Abstract
As infants with proven viral infection present lower risk of bacterial infection, we evaluated how molecular methods detecting viruses on respiratory secretions could contribute to etiological diagnostic of these febrile episodes. From November 2010 to May 2011, we enrolled all febrile infants <90 days presenting to emergency room. Standard workup included viral rapid antigenic test and viral culture on nasopharyngeal aspirate. Samples negative by rapid testing were tested by molecular methods. From 208 febrile episodes (198 infants) with standard techniques, rate of documented microbiological etiology was 13% at emergency department, 47% during hospitalization, and 64% with viral cultures. Molecular methods increased microbiologically documented etiology rate by 12%, to 76%. Contribution of molecular methods was the highest in infants without clinical source of infection, increasing documentation by 18%, from 50% to 68%. Making viral molecular results rapidly available could help identifying a higher proportion of infants at low risk of serious bacterial infection.
Highlights
The management of febrile infants younger than 3 months in the emergency room (ER) is challenging as they have a higher risk of serious bacterial infection (SBI) than older children and because clinical evaluation has a low sensitivity and specificity in identifying those infants with SBI.[1,2,3,4,5,6]
In 200 of the 208 episodes, an nasopharyngeal aspirates (NPA) was available for complete viral evaluation (3 patients were not sampled, 2 samples were not analyzed with rapid test and viral culture, and 3 others were not analyzed with molecular techniques due to technical issues)
This is the first prospective study reporting the contribution of a large panel of techniques, including molecular methods for multiple respiratory viruses, to establish the etiology of febrile episodes in infants younger than 3 months
Summary
The management of febrile infants younger than 3 months in the emergency room (ER) is challenging as they have a higher risk of serious bacterial infection (SBI) than older children and because clinical evaluation has a low sensitivity and specificity in identifying those infants with SBI.[1,2,3,4,5,6] additional examinations are usually performed to diagnose SBI, or to identify those infants at higher and lower risk of SBI. Traditional viral and bacterial diagnostic techniques allow to find the etiology of febrile episodes in about half of the cases only.[7,8] With the development of molecular techniques, the ability to diagnose viral infections has improved substantially in recent years. Rapid report of microbial pathogens identification from clinical specimens has been shown to significantly improve the management and the outcome of infected patients, enabling rapid adjustment of antibiotic treatments, shortened hospital stay, and lower hospitalization costs.[12,13] Regarding the management of febrile infants younger than 3 months, several authors have shown that infants presenting a proven viral infection have a significantly lower risk of SBI.[14,15,16,17,18] An early diagnosis of a viral infection could help consider a larger proportion of febrile infants
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