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

• Type of Material: Article
• Authors: Christina Rostad, Emory University; Neena Kanwar, Children's Mercy Hospital; Jumi Yi, Emory University; Claudia Morris, Emory University; Jennifer Dien Bard, Children's Hospital Los Angeles; Amy Leber, Nationwide Children's Hospital; James Dunn, Texas Children's Hospital; Kimberle C. Chapin, Rhode Island Hospital; Anne J. Blaschke, University of Utah; Judy A. Daly, Primary Children's Hospital; Leslie A. Hueschen, Children's Mercy Hospital; Matthew Jones, BioFire Diagnostics LLC; Elizabeth Ott, BioFire Diagnostics LLC; Jeffrey Bastar, BioFire Diagnostics LLC; Kevin M. Bourzac, BioFire Diagnostics LLC; Rangaraj Selvarangan, Children's Mercy Hospital
• Language: English
• Date: 2021-05-18
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12887-021-02699-9
• Title of Journal or Parent Work: BMC Pediatr
• Volume: 21
• Issue: 1
• Start Page: 238
• End Page: 238
• Grant/Funding Information: This study was designed and funded by BioFire Diagnostics. CAR is supported by funding provided by the Emory + Children’s Pediatric Institute.; There was no honorarium, grant, or other form of payment given to produce the manuscript.
• Keywords: Adenovirus; Enterovirus; Serious bacterial infections; Pediatrics; Human parechovirus; Parvovirus B19; Cytomegalovirus; Viremia
• Research Categories: Health Sciences, Health Care Management; Biology, Virology

Abstract

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.