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Shah P, Voice M, Calvo-Bado L, Rivero-Calle I, Morris S, Nijman R, Broderick C, De T, Eleftheriou I, Galassini R, Khanijau A, Kolberg L, Kolnik M, Rudzate A, Sagmeister MG, Schweintzger NA, Secka F, Thakker C, van der Velden F, Vermont C, Vincek K, Agyeman PK, Cunnington AJ, De Groot R, Emonts M, Fidler K, Kuijpers TW, Mommert-Tripon M, Brengel-Pesce K, Mallet F, Moll H, Paulus S, Pokorn M, Pollard A, Schlapbach LJ, Shen CF, Tsolia M, Usuf E, van der Flier M, von Both U, Yeung S, Zavadska D, Zenz W, Wright V, Carrol ED, Kaforou M, Martinon-Torres F, Fink C, Levin M, Herberg J. Relationship between molecular pathogen detection and clinical disease in febrile children across Europe: a multicentre, prospective observational study. Lancet Reg Health Eur 2023; 32:100682. [PMID: 37554664 PMCID: PMC10405323 DOI: 10.1016/j.lanepe.2023.100682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND The PERFORM study aimed to understand causes of febrile childhood illness by comparing molecular pathogen detection with current clinical practice. METHODS Febrile children and controls were recruited on presentation to hospital in 9 European countries 2016-2020. Each child was assigned a standardized diagnostic category based on retrospective review of local clinical and microbiological data. Subsequently, centralised molecular tests (CMTs) for 19 respiratory and 27 blood pathogens were performed. FINDINGS Of 4611 febrile children, 643 (14%) were classified as definite bacterial infection (DB), 491 (11%) as definite viral infection (DV), and 3477 (75%) had uncertain aetiology. 1061 controls without infection were recruited. CMTs detected blood bacteria more frequently in DB than DV cases for N. meningitidis (OR: 3.37, 95% CI: 1.92-5.99), S. pneumoniae (OR: 3.89, 95% CI: 2.07-7.59), Group A streptococcus (OR 2.73, 95% CI 1.13-6.09) and E. coli (OR 2.7, 95% CI 1.02-6.71). Respiratory viruses were more common in febrile children than controls, but only influenza A (OR 0.24, 95% CI 0.11-0.46), influenza B (OR 0.12, 95% CI 0.02-0.37) and RSV (OR 0.16, 95% CI: 0.06-0.36) were less common in DB than DV cases. Of 16 blood viruses, enterovirus (OR 0.43, 95% CI 0.23-0.72) and EBV (OR 0.71, 95% CI 0.56-0.90) were detected less often in DB than DV cases. Combined local diagnostics and CMTs respectively detected blood viruses and respiratory viruses in 360 (56%) and 161 (25%) of DB cases, and virus detection ruled-out bacterial infection poorly, with predictive values of 0.64 and 0.68 respectively. INTERPRETATION Most febrile children cannot be conclusively defined as having bacterial or viral infection when molecular tests supplement conventional approaches. Viruses are detected in most patients with bacterial infections, and the clinical value of individual pathogen detection in determining treatment is low. New approaches are needed to help determine which febrile children require antibiotics. FUNDING EU Horizon 2020 grant 668303.
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Affiliation(s)
- Priyen Shah
- Section of Paediatric Infectious Disease, Department of Infectious Diseases, and Centre for Paediatrics and Child Health, Imperial College, London, UK
| | - Marie Voice
- Micropathology Ltd, University of Warwick, Coventry, UK
| | | | - Irene Rivero-Calle
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
- GENVIP Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Galicia, Spain
| | - Sophie Morris
- Micropathology Ltd, University of Warwick, Coventry, UK
| | - Ruud Nijman
- Section of Paediatric Infectious Disease, Department of Infectious Diseases, and Centre for Paediatrics and Child Health, Imperial College, London, UK
| | - Claire Broderick
- Section of Paediatric Infectious Disease, Department of Infectious Diseases, and Centre for Paediatrics and Child Health, Imperial College, London, UK
| | - Tisham De
- Section of Paediatric Infectious Disease, Department of Infectious Diseases, and Centre for Paediatrics and Child Health, Imperial College, London, UK
| | - Irini Eleftheriou
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, “P. and A. Kyriakou” Children's Hospital, Thivon and Levadias, Goudi, Athens, Greece
| | - Rachel Galassini
- Section of Paediatric Infectious Disease, Department of Infectious Diseases, and Centre for Paediatrics and Child Health, Imperial College, London, UK
| | - Aakash Khanijau
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
| | - Laura Kolberg
- Division Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Mojca Kolnik
- Division of Pediatrics and Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia
| | | | - Manfred G. Sagmeister
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Nina A. Schweintzger
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Fatou Secka
- Medical Research Council Unit The Gambia at LSHTM, Fajara, The Gambia
| | - Clare Thakker
- Section of Paediatric Infectious Disease, Department of Infectious Diseases, and Centre for Paediatrics and Child Health, Imperial College, London, UK
| | - Fabian van der Velden
- Great North Children's Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - Clementien Vermont
- Department of Paediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Katarina Vincek
- Division of Pediatrics and Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia
| | - Philipp K.A. Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Aubrey J. Cunnington
- Section of Paediatric Infectious Disease, Department of Infectious Diseases, and Centre for Paediatrics and Child Health, Imperial College, London, UK
| | - Ronald De Groot
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands and Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, the Netherlands
| | - Marieke Emonts
- Great North Children's Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katy Fidler
- Royal Alexandra Children's Hospital, Brighton, UK
| | - Taco W. Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam University Medical Center (AUMC), University of Amsterdam, Amsterdam, the Netherlands
- Sanquin Research Institute, & Landsteiner Laboratory at the AMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Karen Brengel-Pesce
- Open Innovation & Partnerships (OIP), bioMérieux S.A., Marcy l'Etoile, France
| | - Francois Mallet
- Open Innovation & Partnerships (OIP), bioMérieux S.A., Marcy l'Etoile, France
| | - Henriette Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Stéphane Paulus
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Marko Pokorn
- Division of Pediatrics and Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Andrew Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Luregn J. Schlapbach
- Department of Intensive Care and Neonatology, Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ching-Fen Shen
- Department of Paediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Maria Tsolia
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, “P. and A. Kyriakou” Children's Hospital, Thivon and Levadias, Goudi, Athens, Greece
| | - Effua Usuf
- Medical Research Council Unit The Gambia at LSHTM, Fajara, The Gambia
| | - Michiel van der Flier
- Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands and Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, the Netherlands
- Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ulrich von Both
- Division Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Shunmay Yeung
- Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Dace Zavadska
- Children's Clinical University Hospital, Riga, Latvia
- Riga Stradins University, Riga, Latvia
| | - Werner Zenz
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Victoria Wright
- Section of Paediatric Infectious Disease, Department of Infectious Diseases, and Centre for Paediatrics and Child Health, Imperial College, London, UK
| | - Enitan D. Carrol
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
- Department of Infectious Diseases, Alder Hey Children's Hospital, Eaton Road, Liverpool, UK
| | - Myrsini Kaforou
- Section of Paediatric Infectious Disease, Department of Infectious Diseases, and Centre for Paediatrics and Child Health, Imperial College, London, UK
| | - Federico Martinon-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
- GENVIP Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Galicia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Colin Fink
- Micropathology Ltd, University of Warwick, Coventry, UK
| | - Michael Levin
- Section of Paediatric Infectious Disease, Department of Infectious Diseases, and Centre for Paediatrics and Child Health, Imperial College, London, UK
| | - Jethro Herberg
- Section of Paediatric Infectious Disease, Department of Infectious Diseases, and Centre for Paediatrics and Child Health, Imperial College, London, UK
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van der Velden FJS, de Vries G, Martin A, Lim E, von Both U, Kolberg L, Carrol ED, Khanijau A, Herberg JA, De T, Galassini R, Kuijpers TW, Martinón-Torres F, Rivero-Calle I, Vermont CL, Hagedoorn NN, Pokorn M, Pollard AJ, Schlapbach LJ, Tsolia M, Elefhteriou I, Yeung S, Zavadska D, Fink C, Voice M, Zenz W, Kohlmaier B, Agyeman PKA, Usuf E, Secka F, de Groot R, Levin M, van der Flier M, Emonts M, Cunnington A, De T, Herberg J, Kaforou M, Wright V, Baumard L, Bellos E, D’Souza G, Galassini R, Habgood-Coote D, Hamilton S, Hoggart C, Hourmat S, Jackson H, Maconochie I, Menikou S, Lin N, Nichols S, Nijman R, Powell O, Pena Paz I, Shah P, Shen CF, Vito O, Wilson C, Abdulla A, Ali L, Darnell S, Jorgensen R, Mustafa S, Persand S, Stevens MM, Kim N, Kim E, Fidler K, Dudley J, Richmond V, Tavliavini E, Shen CF, Liu CC, Wang SM, Martinón-Torres F, Salas A, González FÁ, Farto CB, Barral-Arca R, Castro MB, Bello X, García MB, Carnota S, Cebey-López M, Curras-Tuala MJ, Suárez CD, Vicente LG, Gómez-Carballa A, Rial JG, Iglesias PL, Martinón-Torres F, Martinón-Torres N, Sánchez JMM, Pérez BM, Pardo-Seco J, Rodríguez LP, Pischedda S, Vázquez SR, Calle IR, Rodríguez-Tenreiro C, Redondo-Collazo L, Ora MS, Salas A, Fernández SS, Trasorras CS, Iglesias MV, Zavadska D, Balode A, Bārzdiņa A, Deksne D, Gardovska D, Grāvele D, Grope I, Meiere A, Nokalna I, Pavāre J, Pučuka Z, Selecka K, Rudzāte A, Svile D, Urbāne UN, Usuf E, Bojang K, Zaman SMA, Secka F, Anderson S, Sarr AR, Saidykhan M, Darboe S, Ceesay S, D’alessandro U, Moll HA, Vermont CL, Borensztajn DM, Hagedoorn NN, Tan C, Zachariasse J, Dik W, Agyeman PKA, Berger C, Giannoni E, Stocker M, Posfay-Barbe KM, Heininger U, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Natalucci G, Relly C, Riedel T, Aebi C, Schlapbach LJ, Carrol ED, Cocklin E, Jennings R, Johnston J, Khanijau A, Leigh S, Lewis-Burke N, Newall K, Romaine S, Tsolia M, Eleftheriou I, Tambouratzi M, Marmarinos A, Xagorari M, Syggelou K, Fink C, Voice M, Calvo-Bado L, Zenz W, Kohlmaier B, Schweintzger NA, Sagmeister MG, Kohlfürst DS, Zurl C, Binder A, Hösele S, Leitner M, Pölz L, Rajic G, Bauchinger S, Baumgart H, Benesch M, Ceolotto A, Eber E, Gallistl S, Gores G, Haidl H, Hauer A, Hude C, Keldorfer M, Krenn L, Pilch H, Pfleger A, Pfurtscheller K, Nordberg G, Niedrist T, Rödl S, Skrabl-Baumgartner A, Sperl M, Stampfer L, Strenger V, Till H, Trobisch A, Löffler S, Yeung S, Dewez JE, Hibberd M, Bath D, Miners A, Nijman R, Fitchett E, de Groot R, van der Flier M, de Jonge MI, van Aerde K, Alkema W, van den Broek B, Gloerich J, van Gool AJ, Henriet S, Huijnen M, Philipsen R, Willems E, Gerrits G, van Leur M, Heidema J, de Haan L, Miedema C, Neeleman C, Obihara C, Tramper-Stranders G, Pollard AJ, Kandasamy R, Paulus S, Carter MJ, O’Connor D, Bibi S, Kelly DF, Gurung M, Thorson S, Ansari I, Murdoch DR, Shrestha S, Oliver Z, Emonts M, Lim E, Valentine L, Allen K, Bell K, Chan A, Crulley S, Devine K, Fabian D, King S, McAlinden P, McDonald S, McDonnell A, Pickering A, Thomson E, Wood A, Wallia D, Woodsford P, Baxter F, Bell A, Rhodes M, Agbeko R, Mackerness C, Baas B, Kloosterhuis L, Oosthoek W, Arif T, Bennet J, Collings K, van der Giessen I, Martin A, Rashid A, Rowlands E, de Vries G, van der Velden F, Soon J, Valentine L, Martin M, Mistry R, von Both U, Kolberg L, Zwerenz M, Buschbeck J, Bidlingmaier C, Binder V, Danhauser K, Haas N, Griese M, Feuchtinger T, Keil J, Kappler M, Lurz E, Muench G, Reiter K, Schoen C, Mallet F, Brengel-Pesce K, Pachot A, Mommert M, Pokorn M, Kolnik M, Vincek K, Srovin TP, Bahovec N, Prunk P, Osterman V, Avramoska T, Kuijpers T, Jongerius I, van den Berg JM, Schonenberg D, Barendregt AM, Pajkrt D, van der Kuip M, van Furth AM, Sprenkeler E, Zandstra J, van Mierlo G, Geissler J. Correction to: Febrile illness in high-risk children: a prospective, international observational study. Eur J Pediatr 2023; 182:555-556. [PMID: 36689005 PMCID: PMC9899168 DOI: 10.1007/s00431-022-04788-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Fabian J. S. van der Velden
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gabriella de Vries
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.416135.40000 0004 0649 0805Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Alexander Martin
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Lim
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ulrich von Both
- grid.5252.00000 0004 1936 973XDivision Paediatric Infectious Diseases, Dr. Von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Laura Kolberg
- grid.5252.00000 0004 1936 973XDivision Paediatric Infectious Diseases, Dr. Von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Enitan D. Carrol
- grid.10025.360000 0004 1936 8470Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK ,grid.417858.70000 0004 0421 1374Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Aakash Khanijau
- grid.10025.360000 0004 1936 8470Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK ,grid.417858.70000 0004 0421 1374Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Jethro A. Herberg
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Tisham De
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Rachel Galassini
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Taco W. Kuijpers
- grid.7177.60000000084992262Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Federico Martinón-Torres
- grid.411048.80000 0000 8816 6945Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain ,grid.11794.3a0000000109410645Grupo de Genetica, Vacunas, Infecciones y Pediatria, Instituto de Investigacion Sanitaria de Santiago, Universidad de Santiago, Santiago de Compostela, Spain ,grid.512891.6Consorcio Centro de Investigacion Biomedicaen Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Irene Rivero-Calle
- grid.411048.80000 0000 8816 6945Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Clementien L. Vermont
- grid.416135.40000 0004 0649 0805Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Nienke N. Hagedoorn
- grid.416135.40000 0004 0649 0805Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Marko Pokorn
- grid.29524.380000 0004 0571 7705University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrew J. Pollard
- grid.4991.50000 0004 1936 8948Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Luregn J. Schlapbach
- grid.412341.10000 0001 0726 4330Neonatal and Pediatric Intensive Care Unit, Children’s Research Center, University Children’s Hospital Zürich, University of Zürich, Zurich, Switzerland
| | - Maria Tsolia
- grid.5216.00000 0001 2155 08002nd Department of Pediatrics, National and Kapodistrian University of Athens, Children’s Hospital ‘P, and A. Kyriakou’, Athens, Greece
| | - Irini Elefhteriou
- grid.5216.00000 0001 2155 08002nd Department of Pediatrics, National and Kapodistrian University of Athens, Children’s Hospital ‘P, and A. Kyriakou’, Athens, Greece
| | - Shunmay Yeung
- grid.8991.90000 0004 0425 469XClinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Dace Zavadska
- grid.17330.360000 0001 2173 9398Department of Pediatrics, Rīgas Stradina Universitāte, Children’s Clinical University Hospital, Riga, Latvia
| | - Colin Fink
- grid.7372.10000 0000 8809 1613Micropathology Ltd, University of Warwick, Warwick, UK
| | - Marie Voice
- grid.7372.10000 0000 8809 1613Micropathology Ltd, University of Warwick, Warwick, UK
| | - Werner Zenz
- grid.11598.340000 0000 8988 2476Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Benno Kohlmaier
- grid.11598.340000 0000 8988 2476Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Philipp K. A. Agyeman
- grid.5734.50000 0001 0726 5157Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Effua Usuf
- grid.415063.50000 0004 0606 294XMedical Research Council Unit, Serrekunda, The Gambia
| | - Fatou Secka
- grid.415063.50000 0004 0606 294XMedical Research Council Unit, Serrekunda, The Gambia
| | - Ronald de Groot
- grid.461578.9Pediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael Levin
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Michiel van der Flier
- grid.461578.9Pediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.7692.a0000000090126352Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. .,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK. .,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK.
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Dewez JE, Pembrey L, Nijman RG, del Torso S, Grossman Z, Hadjipanayis A, Van Esso D, Lim E, Emonts M, Burns J, Gras-LeGuen C, Kohlfuerst D, Dornbusch HJ, Brengel-Pesce K, Mallet F, von Both U, Tsolia M, Eleftheriou I, Zavadska D, de Groot R, van der Flier M, Moll H, Hagedoorn N, Borensztajn D, Oostenbrink R, Kuijpers T, Pokorn M, Vincek K, Martinón-Torres F, Rivero I, Agyeman P, Carrol ED, Paulus S, Cunnington A, Herberg J, Levin M, Mujkić A, Geitmann K, Da Dalt L, Valiulis A, Lapatto R, Syridou G, Altorjai P, Torpiano P, Størdal K, Illy K, Mazur A, Spreitzer MV, Rios J, Wyder C, Romankevych I, Basmaci R, Ibanez-Mico S, Yeung S. Availability and use of rapid diagnostic tests for the management of acute childhood infections in Europe: A cross-sectional survey of paediatricians. PLoS One 2022; 17:e0275336. [PMID: 36538525 PMCID: PMC9767335 DOI: 10.1371/journal.pone.0275336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 09/14/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Point-of-care-tests (POCTs) have been advocated to optimise care in patients with infections but their actual use varies. This study aimed to estimate the variability in the adoption of current POCTs by paediatricians across Europe, and to explore the determinants of variability. METHODS AND FINDINGS A cross-sectional survey was conducted of hospital and primary care paediatricians, recruited through professional networks. Questions focused on the availability and use of currently available POCTs. Data were analysed descriptively and using Median Odds Ratio (MOR) to measure variation between countries. Multilevel regression modelling using changes in the area under the receiver operating characteristic curve of models were used to assess the contribution of individual or workplace versus country level factors, to the observed variation. The commonest POCT was urine dipsticks (UD) which were available to >80% of primary care and hospital paediatricians in 68% (13/19) and 79% (23/29) countries, respectively. Availability of all POCTs varied between countries. In primary care, the country (MOR) varied from 1.61 (95%CI: 1.04-2.58) for lactate to 7.28 (95%CI: 3.04-24.35) for UD. In hospitals, the country MOR varied from 1.37 (95%CI:1.04-1.80) for lactate to 11.93 (95%CI:3.35-72.23) for UD. Most paediatricians in primary care (69%, 795/1154) and hospital (81%, 962/1188) would use a diagnostic test in the case scenario of an infant with undifferentiated fever. Multilevel regression modelling showed that the country of work was more important in predicting both the availability and use of POCTs than individual or workplace characteristics. CONCLUSION There is substantial variability in the adoption of POCTs for the management of acute infections in children across Europe. To inform future implementation of both existing and innovative tests, further research is needed to understand what drives the variation between countries, the needs of frontline clinicians, and the role of diagnostic tests in the management of acute childhood infections.
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Affiliation(s)
- Juan Emmanuel Dewez
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
| | - Lucy Pembrey
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ruud G. Nijman
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, United Kingdom
- Research in European Paediatric Emergency Medicine (REPEM)
| | - Stefano del Torso
- ChildCare WorldWide, Padova, Italy
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
| | - Zachi Grossman
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Pediatric Clinic, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Adamos Hadjipanayis
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Paediatric Department, Larnaca General Hospital, Larnaca, Cyprus
- Medical School, European University Cyprus, Nicosia, Cyprus
| | - Diego Van Esso
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Primary Care Paediatrician, Health Care Centre Pere Grau, Barcelona, Spain
| | - Emma Lim
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Great North Children’s Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marieke Emonts
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Great North Children’s Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - James Burns
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christèle Gras-LeGuen
- Centre d’Investigation Clinique CIC1413, INSERM-Nantes University Hospital, Nantes, France
| | - Daniela Kohlfuerst
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Medical University of Graz, Graz, Austria
| | - Hans Jürgen Dornbusch
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Medical University of Graz, Graz, Austria
| | - Karen Brengel-Pesce
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- BioMérieux, Lyon, France
| | - Francois Mallet
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- BioMérieux, Lyon, France
| | - Ulrich von Both
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| | - Maria Tsolia
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- P. and A. Kyriakou Children’s Hospital, Athens, Greece
| | - Irini Eleftheriou
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- P. and A. Kyriakou Children’s Hospital, Athens, Greece
| | - Dace Zavadska
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Children Clinical University Hospital, Riga, Latvia
| | - Ronald de Groot
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michiel van der Flier
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Henriëtte Moll
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Research in European Paediatric Emergency Medicine (REPEM)
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Nienke Hagedoorn
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Dorine Borensztajn
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Rianne Oostenbrink
- Research in European Paediatric Emergency Medicine (REPEM)
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Taco Kuijpers
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marko Pokorn
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katarina Vincek
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Federico Martinón-Torres
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Irene Rivero
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Philipp Agyeman
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Enitan D. Carrol
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Stéphane Paulus
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Aubrey Cunnington
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, United Kingdom
| | - Jethro Herberg
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, United Kingdom
| | - Michael Levin
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, United Kingdom
| | - Aida Mujkić
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, Zagreb, Croatia
| | - Karin Geitmann
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Primary Care Paediatrician, BVKJ, Hagen, Germany
| | - Liviana Da Dalt
- Research in European Paediatric Emergency Medicine (REPEM)
- Department of Woman’s and Child’s Health Padova University Hospital, Padua, Italy
| | - Arūnas Valiulis
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Vilnius University Medical Faculty, Institute of Clinical Medicine, Clinic of Children’s Diseases, Vilnius, Lithuania
| | - Risto Lapatto
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Department of Paediatrics, Helsinki University Hospital, Helsinki, Finland
| | - Garyfallia Syridou
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Attiko University Hospital, Chaidari, Greece
| | - Péter Altorjai
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Association of Hungarian Primary Care Paediatricians, Budapest, Hungary
| | - Paul Torpiano
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Department of Paediatrics and Adolescent Health at Mater Dei Hospital, Valletta, Malta
| | - Ketil Størdal
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Paediatric Research Institute, University of Oslo, Oslo, Norway
| | - Károly Illy
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Dutch Society of Paediatrics NVK, Utrecht, the Netherlands
| | - Artur Mazur
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Medical College of Rzeszow University, Rzeszów, Poland
| | - Mateja Vintar Spreitzer
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Zdravstveni dom Domžale, Slovenian Paediatric Society, Burnaby, Slovenia
| | - Joana Rios
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Hospital Beatriz Ângelo, Loures, Portugal
| | - Corinne Wyder
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Kinderärzte KurWerk, Burgdorf, Switzerland
| | - Ivanna Romankevych
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Ukrainian Academy of Pediatric Specialties, Ukraine
| | - Romain Basmaci
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Service de Pédiatrie-Urgences, AP-HP, Hôpital Louis-Mourier, Colombes, France
| | | | - Shunmay Yeung
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Paediatrics, St Mary’s Imperial College Hospital, London, United Kingdom
- * E-mail:
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Zajc Avramovic M, Vincek K, Mlakar G, Emersic N, Plankar Srovin T, Avsic-Zupanc T, Ihan A, Avcin T. POS1318 A NATIONWIDE COHORT STUDY ON CLINICAL AND LABORATORY MANIFESTATIONS IN CHILDREN WITH MULTISYSTEM INFLAMMATORY SYNDROME (MIS-C). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Multisystem inflammatory syndrome in children (MIS-C) was recognized during the 2020 pandemic of SARS-CoV-2. Because of the relative rarity current knowledge is limited, especially in the European Caucasian population.Objectives:To report the epidemiology, clinical and laboratory characteristics of patients with MIS-C in a nationwide cohort study in Slovenia.Methods:This is a nationwide prospective cohort study of all consecutive patients with MIS-C, admitted from the beginning of epidemics to 31st December 2020 to University Medical Centre Ljubljana, Slovenia, the only tertiary care pediatric rheumatology center in the country. The inclusion criteria were meeting the CDC criteria for MIS-C. Infection with SARS-CoV-2 was confirmed in all patients by positive antibodies for SARS-CoV-2. Data were collected from the patients’ medical records. Data on the COVID-19 epidemics in Slovenia were collected from National Institute of Public Health. Population data were provided by the Statistical Office of the Republic of Slovenia.Results:Twenty-three patients with MIS-C were diagnosed nationwide in Slovenia, all of them in the second wave of epidemics from 14th September to 31st December 2020. All patients were Caucasian and the estimated prevalence of MIS-C was 5.8/100 000 persons younger than 19 years of age. Detailed analyses were available in 20 patients of which 14 were boys (70 %), median age was 12.4 years (4 months to 17.7 years). Two patients (10 %) were treated in the intensive care unit and none of the patients died. Troponin was elevated in 15/20 (75 %) patients during the disease course, and 7/15 (47 %) of these had normal troponin level at admission. The serum level of troponin closely followed the serum level of CRP. Six out of 20 (30 %) patients had elevated pancreatic enzymes in the second week of the disease after treatment was already given,and one patient developed asymptomatic acute pancreatitis with serum lipase level reaching the maximum of 25μkat/L. All patients had elevated levels of D-dimer with no signs of thrombosis. Five patients (5/20; 25 %) had pleural effusions and five patients (5/20, 25 %) had ascites. Half of the patients (10/20; 50 %) had hepatosplenomegaly and eight (8/20; 40 %) had mesenterial lymphadenopathy. Three patients (3/20; 15 %) had radiologic signs of cholecystitis. Two patients had thickened lung parenchyma. All patients received IVIG and systemic glucocorticosteroids. Because of resistant or organ threatening disease 4 patients (4/20, 20%) received high dose methylprednisolone pulse therapy. Biologic therapy with anakinra was started in 2 patients. Nineteen patients (19/20, 95%) received acetylsalicylic acid and prophylactic anticoagulation was prescribed in 15/20 (75%) of patients.The mean follow up was 50 days (14 – 122). At the last follow-up visit all patients had normal laboratory parameters of inflammation, troponin, pro-BNP, d-dimer values and normal heart function.Table 1.Clinical characteristics.n (%)Fever n (%)20 (100)Fever duration (days) [ min; max]5.9 [4; 8]Headache8 (40)Lymphadenopathy15 (75)Chest pain6 (30)Tachycardia16 (80)Gastrointestinal involvement19 (95)•Abdominal pain16 (80)•Vomiting11 (55)•Diarrhoea9 (45)•Loss of apetite18 (90)Cough7 (35)Skin and mucous involvement14 (70)•Rash12 (60)•Palmar/plantar oedema3 (15)•Lip and mouth changes12 (60)•Bilateral conjunctivitis14 (70)Myocarditis19 (95)Conclusion. A very high incidence of MIS-C, estimated 5.8/100 000 persons under the age of 19 with a predominantly cardiac involvement but very good outcome was noted in European Caucasian population in a nationwide cohort study in Slovenia. Attention to newly described pancreatic involvement should be raised.Conclusion:A very high incidence of MIS-C, estimated 5.8/100 000 persons under the age of 19 with a predominantly cardiac involvement but very good outcome was noted in European Caucasian population in a nationwide cohort study in Slovenia. Attention to newly described pancreatic involvement should be raised.Disclosure of Interests:None declared
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