The rapid detection of respiratory pathogens in critically ill children.


Type
Article
Change log
Authors
Conway Morris, Andrew  ORCID logo  https://orcid.org/0000-0002-3211-3216
Curran, Martin D 
Daubney, Esther 
Abstract

PURPOSE: Respiratory infections are the most common reason for admission to paediatric intensive care units (PICU). Most patients with lower respiratory tract infection (LRTI) receive broad-spectrum antimicrobials, despite low rates of bacterial culture confirmation. Here, we evaluated a molecular diagnostic test for LRTI to inform the better use of antimicrobials. METHODS: The Rapid Assay for Sick Children with Acute Lung infection Study was a single-centre, prospective, observational cohort study of mechanically ventilated children (> 37/40 weeks corrected gestation to 18 years) with suspected community acquired or ventilator-associated LRTI. We evaluated the use of a 52-pathogen custom TaqMan Array Card (TAC) to identify pathogens in non-bronchoscopic bronchoalveolar lavage (mini-BAL) samples. TAC results were compared to routine microbiology testing. Primary study outcomes were sensitivity and specificity of TAC, and time to result. RESULTS: We enrolled 100 patients, all of whom were tested with TAC and 91 of whom had matching culture samples. TAC had a sensitivity of 89.5% (95% confidence interval (CI95) 66.9-98.7) and specificity of 97.9% (CI95 97.2-98.5) compared to routine bacterial and fungal culture. TAC took a median 25.8 h (IQR 9.1-29.8 h) from sample collection to result. Culture was significantly slower: median 110.4 h (IQR 85.2-141.6 h) for a positive result and median 69.4 h (IQR 52.8-78.6) for a negative result. CONCLUSIONS: TAC is a reliable and rapid adjunct diagnostic approach for LRTI in critically ill children, with the potential to aid early rationalisation of antimicrobial therapy.

Description

Funder: NIHR Cambridge Biomedical Research Centre

Keywords
Critical care, Diagnostic techniques, Healthcare-associated pneumonia, Paediatric, Pneumonia, Respiratory system, Humans, Child, Prospective Studies, Critical Illness, Pneumonia, Respiratory Tract Infections, Bacteria, Bronchoalveolar Lavage Fluid
Journal Title
Crit Care
Conference Name
Journal ISSN
1364-8535
1466-609X
Volume Title
Publisher
Springer Science and Business Media LLC
Sponsorship
Wellcome Trust (215515/Z/19/Z)
MRC (MR/V006118/1)
Medical Research Council (MR/N029399/1)
Wellcome Trust (205214/Z/16/Z)