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Performance of blood enterovirus and parechovirus polymerase chain reaction testing in young febrile infants: a prospective multicentre observational study
  1. Jose Antonio Alonso-Cadenas1,2,
  2. Roberto Velasco3,
  3. Nuria Clerigué Arrieta4,
  4. Jone Amasorrain Urrutia5,
  5. Maria Suarez-Bustamante Huélamo1,
  6. Santiago Mintegi6,7,8,
  7. Borja Gomez6,7
  1. 1Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
  2. 2Instituto de Investigacion del Hospital de La Princesa, Madrid, Spain
  3. 3Pediatric Emergency Department, Hospital Universitari Parc Tauli, Sabadell, Spain
  4. 4Navarre Hospital Complex, Pamplona, Spain
  5. 5Hospital of Mendaro, Mendaro, Spain
  6. 6Pediatric Emergency Department, Hospital Universitario Cruces, Barakaldo, Spain
  7. 7Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
  8. 8University of the Basque Country, Bilbao, Spain
  1. Correspondence to Dr Jose Antonio Alonso-Cadenas; jalonsocadenas{at}gmail.com

Abstract

Objectives To analyse the performance of blood enterovirus and parechovirus PCR testing (ev-PCR) for invasive bacterial infection (IBI) (isolation of a single bacterial pathogen in a blood or cerebrospinal fluid culture) when evaluating well-appearing infants ≤90 days of age with fever without a source (FWS).

Methods We describe the well-appearing infants ≤90 days of age with FWS and normal urine dipstick. We performed a prospective, observational multicentre study at five paediatric emergency departments between October 2020 and September 2023.

Results A total of 656 infants were included, 22 (3.4%) of whom were diagnosed with an IBI (bacteraemia in all of them and associated with meningitis in four). The blood ev-PCR test was positive in 145 (22.1%) infants. One patient with positive blood ev-PCR was diagnosed with an IBI, accounting for 0.7% (95% CI 0.02 to 3.8) compared with 4.1% (95% CI 2.6 to 6.2) in those with a negative test (p=0.04). All four patients with bacterial meningitis had a negative blood ev-PCR result. Infants with a positive blood ev-PCR had a shorter hospital stay (median 3 days, IQR 2–4) compared with 4 days (IQR 2–6) for those with negative blood ev-PCR (p=0.02), as well as shorter duration of antibiotic treatment (median 2 days, IQR 0–4 vs 2.5 days, IQR 0–7, p=0.01).

Conclusions Young febrile infants with a positive blood ev-PCR are at a low risk of having an IBI. Incorporating the blood ev-PCR test into clinical decision-making may help to reduce the duration of antibiotic treatments and length of hospital stay.

  • paediatric emergency medicine
  • emergency care

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/archdischild-2024-327367

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • X @RoberVelasco80, @MintegiSanti

    • Contributors JAAC contributed to the study conception and design, material preparation and analysis, wrote the first draft of the manuscript and act as the guarantor. BG and RV conceptualised and designed the study, coordinated and supervised the data collection, and critically reviewed the manuscript. NCA, JAU, MS-BH and SM revised the data collection form, collected data and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects contained.

    • 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.