparison of Treated (T) vs BT groups. Further, 126 DQPs were depleted, and 34 were abundant in comparison to T vs C groups. The DQPs we report were mostly immunological and were involved in unique biological functions and pathways. The interesting protein we report, where some of the proteins are for the first time in fish, shows the protein-rich structure of the mucus of fish, which may act as a biomarker to be targeted for bacterial disease therapy in fish and ultimately hint to the way of making resistance in fish against bacterial pathogens.
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  • 文章类型: Case Reports
    尽管在过去十年中,癌症治疗策略的疗效一直在稳步提高,此类治疗后的不良事件概况也变得越来越复杂.本报告描述了一名67岁的男性残胃癌伴肝浸润的病例。患者接受奥沙利铂和卡培他滨(CAPEOX方案)化疗,联合程序性细胞死亡蛋白-1(PD-1)抑制剂tislelizumab。治疗后,病人发冷,高烧面部潮红,接着是震惊。相关检查结果显示严重的多器官损伤,以及IL-6和降钙素原(PCT)水平显着升高。最初,患者被诊断为与tislelizumab引起的细胞因子释放综合征相关的免疫相关不良事件(irAEs)或严重的细菌感染.然而,当停止tislelizumab治疗并重新应用CAPEOX化疗方案时,类似症状复发。筛选后,最终确定奥沙利铂引起的严重超敏反应(HSR)是这些症状的根本原因.然后进行了文献综述,发现严重的奥沙利铂相关的HSR很少见,使目前的情况变得非典型。本案没有常见的HSR症状,如皮肤和呼吸道症状。然而,病人患有严重的多器官损伤,奥沙利铂化疗联合PD-1抑制剂时误诊为irAE。此外,这种明显严重的奥沙利铂相关HSR导致PCT水平显着增加,被误诊为严重的细菌感染,并阻止了糖皮质激素的使用。这个,反过来,加重了这个病人的伤害.
    Although the efficacy of treatment strategies for cancer have been improving steadily over the past decade, the adverse event profile following such treatments has also become increasingly complex. The present report described the case of a 67-year-old male patient with gastric stump carcinoma with liver invasion. The patient was treated with oxaliplatin and capecitabine (CAPEOX regimen) chemotherapy, combined with the programmed cell death protein-1 (PD-1) inhibitor tislelizumab. Following treatment, the patient suffered from chills, high fever and facial flushing, followed by shock. Relevant examination results revealed severe multiple organ damage, as well as a significant elevation in IL-6 and procalcitonin (PCT) levels. Initially, the patient was diagnosed with either immune-related adverse events (irAEs) associated with cytokine release syndrome caused by tislelizumab or severe bacterial infection. However, when tislelizumab treatment was stopped and the CAPEOX chemotherapy regimen was reapplied, similar symptoms recurred. Following screening, it was finally determined that severe hypersensitivity reaction (HSR) caused by oxaliplatin was the cause underlying these symptoms. A literature review was then performed, which found that severe oxaliplatin-related HSR is rare, rendering the present case atypical. The present case exhibited no common HSR symptoms, such as cutaneous and respiratory symptoms. However, the patient suffered from serious multiple organ damage, which was misdiagnosed as irAE when oxaliplatin chemotherapy combined with the PD-1 inhibitor was administered. In addition, this apparent severe oxaliplatin-related HSR caused a significant increase in PCT levels, which was misdiagnosed as severe bacterial infection and prevented the use of glucocorticoids. This, in turn, aggravated the damage in this patient.
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  • 文章类型: Journal Article
    慢性伤口易受细菌感染,并且具有发展抗生素抗性细菌感染的高风险。银是通过靶向慢性伤口中几乎所有类型的细菌来减少感染区域中的细菌负荷并进一步促进愈合过程的抗微生物剂。这项研究的重点是探索银基敷料在治疗慢性伤口方面是否优于非银敷料。PubMed,从开始到2024年3月,对WebofScience和Embase进行了全面搜索,以进行随机临床试验和观察性研究。伤口愈合率方面的终点,完整的愈合时间,使用ReviewManager5.4软件分析伤口表面积和伤口感染率的减少。最终纳入了总共15项研究,涉及5046名患者。结果表明,与提供非银敷料的患者相比,使用银基敷料的患者伤口愈合率较高(OR:1.43,95%CI:1.10-1.85,p=0.008),较短的完全愈合时间(MD:-0.96,95%CI:-1.08〜-0.85,p<0.00001)和较低的伤口感染率(OR:0.56,95%CI:0.40-0.79,p=0.001);发现伤口表面积的减少没有显着差异(MD:12.41,95%CI:-19.59-44.40,p=0.45)。这些发现表明,银基敷料能够提高慢性伤口愈合率,缩短完全愈合时间,降低伤口感染率,但伤口表面积的减少没有显着改善。需要大规模和严格的研究来确认银基敷料对慢性伤口愈合的有益效果。
    Chronic wounds are susceptible to bacterial infections and at high risk of developing antibiotic-resistant bacterial infections. Silver is an antimicrobial by targeting almost all types of bacteria in chronic wounds to reduce the bacterial load in the infected area and further facilitate the healing process. This study focused on exploring whether silver-based dressings were superior to non-silver dressings in the treatment of chronic wounds. PubMed, Web of Science and Embase were comprehensively searched from inception to March 2024 for randomized clinical trials and observational studies. The endpoints in terms of wound healing rate, complete healing time, reduction on wound surface area and wound infection rate were analysed using Review Manager 5.4 software. A total of 15 studies involving 5046 patients were eventually included. The results showed that compared with patients provided with non-silver dressings, patients provided with silver-based dressings had higher wound healing rate (OR: 1.43, 95% CI: 1.10-1.85, p = 0.008), shorter complete healing time (MD: -0.96, 95% CI: -1.08 ~ -0.85, p < 0.00001) and lower wound infection rate (OR: 0.56, 95% CI: 0.40-0.79, p = 0.001); no significant difference in the reduction on wound surface area (MD: 12.41, 95% CI: -19.59-44.40, p = 0.45) was found. These findings suggested that the silver-based dressings were able to enhance chronic wound healing rate, shorten the complete healing time and reduce wound infection rate, but had no significant improvement in the reduction on wound surface area. Large-scale and rigorous studies are required to confirm the beneficial effects of silver-based dressings on chronic wound healing.
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  • 文章类型: Journal Article
    在重症监护病房(ICU)保持清洁卫生的环境对于确保患者安全至关重要,预防感染,减少与医疗保健相关的并发症。随着感染的流行以及病毒和细菌对标准抗菌剂的耐药性的出现,迫切需要创新的防腐解决方案。纳米技术越来越多地应用于医学,特别是侧重于减轻各种病原体的活动,包括那些与医院获得性感染有关的。本文探讨了纳米技术的当前影响,特别关注细菌感染和SARS-CoV-2,这对医疗保健系统造成了严重的压力,然后讨论纳米技术如何增强现有的治疗方法。我们强调了基于纳米技术的杀菌剂Bio-Kil在减少ICU细菌计数方面的有效性。目的是教育医疗保健专业人员纳米技术在解决流行传染病方面的现有作用和前景。
    To maintain a clean and hygienic environment in the intensive care unit (ICU) is crucial for ensuring patient safety, preventing infections, and reducing healthcare-associated complications. With the increasing prevalence of infections and the emergence of viral and bacterial resistance to standard antiseptics, there is a pressing need for innovative antiseptic solutions. Nanotechnology is increasingly being employed in medicine, particularly focusing on mitigating the activities of various pathogens, including those associated with hospital-acquired infections. This paper explores the current impact of nanotechnology, with a particular focus on bacterial infections and SARS-CoV-2, which significantly strain healthcare systems, and then discusses how nanotechnology can enhance existing treatment methodologies. We highlight the effectiveness of the nanotechnology-based bactericide Bio-Kil in reducing bacterial counts in an ICU. The aim is to educate healthcare professionals on the existing role and prospects of nanotechnology in addressing prevalent infectious diseases.
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  • 文章类型: Journal Article
    皮肤损伤是人类最常见的损伤之一,影响人类的健康。然而,皮肤损伤常伴有细菌感染和伤口微环境变化,对正常细胞造成损害并抑制伤口愈合。在这里,我们设计了一种负载过氧化氢酶(CAT)样Au@Pt@MgSiO3纳米颗粒(APMNPs)和庆大霉素(GM)的热响应抗菌水凝胶(GAG水凝胶),以促进伤口愈合。GAG水凝胶用于光热疗法(PTT)/抗生素组合以杀死细菌,减少抗生素的使用,改善伤口微环境,促进细胞增殖,加速伤口愈合.在近红外激光照射下,水凝胶中的APMNP产生局部热疗以杀死细菌。同时,产生的热量导致水凝胶形态的变化,使其能够释放GM和APMNPs,以防止抗生素的过度使用。随后,APMNP的CAT样能力降低了过氧化氢(H2O2)引起的氧化应激,从而重塑伤口微环境。然后,伤口的弱酸性微环境导致APMNP的分解和镁离子(Mg2+)的释放,促进伤口愈合细胞的生长和迁移。因此,研究的热响应抗菌(GAG)水凝胶在伤口愈合领域具有潜力。
    Skin damage is one of the most prevalent human injuries, which affects the health of human beings. However, skin damage is often accompanied by bacterial infection and wound microenvironment changes, causing damage to normal cells and inhibiting wound healing. Herein, we designed a thermal-responsive antibacterial hydrogel (GAG hydrogel) loaded with catalase (CAT)-like Au@Pt@MgSiO3 nanoparticles (APM NPs) and gentamicin (GM) to promote wound healing. The GAG hydrogel was used in a photothermal therapy (PTT)/antibiotic combination to kill bacteria, reduce the use of antibiotics, improve the wound microenvironment, promote cell proliferation, and accelerate wound healing. Under near-infrared laser irradiation, APM NPs in the hydrogel generated local hyperthermia to kill bacteria. Meanwhile, the generated heat led to a change in the hydrogel\'s morphology, enabling it to release GM and APM NPs to prevent the overuse of antibiotics. Subsequently, the CAT-like ability of the APM NPs decreased the oxidative stress caused by hydrogen peroxide (H2O2), thus remodeling the wound microenvironment. Then, the weakly acidic microenvironment of the wound caused the decomposition of the APM NPs and the release of magnesium ions (Mg2+), promoting the growth and migration of cells for wound healing. Therefore, the studied thermal-responsive antibacterial (GAG) hydrogel has potential in the field of wound healing.
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  • 文章类型: Journal Article
    确定细菌感染的精确过程需要丰富的体内实时数据。同步监测细菌负荷,温度,免疫应答可以满足体内实时数据的不足。这里,我们在关节感染小鼠模型中进行了一项研究,以同步监测细菌负荷,温度,和使用第二近红外(NIR-II)荧光成像的免疫反应,红外热成像,免疫应答分析2周。金黄色葡萄球菌(S。金黄色葡萄球菌)在体外和皮下感染模型中被证明成功地用葡萄糖缀合的量子点标记。NIR-II荧光成像显示的细菌负荷在感染后1天急剧下降。同时,通过感染同步带来的红外热成像检测到的温度间隙达到最低值。同时,流式细胞术分析表明,包括巨噬细胞在内的免疫反应,中性粒细胞,B淋巴细胞,T淋巴细胞在感染后1天增加到峰值。此外,血液中的M1巨噬细胞和M2巨噬细胞在感染后第1天都有明显的变化,变化是相反的。总之,这项研究不仅获得了实时和长时间的体内细菌负荷数据,温差,和金黄色葡萄球菌感染小鼠模型中的免疫反应,但也发现感染后1天是针对金黄色葡萄球菌感染的免疫反应的关键时间点。我们的研究将有助于在动物水平上同步,精确地研究细菌感染后复杂的动态关系。
    Determining the precise course of bacterial infection requires abundant in vivo real-time data. Synchronous monitoring of the bacterial load, temperature, and immune response can satisfy the shortage of real-time in vivo data. Here, we conducted a study in the joint-infected mouse model to synchronously monitor the bacterial load, temperature, and immune response using the second near-infrared (NIR-II) fluorescence imaging, infrared thermography, and immune response analysis for 2 weeks. Staphylococcus aureus (S. aureus) was proved successfully labeled with glucose-conjugated quantum dots in vitro and in subcutaneous-infected model. The bacterial load indicated by NIR-II fluorescence imaging underwent a sharp drop at 1 day postinfection. At the same time, the temperature gap detected through infrared thermography synchronously brought by infection reached lowest value. Meanwhile, the flow cytometry analysis demonstrated that immune response including macrophage, neutrophil, B lymphocyte, and T lymphocyte increased to the peak at 1 day postinfection. Moreover, both M1 macrophage and M2 macrophage in the blood have an obvious change at ~ 1 day postinfection, and the change was opposite. In summary, this study not only obtained real-time and long-time in vivo data on the bacterial load, temperature gap, and immune response in the mice model of S. aureus infection, but also found that 1 day postinfection was the key time point during immune response against S. aureus infection. Our study will contribute to synchronously and precisely studying the complicated complex dynamic relationship after bacterial infection at the animal level.
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  • 文章类型: Journal Article
    目的:本研究的目的是评估病毒和细菌感染患者血液中肿瘤坏死因子相关凋亡诱导配体(TRAIL)水平的变化,以及TRAIL对病毒和细菌感染的诊断性能。
    方法:调查包括169名成年(>18岁)患者出现急性感染的医学体征(纳入标准包括体温超过37.5°C,症状发作不超过12天)。参考标准基于严格的专家小组,大多数小组确定了感染性病因。最后,本研究纳入104例患者,其中78例细菌和26例病毒参考标准结果(根据排除标准排除24例;41例参考标准诊断不确定)。ELISA用于测量78例细菌感染受试者和26例病毒感染受试者的TRAIL水平。通过受试者工作特征(ROC)分析确定TRAIL的诊断性能。
    结果:细菌感染患者的TRAIL水平明显低于病毒感染患者(16.59(2.61-32.6)pg/mLvs.97.39(36.18-127.74)pg/mL,P<0.05)。用于鉴定细菌和病毒感染的TRAIL的ROC曲线下面积(AUC)为0.86(95CI:0.79至0.94)。TRAIL与C反应蛋白(CRP)联合使用,AUC为0.94(95CI:0.89至1.00)。
    结论:TRAIL用于区分病毒和细菌感染。将TRAIL与CRP组合增加AUC。
    OBJECTIVE: The aim of the investigation was to evaluate variations in blood TNF-related apoptosis-inducing ligand (TRAIL) levels between patients with viral and bacterial infections and the diagnostic performance of TRAIL for identifying viral and bacterial infections.
    METHODS: The investigation included 169 adult (>18 years) patients presenting with medical signs of acute infections (inclusion criteria included a body temperature over 37.5 °C, an onset of symptoms no more than 12 days). Reference standard was based on a rigorous expert panel and the majority of the panel determined the infectious etiology. Finally, 104 patients with 78 bacterial and 26 viral reference standard outcomes were enrolled in this investigation (24 were eliminated depending on the exclusion criteria; 41 had indeterminate reference standard diagnosis). ELISA was employed to measure TRAIL levels in the group of 78 subjects with bacterial infections and 26 individuals with viral infections, and the diagnostic performance of TRAIL was identified by receiver operating characteristic (ROC) analysis.
    RESULTS: The TRAIL level in individuals with bacterial infections was significantly lower than that in subjects with viral infections (16.59 (2.61-32.6) pg/mL vs. 97.39 (36.18-127.74) pg/mL, P < 0.05). The area under the ROC curve (AUC) of TRAIL was 0.86 (95 %CI:0.79 to 0.94) for identifying bacterial and viral infections. Combining TRAIL with C-reactive protein (CRP), the AUC was 0.94 (95 %CI:0.89 to 1.00).
    CONCLUSIONS: TRAIL is diagnostic for discriminating between viral and bacterial infections. Combining TRAIL with CRP increases the AUC.
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