Viremia as a predictor of absence of serious bacterial infection in children with fever without source.

Autor: Galetto-Lacour A; Division of Pediatric Emergencies, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Cordey S; Laboratory of Virology, Diagnostics Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Papis S; Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Mardegan C; Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Luterbacher F; Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Combescure C; Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Lacroix L; Division of Pediatric Emergencies, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Gervaix A; Division of Pediatric Emergencies, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Kaiser L; Laboratory of Virology, Diagnostics Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.; Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Posfay-Barbe KM; Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.; Pediatric Infectious Diseases Unit, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., L'Huillier AG; Laboratory of Virology, Diagnostics Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. arnaud.lhuillier@hcuge.ch.; Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. arnaud.lhuillier@hcuge.ch.; Pediatric Infectious Diseases Unit, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. arnaud.lhuillier@hcuge.ch.
Jazyk: angličtina
Zdroj: European journal of pediatrics [Eur J Pediatr] 2023 Feb; Vol. 182 (2), pp. 941-947. Date of Electronic Publication: 2022 Nov 18.
DOI: 10.1007/s00431-022-04690-7
Abstrakt: Most children with fever without source (FWS) require diagnostic laboratory tests to exclude a serious bacterial infection (SBI), often followed by admission and empirical antibiotics. As febrile children with a viral infection are less likely to have a SBI, identifying patients with systemic viral infection could contribute to exclude SBI. We evaluated whether the presence of virus in the blood could be used as a biomarker to rule out SBI. Children < 3 years old with FWS were prospectively enrolled and had real-time (reverse-transcription) PCR performed on the blood for adenovirus, enterovirus, parechovirus, and HHV6. 20/135 patients had SBI, and in 47/135, at least one virus was detected in the blood. Viremia had a higher sensitivity and negative predictive value (90% and 96%) to rule out SBI compared to CRP (65% and 93%) and PCT (55% and 90%). The odds ratio (OR) for the presence of SBI among non-viremic patients was 5.8 (p = 0.0225), compared to 5.5 for CRP ≥ 40 mg/l (p = 0.0009) and 3.7 for PCT ≥ 0.5 ng/mL (0.0093). This remained significant after adjusting for CRP and PCT (OR 5.6 and 5.9, respectively; p = 0.03 for both). Area under the ROC curve for CRP and PCT were 0.754 and 0.779, respectively, but increased to 0.803 and 0.832, respectively, when combined with viremia.
Conclusion: The presence of viremia had a better performance than commonly used biomarkers to rule-out SBI and could potentially be used in conjunction with CRP and/or PCT in the evaluation of children with FWS. Larger studies should evaluate the role of point-of-care testing of viruses by (revere-transcription) PCR in the plasma in management algorithms of children with FWS.
What Is Known: • Most children with FWS have a viral infection, but up to 15% have a SBI; most require laboratory tests, and many admission and empirical antibiotics. • Children with a viral infection are less likely to have a SBI.
What Is New: • Children with a systemic viral infection are less likely to have an SBI. • Viremia is a better predictor of absence of SBI than commonly used biomarkers and could potentially be used in conjunction with CRP and/or PCT in the evaluation of children with FWS.
(© 2022. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje