Journal Article

The rapid detection of respiratory pathogens in critically ill children

Kean, Iain R. L., Pathan, Nazima, Maes, Mailis, Navapurkar, Vilas, Bartholdson Scott, Josefin, Agrawal, Shruti, Gouliouris, Theodore, Clark, John A., Daubney, Esther, Khokhar, Fahad, Conway Morris, Andrew, Curran, Martin D., Zhang, Zhenguang, White, Deborah, Bousfield, Rachel, Török, M. Estée, Inwald, David, Kanaris, Constantinos, Baker, Stephen

2023

Overview

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 (CI 95 ) 66.9–98.7) and specificity of 97.9% (CI 95 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.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Anti-infective agents / Bacteria / Bronchoalveolar Lavage Fluid - microbiology / Care and treatment / Child / Control / Critical care / Critical Care Medicine / Critical Illness / Critically ill children / Diagnosis / Diagnostic techniques / Dosage and administration / Emergency Medicine / Healthcare-associated pneumonia / Humans / Identification and classification / Intensive / Medicine / Medicine & Public Health / Paediatric / Pathogenic microorganisms / Pediatric intensive care / Pneumonia / Pneumonia - diagnosis / Pneumonia in children / Prospective Studies / Respiratory system / Respiratory Tract Infections - diagnosis / Risk factors / Services