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Original research
Blood enterovirus polymerase chain reaction testing in young febrile infants
  1. Carla Pintos1,
  2. Santiago Mintegi1,2,
  3. Javier Benito1,2,
  4. Maitane Aranzamendi3,
  5. Leire Bonilla1,
  6. Borja Gomez1,2
  1. 1 Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain
  2. 2 University of the Basque Country, Bilbao, Spain
  3. 3 Department of Microbiology, Cruces University Hospital, Barakaldo, Spain
  1. Correspondence to Dr Borja Gomez, Pediatric Emergency Department, Cruces University Hospital, Barakaldo 48903, País Vasco, Spain; borja.gomezcortes{at}osakidetza.eus

Abstract

Objective To analyse the impact of blood enterovirus and human parechovirus PCR (ev-PCR) testing in young infants with fever without a source (FWS).

Design Observational study, subanalysis of a prospective registry.

Setting Paediatric emergency department.

Patients Infants ≤90 days of age with FWS seen between September 2015 and August 2019 with blood ev-PCR, blood and urine cultures and urine dipstick test performed.

Main outcome measures Prevalence of invasive bacterial infection (IBI: bacterial pathogen in blood or cerebrospinal fluid) in infants with positive or negative ev-PCR test results. Secondarily, we also compared length of stay and antibiotic treatment in hospitalised infants.

Results Of 703 infants, 174 (24.7%) had a positive blood ev-PCR and none of them were diagnosed with an IBI (vs 2.6% (95% CI 1.3% to 4.0%) of those with a negative result, p=0.02). Prevalence of non-IBI (mainly urinary tract infection) was also lower among infants with a positive blood ev-PCR (2.3% (95% CI 0.1% to 4.5%) vs 17.6% (95% CI 14.3% to 20.8%), p<0.01).

Overall, 258 infants were hospitalised (36.6%) and 193 (74.8%) of them received antibiotics. Length of hospital stay and antibiotic treatment were shorter in those with a positive blood ev-PCR (median: 3 days vs 5 days and 1 day vs 5 days, respectively; p<0.01). Differences remained statistically significant among well-appearing infants >21 days old with normal urine dipstick.

Conclusion Blood ev-PCR identifies a group of infants under 90 days of age with FWS at very low risk of IBI. This test may help to guide clinical decision making in young febrile infants.

  • virology
  • microbiology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. This study used deidentified participant data from a prospective registry developed at the Pediatric Emergency Department of Cruces University Hospital. For additional data to be made available to a third party, specific ethical and HRA approvals would be required.

https://doi.org/10.1136/archdischild-2020-321077

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. This study used deidentified participant data from a prospective registry developed at the Pediatric Emergency Department of Cruces University Hospital. For additional data to be made available to a third party, specific ethical and HRA approvals would be required.

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    Footnotes

    • Contributors CP collected data, collaborated in the data analysis and wrote the initial draft of the manuscript. SM designed the data collection instruments, collaborated in the data analysis, and reviewed and revised the manuscript. MA provided information related to the microbiological tests analysed in the study and reviewed and revised the manuscript. LB collected data and reviewed and revised the manuscript. JB reviewed and revised the manuscript. BG conceptualised and designed the study, coordinated and supervised data collection, analysed the data and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.