PDF(Pubmed)
Abstract：
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.
CONCLUSIONS: 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.
BACKGROUND: • 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.
BACKGROUND: • 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.
CONCLUSIONS: 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.
BACKGROUND: • 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.
BACKGROUND: • 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.
摘要：
大多数无源发热（FWS）的儿童需要进行诊断性实验室检查以排除严重的细菌感染（SBI）。通常是入院和经验性抗生素。由于患有病毒感染的发热儿童不太可能患有SBI，确定全身病毒感染患者可能有助于排除SBI.我们评估了血液中病毒的存在是否可以用作生物标志物以排除SBI。前瞻性招募<3岁的FWS儿童，并对血液中的腺病毒进行实时（逆转录）PCR，肠病毒,副病毒,HHV620/135名患者患有SBI，在47/135中，血液中至少检测到一种病毒。与CRP（65％和93％）和PCT（55％和90％）相比，病毒血症具有更高的敏感性和阴性预测值（90％和96％）以排除SBI。在非病毒血症患者中存在SBI的比值比（OR）为5.8（p=0.0225），CRP≥40mg/l（p=0.0009）为5.5，PCT≥0.5ng/mL（0.0093）为3.7。在调整CRP和PCT后，这仍然是显著的（OR分别为5.6和5.9；两者的p=0.03）。CRP和PCT的ROC曲线下面积分别为0.754和0.779。但分别增加到0.803和0.832，当合并病毒血症时。
结论：在排除SBI方面，病毒血症的存在比常用的生物标志物具有更好的表现，并且可能与CRP和/或PCT联合用于FWS患儿的评估。较大的研究应评估通过血浆中（逆转录）PCR对病毒进行即时检测在FWS儿童管理算法中的作用。
背景：•大多数FWS儿童患有病毒感染，但高达15%的人有SBI；大多数需要实验室测试，以及许多入院和经验性抗生素。•患有病毒感染的儿童不太可能患有SBI。
背景：•患有全身性病毒感染的儿童不太可能患有SBI。•病毒血症比常用的生物标志物更好地预测SBI缺乏，并且可能与CRP和/或PCT一起用于评估FWS儿童。
结论：在排除SBI方面，病毒血症的存在比常用的生物标志物具有更好的表现，并且可能与CRP和/或PCT联合用于FWS患儿的评估。较大的研究应评估通过血浆中（逆转录）PCR对病毒进行即时检测在FWS儿童管理算法中的作用。
背景：•大多数FWS儿童患有病毒感染，但高达15%的人有SBI；大多数需要实验室测试，以及许多入院和经验性抗生素。•患有病毒感染的儿童不太可能患有SBI。
背景：•患有全身性病毒感染的儿童不太可能患有SBI。•病毒血症比常用的生物标志物更好地预测SBI缺乏，并且可能与CRP和/或PCT一起用于评估FWS儿童。
