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

Article Article scientifique Article Viremia as a predictor of absence of serious bacterial infection in children with fever without source eng 2022-11-18 2023-02 author Galetto-Lacour Annick Division of Pediatric Emergencies, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 32921 Structure enseignement (ENSI) author Cordey Samuel Laboratory of Virology, Diagnostics Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 507357 author Papis Sébastien Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 719312 author Mardegan Chiara 0009-0000-1999-6045 Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 845410 author Iafrate-Luterbacher Fanny Division of General Pediatrics, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 717464 Fanny Luterbacher author Combescure Christophe 0000-0003-2631-4780 Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 670542 Centre de recherche clinique HUG-FACMED (CRCHF) author Lacroix Anne Laurence Division of Pediatric Emergencies, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 79292 author Gervaix Alain Division of Pediatric Emergencies, Department of Women, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 31715 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) author Kaiser Laurent 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. 28229 Département de médecine (DEMED) author Posfay Barbe Klara 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. 39230 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) author L'Huillier Arnaud 0000-0001-9230-7285 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. 543058 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) 941-947 10.1007/s00431-022-04690-7 36399200 0340-6199 PMC9672567 Unlabelled: 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. Biomarker C-reactive protein Negative predictive value Predictor Procalcitonin Prognostic accuracy Sensitivity Viral systemic infection Humans Child Infant Child, Preschool Viremia / diagnosis C-Reactive Protein / analysis Bacterial Infections / complications Bacterial Infections / diagnosis Fever / diagnosis Fever / etiology Biomarkers Anti-Bacterial Agents Dewey 616 Dewey 618 58 Département de pédiatrie, gynécologie et obstétrique 223 217 Centre de recherche clinique 201 56 Département de médecine 221 false 515 Recherche en infectiologie pédiatrique et en pédiatrie générale 853 88 Epidémiologie clinique et biostatistique 115 400 Groupe Laurent Kaiser (virologie clinique) 668 149 Etiologie des pneumonies et marqueurs inflammatoires chez l'enfant fébrile 183 European journal of pediatrics 182 2 c7f16a2b-d0f0-45fe-8445-70c9cec8e4eb Article (Published version) Public Article-scientifique-from-unpaywall.pdf 1352270 application/pdf CC BY-4.0 ab8dda0478eaa1ef38697c33f26420ee489ef3401d3f5e75c910dbe9238dbd48 045b067c-4103-41f8-8f03-ae4eb1fa6e1a Supplemental data Public Copie de 431_2022_4690_MOESM1_ESM.xlsx 21181 application/vnd.openxmlformats-officedocument.spreadsheetml.sheet 189123e8428e38382c5b0302f0763f01ee14ab55bf7ee8ec17b8fdae2a08c0bc 7024cb9d-b962-4129-b8ab-2d9aec884439 Supplemental data Public Copie de 431_2022_4690_MOESM2_ESM.xlsx 11052 application/vnd.openxmlformats-officedocument.spreadsheetml.sheet ab01dbcdb4868d381530b4717d200995bcbc0f33145a04cff60fe8540b91528c f8357b86-4263-438b-8e8a-71688c3916e8 Supplemental data Public Copie de 431_2022_4690_MOESM3_ESM-1.xlsx 16953 application/vnd.openxmlformats-officedocument.spreadsheetml.sheet 60113fc0906f43aeeb59aace628f8f172a1712646e44acbc32ad058369e0863e 22db3c04-034a-4885-9293-24d62daa02db Supplemental data Public Copie de 431_2022_4690_MOESM4_ESM-1.xlsx 16360 application/vnd.openxmlformats-officedocument.spreadsheetml.sheet b62ee8e50ba9d86da10a60def3cc5af390f8093d35c8d8ecf909cc54e2f3e5ca 50979a78-8860-409d-a891-53dab85b803b Supplemental data Public 431_2022_4690_MOESM5_ESM(1).docx 79783 application/vnd.openxmlformats-officedocument.wordprocessingml.document be92d642e3167b3bf6e241ac2bc8f95389effbff9ce1e1a0919780a3a369a2fa openAccess Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique Faculté de médecine / Centre de recherche clinique Faculté de médecine / Section de médecine clinique / Département de médecine

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Viremia as a predictor of absence of serious bacterial infection in children with fever without source	European journal of pediatrics			2023	119	59

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Lacroix, Anne Laurence