en
Scientific article
Open access
English

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

Published inEuropean journal of pediatrics, vol. 182, no. 2, p. 941-947
Publication date2023-02
First online date2022-11-18
Abstract

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.

eng
Keywords
  • 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
Citation (ISO format)
GALETTO-LACOUR, Annick et al. Viremia as a predictor of absence of serious bacterial infection in children with fever without source. In: European journal of pediatrics, 2023, vol. 182, n° 2, p. 941–947. doi: 10.1007/s00431-022-04690-7
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Article (Published version)
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Identifiers
ISSN of the journal0340-6199
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Creation09/19/2023 7:57:16 AM
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