Rhinovirus in Febrile Infants and Risk of Bacterial Infection

Blaschke, Anne J.; Korgenski, E. Kent; Wilkes, Jacob; Presson, Angela P.; Thorell, Emily A.; Pavia, Andrew T.; Knackstedt, Elizabeth D.; Reynolds, Carolyn; Schunk, Jeff E.; Daly, Judy A.; Byington, Carrie L.

doi:10.1542/peds.2017-2384

Cited by 46 publications

(44 citation statements)

References 31 publications

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“…Of the 1,003 samples, 280 (27.9%) were positive for HRV (HRV-A, 50.0%; HRV-B, 7.5%; HRV-C, 20%; and HRV-untyped, 22.5%). This HRV detection rate is consistent with prior studies (11.0–40.6%) worldwide, as are the proportions of the three HRV species (HRV-A, 44.4–56%; HRV-B, 2–12%; and HRV-C, 25–45.3%) ( Xiang et al, 2010 ; Henquell et al, 2012 ; Rahamat-Langendoen et al, 2013 ; Marcone et al, 2014 ; Tsatsral et al, 2015 ; Xiao et al, 2015 ; Milanoi et al, 2016 ; van der Linden et al, 2016 ; Blaschke et al, 2018 ). This prevalence of HRV-untyped is higher than in a recent study in Chongqing (13%) ( Xiao et al, 2015 ), perhaps because our study involved patients with SARI.…”

Section: Discussionsupporting

confidence: 91%

“…Almost half (46.8%) of the HRV-positive patients were co-infected with other respiratory viruses, most frequently ADV, HBoV, and hRSV. This may reflect the viruses in circulation at the time, consistent with previous reports ( Xiang et al, 2010 ; van der Linden et al, 2016 ; Blaschke et al, 2018 ). Additionally, for those patients infected with 2–4 respiratory viruses, further research is necessary to demonstrate the dominant virus by qPCR positive with CT value and impact on disease severity.…”

Section: Discussionsupporting

confidence: 91%

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Genotypic Diversity and Epidemiology of Human Rhinovirus Among Children With Severe Acute Respiratory Tract Infection in Shanghai, 2013–2015

Zhao

Shen

et al. 2018

Front. Microbiol.

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Human rhinovirus (HRV), and particularly HRV-C, is increasingly recognized as a cause of severe acute respiratory infections (SARIs). However, little is known about the genotypic diversity and epidemiology of HRV among children with SARI. Thus, we investigated the genotypic diversity and epidemiology of HRV in children with SARI in China over a 2-year period. In total 1,003, nasopharyngeal aspirates were collected from children hospitalized with SARI in Shanghai from 2013 to 2015. HRV was screened for by a PCR method targeting the viral 5′ UTR and was genotyped by sequencing of the VP4–VP2 region of the HRV genome. We also screened for 15 other common respiratory viruses to assess the prevalence of co-infection with HRV. The patient demographic and clinical data were reviewed. HRV was detected in 280 (27.9%) of the 1,003 specimens: HRV-A in 140 (14.0%), HRV-B in 21 (2.1%), HRV-C in 56 (5.6%), and HRV-untyped in 63 (6.3%). A phylogenetic analysis identified 77 genotypes (43 HRV-A, 10 HRV-B, and 24 HRV-C), among which A78, A12, A89, B70, C2, C6, and C24 predominated. HRV-A was detected mainly in winter 2013 and autumn 2014, while HRV-C detection peaked in autumn 2013 and 2014. The detection frequency of HRV-A was highest in patients <5 years old. Most HRV co-infections involved adenovirus, human bocavirus, and/or human respiratory syncytial virus. In conclusion, HRV-A and -C predominate in children with SARI in Shanghai. Among the 77 genotypes detected, A78, A12, A89, B70, C2, C6, and C24 were the most frequent. The HRV species responsible for SARIs differs according to season and age.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Genotypic Diversity and Epidemiology of Human Rhinovirus Among Children With Severe Acute Respiratory Tract Infection in Shanghai, 2013–2015

Zhao

Shen

et al. 2018

Front. Microbiol.

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“…In RSV, for which skilled handling already exists due to rapid antigen‐based tests, no decrease in antibiotic prescription and hospital length of stay was seen. The development of standard operation procedures (SOP) with therapy guidelines for the handling of viral pathogen detection considering clinical parameters could lead to a decrease in antibiotic treatment, duration of stay in hospital and thus costs . Furthermore, the patients’ past medical history and prehospital antimicrobial therapy support specific diagnostics.…”

Section: Discussionmentioning

confidence: 99%

The clinical impact of PCR‐based point‐of‐care diagnostic in respiratory tract infections in children

Reischl

Schreiner

Poplawska

et al. 2020

Clinical Laboratory Analysis

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractBackground: Children are commonly affected by respiratory tract infections. Based on clinical symptoms, laboratory evaluation, and imaging, the causative pathogen often cannot be delineated. Point-of-care-testing systems that provide an opportunity for fast detection of common viruses and some bacteria can therefore influence treatment's options. We aimed to examine whether the Biofire® FilmArray® has an effect on antibiotic treatment, duration of antibiotic therapy, and length of hospital stay within a pediatric cohort. Methods:We included children who were admitted to inpatient treatment with an acute respiratory tract infection from 02/2017 to 04/2018 using the FA respiratory panel for pathogen detection. The study group data were compared to the retrospective data of children admitted from 02/2016 to 02/2017, using a proprietary multiplex RT-PCR. Results:A total of 322 children of the study group and 464 children of the control group were analyzed for clinical symptoms, laboratory findings, antibiotic treatment, and length of hospital stay. There was no significant reduction (P < .05) of antibiotic treatment and length of hospital stay. CRP, prehospital antibiotic treatment, antibiotic treatment, past medical history, age, and further pathogen detection showed a significant impact on antibiotic therapy, duration of antibiotic treatment, and length of hospital stay. Conclusion:The use of the FA did not result in a significant reduction of antibiotic treatment or in length of hospital stay. Other parameters had a more significant impact. Therefore, we suggest that standard operation procedures with therapy guidelines are necessary to provide an effective application of POCT systems. K E Y W O R D S acute respiratory tract infections, antibiotic treatment, Biofire® FilmArray®, multiplex RT-PCR, point-of-care-testing How to cite this article: Reischl AT, Schreiner D, Poplawska K, et al. The clinical impact of PCR-based point-of-care diagnostic in respiratory tract infections in children. J Clin Lab

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“…Despite this concern, our observed IBI rates are similar to other recent ED febrile infant cohorts. 2,9,28,39,[46][47][48] Although we cannot apply either the Boston or the Philadelphia criteria to those infants who did not have CSF obtained, newer strategies should focus on methods to identify febrile infants who may safely avoid diagnostic lumbar puncture.…”

Section: Discussionmentioning

confidence: 99%

“…Febrile young infants pose a diagnostic challenge for clinicians. Although most febrile young infants have self-limited viral infections, 1,2 even well-appearing infants can have occult bacterial infections. [3][4][5] Because clinical appearance alone cannot be used to identify infants who have bacteremia or meningitis, 5,6 clinicians frequently obtain blood, urine, and cerebrospinal fluid (CSF) specimens for screening tests and cultures.…”

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confidence: 99%

Performance of the Modified Boston and Philadelphia Criteria for Invasive Bacterial Infections

et al. 2020

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BACKGROUND: The ability of the decades-old Boston and Philadelphia criteria to accurately identify infants at low risk for serious bacterial infections has not been recently reevaluated. METHODS: We assembled a multicenter cohort of infants 29 to 60 days of age who had cerebrospinal fluid (CSF) and blood cultures obtained. We report the performance of the modified Boston criteria (peripheral white blood cell count [WBC] $20 000 cells per mm 3 , CSF WBC $10 cells per mm 3 , and urinalysis with .10 WBC per high-power field or positive urine dip result) and modified Philadelphia criteria (peripheral WBC $15 000 cells per mm 3 , CSF WBC $8 cells per mm 3 , positive CSF Gram-stain result, and urinalysis with .10 WBC per high-power field or positive urine dip result) for the identification of invasive bacterial infections (IBIs). We defined IBI as bacterial meningitis (growth of pathogenic bacteria from CSF culture) or bacteremia (growth from blood culture). RESULTS: We applied the modified Boston criteria to 8344 infants and the modified Philadelphia criteria to 8131 infants. The modified Boston criteria identified 133 of the 212 infants with IBI (sensitivity 62.7% [95% confidence interval (CI) 55.9% to 69.3%] and specificity 59.2% [95% CI 58.1% to 60.2%]), and the modified Philadelphia criteria identified 157 of the 219 infants with IBI (sensitivity 71.7% [95% CI 65.2% to 77.6%] and specificity 46.1% [95% CI 45.0% to 47.2%]). The modified Boston and Philadelphia criteria misclassified 17 of 53 (32.1%) and 13 of 56 (23.3%) infants with bacterial meningitis, respectively. CONCLUSIONS: The modified Boston and Philadelphia criteria misclassified a substantial number of infants 29 to 60 days old with IBI, including those with bacterial meningitis. WHAT'S KNOWN ON THIS SUBJECT: The Boston and Philadelphia criteria for febrile infants were developed decades ago, before widespread conjugate vaccine use to identify infants at low risk of serious and invasive bacterial infections. The continued applicability of these tools remains unclear. WHAT THIS STUDY ADDS: The Boston and Philadelphia criteria misclassified approximately one-third of infants 29 to 60 days old who had invasive bacterial infections as being low risk, including those with bacterial meningitis. Newer tools

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Rhinovirus in Febrile Infants and Risk of Bacterial Infection

Abstract: HRV is common in febrile infants. Detection did not alter risk of concomitant urinary tract infection at any age or risk of IBI in infants 1-28 days old. HRV detection may be relevant in considering risk of IBI for infants 29-90 days of age.

Cited by 46 publications

References 31 publications

Genotypic Diversity and Epidemiology of Human Rhinovirus Among Children With Severe Acute Respiratory Tract Infection in Shanghai, 2013–2015

Genotypic Diversity and Epidemiology of Human Rhinovirus Among Children With Severe Acute Respiratory Tract Infection in Shanghai, 2013–2015

The clinical impact of PCR‐based point‐of‐care diagnostic in respiratory tract infections in children

Performance of the Modified Boston and Philadelphia Criteria for Invasive Bacterial Infections

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