Clinical Utility of Myxovirus resistance protein A (MxA) for Differentiation Between Viral and Bacterial Infection in Adult Acute Care: A prospective study

Clinical Utility of Myxovirus resistance protein A (MxA) for Differentiation Between Viral and Bacterial Infection in Adult Acute Care: A prospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Utility of Myxovirus resistance protein A (MxA) for Differentiation Between Viral and Bacterial Infection in Adult Acute Care: A prospective study Jiri Muller, Daniel Rajdl, Hana Vimmerova, Martin Matejovic This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8238199/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Background Distinguishing between viral and bacterial infections remains a diagnostic challenge with major implications for treatment and appropriate antibiotic use. This study aimed to evaluate the performance of Myxovirus resistance protein A (MxA) as a marker of viral infection in acutely ill adult patients. Methods A total of 869 consecutive adult patients was allocated into groups based on the presence or absence of infection and its etiology. The effectiveness of MxA and MxA-based ratios in identifying viral infections was evaluated and results were compared with an optimal statistical model obtained through multivariate logistic regression analysis. Confounding factors influencing MxA production were identified. Additionally, we developed an algorithm to guide antibiotic prescription in a subgroup of patients with respiratory tract infections. Results MxA was significantly elevated in viral infections and coinfections. With an AUC of 0.87, a sensitivity of 79.8% and a specificity of 87.1% at an optimal cut-off of 21 µg/l, MxA exhibited a high diagnostic yield. Combining MxA with CRP and procalcitonin further enhanced its performance and was comparable to that of the optimal statistical model. The magnitude of MxA production differed by viral etiology. Comorbidities were not associated with any consistent alteration in MxA expression. Conclusion MxA is a reliable biomarker for distinguishing viral from bacterial infections in acutely ill adults. The MxA/PCT ratio further improves diagnostic accuracy and may enhance antibiotic stewardship through a simple algorithm for guiding antibiotic use. Myxovirus resistance protein A Biomarker Viral infection Respiratory tract infection Antibiotic stewardship Adult acute care Full Text Additional Declarations No competing interests reported. Supplementary Files supplement.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 15 May, 2026 Reviews received at journal 13 May, 2026 Reviewers agreed at journal 03 May, 2026 Reviews received at journal 10 Apr, 2026 Reviewers agreed at journal 30 Mar, 2026 Reviewers invited by journal 08 Dec, 2025 Editor assigned by journal 08 Dec, 2025 Submission checks completed at journal 06 Dec, 2025 First submitted to journal 06 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8238199","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":558478040,"identity":"e9041eb2-a0f8-4562-b9bf-68d403a2278d","order_by":0,"name":"Jiri 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study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Myxovirus resistance protein A, Biomarker, Viral infection, Respiratory tract infection, Antibiotic stewardship, Adult acute care","lastPublishedDoi":"10.21203/rs.3.rs-8238199/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8238199/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eDistinguishing between viral and bacterial infections remains a diagnostic challenge with major implications for treatment and appropriate antibiotic use. This study aimed to evaluate the performance of Myxovirus resistance protein A (MxA) as a marker of viral infection in acutely ill adult patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 869 consecutive adult patients was allocated into groups based on the presence or absence of infection and its etiology. The effectiveness of MxA and MxA-based ratios in identifying viral infections was evaluated and results were compared with an optimal statistical model obtained through multivariate logistic regression analysis. Confounding factors influencing MxA production were identified. Additionally, we developed an algorithm to guide antibiotic prescription in a subgroup of patients with respiratory tract infections.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eMxA was significantly elevated in viral infections and coinfections. With an AUC of 0.87, a sensitivity of 79.8% and a specificity of 87.1% at an optimal cut-off of 21 \u0026micro;g/l, MxA exhibited a high diagnostic yield. Combining MxA with CRP and procalcitonin further enhanced its performance and was comparable to that of the optimal statistical model. The magnitude of MxA production differed by viral etiology. Comorbidities were not associated with any consistent alteration in MxA expression.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eMxA is a reliable biomarker for distinguishing viral from bacterial infections in acutely ill adults. The MxA/PCT ratio further improves diagnostic accuracy and may enhance antibiotic stewardship through a simple algorithm for guiding antibiotic use.\u003c/p\u003e","manuscriptTitle":"Clinical Utility of Myxovirus resistance protein A (MxA) for Differentiation Between Viral and Bacterial Infection in Adult Acute Care: A prospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-11 16:24:04","doi":"10.21203/rs.3.rs-8238199/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-15T07:06:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-13T04:17:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"197654676308553696751671731280033547096","date":"2026-05-03T17:42:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-10T11:16:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227822279623365376189455470306316848323","date":"2026-03-30T14:26:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-08T13:59:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-08T05:17:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-06T09:33:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-12-06T09:26:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f36c267b-94e3-4665-b96d-d16d373f6e9f","owner":[],"postedDate":"December 11th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-15T07:06:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-13T04:17:16+00:00","index":287,"fulltext":""},{"type":"reviewerAgreed","content":"197654676308553696751671731280033547096","date":"2026-05-03T17:42:51+00:00","index":286,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T07:11:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-11 16:24:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8238199","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8238199","identity":"rs-8238199","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}