A multicenter evaluation of viral bloodstream detections in children presenting to the Emergency Department with suspected systemic infection.

Autor: Rostad CA; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA. Christina.rostad@emory.edu.; Children's Healthcare of Atlanta, Atlanta, GA, USA. Christina.rostad@emory.edu., Kanwar N; Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA., Yi J; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA.; Children's Healthcare of Atlanta, Atlanta, GA, USA., Morris CR; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA.; Children's Healthcare of Atlanta, Atlanta, GA, USA., Bard JD; Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California, CA, Los Angeles, USA., Leber A; Nationwide Children's Hospital, Columbus, OH, USA., Dunn J; Texas Children's Hospital, Houston, TX, USA., Chapin KC; Rhode Island Hospital, Providence, RI, USA., Blaschke AJ; University of Utah School of Medicine, Salt Lake City, UT, USA., Daly JA; Primary Children's Hospital, Salt Lake City, UT, USA., Hueschen LA; Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, University of Kansas School of Medicine, Kansas City, MO, USA., Jones M; BioFire Diagnostics, LLC, Salt Lake City, UT, USA., Ott E; BioFire Diagnostics, LLC, Salt Lake City, UT, USA., Bastar J; BioFire Diagnostics, LLC, Salt Lake City, UT, USA., Bourzac KM; BioFire Diagnostics, LLC, Salt Lake City, UT, USA., Selvarangan R; Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.
Jazyk: angličtina
Zdroj: BMC pediatrics [BMC Pediatr] 2021 May 18; Vol. 21 (1), pp. 238. Date of Electronic Publication: 2021 May 18.
DOI: 10.1186/s12887-021-02699-9
Abstrakt: Background: Fever is a common symptom in children presenting to the Emergency Department (ED). We aimed to describe the epidemiology of systemic viral infections and their predictive values for excluding serious bacterial infections (SBIs), including bacteremia, meningitis and urinary tract infections (UTIs) in children presenting to the ED with suspected systemic infections.
Methods: We enrolled children who presented to the ED with suspected systemic infections who had blood cultures obtained at seven healthcare facilities. Whole blood specimens were analyzed by an experimental multiplexed PCR test for 7 viruses. Demographic and laboratory results were abstracted.
Results: Of the 1114 subjects enrolled, 245 viruses were detected in 224 (20.1%) subjects. Bacteremia, meningitis and UTI frequency in viral bloodstream-positive patients was 1.3, 0 and 10.1% compared to 2.9, 1.3 and 9.7% in viral bloodstream-negative patients respectively. Although viral bloodstream detections had a high negative predictive value for bacteremia or meningitis (NPV = 98.7%), the frequency of UTIs among these subjects remained appreciable (9/89, 10.1%) (NPV = 89.9%). Screening urinalyses were positive for leukocyte esterase in 8/9 (88.9%) of these subjects, improving the ability to distinguish UTI.
Conclusions: Viral bloodstream detections were common in children presenting to the ED with suspected systemic infections. Although overall frequencies of SBIs among subjects with and without viral bloodstream detections did not differ significantly, combining whole blood viral testing with urinalysis provided high NPV for excluding SBI.
Databáze: MEDLINE
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