Abstract
Abstract
Background
Differentiating viral from bacterial infections in febrile children is challenging. Traditional markers like CRP and procalcitonin can be non-specific. A newer method, the MeMed MMBV score, combines three host-protein markers (TRAIL, IP-10, CRP) to improve diagnostic accuracy. This meta-analysis is, to our knowledge, the first pediatric-focused evaluation of the test accuracy of the MMBV score and its potential to guide antibiotic use in children.
Methods
We searched for relevant articles up to October 2025 from PubMed, Scopus, Cochrane Library, and Web of Science. Two independent reviewers extracted data from the selected studies, including baseline information, outcomes, antibiotic prescription rates, and diagnostic accuracy estimates of the MMBV score. All data analyses were performed using R version 4.3.3.
Results
We collected 407 records after excluding 252 duplicates. Thorough screening resulted in the retrieval of 17 entries eligible for inclusion in our review. Pooled across 12 studies, the host-protein signature test demonstrated high diagnostic accuracy for distinguishing bacterial from viral infections. The bivariate model summary estimates noted a sensitivity of 89.3% (95% CI: 82.5–93.6%) and a specificity of 91% (95% CI: 89.1–92.5%). The area under the ROC curve was 0.943 (95% CI: 0.88–0.96). Multiple studies indicate the signature has significant potential to reduce inappropriate antibiotic use. Estimates suggest it could lower antibiotic overuse by 88% in viral patients, with relative reductions ranging from 78% to 97% across different settings. In specific models, antibiotic overuse in children with viral infections could fall from 29.6% to 9.1%, a 69.4% relative reduction. Other analyses in emergency departments and hospitals support its utility, showing potential reductions in antibiotic prescriptions and diagnostic errors.
Conclusion
This meta-analysis confirms the high accuracy of the MMBV host-protein signature for differentiating between viral and bacterial febrile illness in children. Its excellent rule-out capability can reduce unnecessary antibiotic prescriptions.