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

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

  • BMC Pediatr. 2021 May 18;21(1):238. doi: 10.1186/s12887-021-02699-9.
Christina A Rostad 1 2,  Neena Kanwar 3,  Jumi Yi 4 5,  Claudia R Morris 4 5,  Jennifer Dien Bard 6,  Amy Leber 7,  James Dunn 8,  Kimberle C Chapin 9,  Anne J Blaschke 10,  Judy A Daly 11,  Leslie A Hueschen 12,  Matthew Jones 13,  Elizabeth Ott 13,  Jeffrey Bastar 13,  Kevin M Bourzac 13,  Rangaraj Selvarangan 3
Affiliations

Affiliations

  • 1 Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA. Christina.rostad@emory.edu.
  • 2 Children's Healthcare of Atlanta, Atlanta, GA, USA. Christina.rostad@emory.edu.
  • 3 Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.
  • 4 Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA.
  • 5 Children's Healthcare of Atlanta, Atlanta, GA, USA.
  • 6 Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California, CA, Los Angeles, USA.
  • 7 Nationwide Children's Hospital, Columbus, OH, USA.
  • 8 Texas Children's Hospital, Houston, TX, USA.
  • 9 Rhode Island Hospital, Providence, RI, USA.
  • 10 University of Utah School of Medicine, Salt Lake City, UT, USA.
  • 11 Primary Children's Hospital, Salt Lake City, UT, USA.
  • 12 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.
  • 13 BioFire Diagnostics, LLC, Salt Lake City, UT, USA.
PMID: 34006235 DOI: 10.1186/s12887-021-02699-9
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.

Keywords

Adenovirus; Cytomegalovirus; Enterovirus; Human parechovirus; Parvovirus B19; Pediatrics; Serious bacterial infections; Viremia.

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