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

• Published in: BMC pediatrics Vol. 21; no. 1; pp. 238 - 8
• Main Authors: Rostad, Christina A., Kanwar, Neena, Yi, Jumi, Morris, Claudia R., Bard, Jennifer Dien, Leber, Amy, Dunn, James, Chapin, Kimberle C., Blaschke, Anne J., Daly, Judy A., Hueschen, Leslie A., Jones, Matthew, Ott, Elizabeth, Bastar, Jeffrey, Bourzac, Kevin M., Selvarangan, Rangaraj
• Format: Journal Article
• Language: English
• Published: London BioMed Central 18.05.2021; BioMed Central Ltd; BMC
• Subjects: Adenovirus; Bacterial infections; Communicable diseases in children; Diagnosis; Emergency service; Enterovirus; Herpes viruses; Hospitals; Internal Medicine; Medicine; Medicine & Public Health; Parvovirus B19; Pediatric research; Pediatrics; Research Article; Septicemia; Serious bacterial infections; Urinary tract infections; Viral infections; Viremia; Virus diseases; United States; United States > US; Pediatrics; Cytomegalovirus; Serious bacterial infections; Viremia; Adenovirus; Parvovirus B19; Enterovirus; Human parechovirus
• ISSN: 1471-2431; 1471-2431
• DOI: 10.1186/s12887-021-02699-9

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.