Febrile illness in high-risk children: a prospective, international observational study

被引：5

作者：

van der Velden, Fabian J. S. ^{[1
,2
]}

de Vries, Gabriella ^{[1
,3
]}

Martin, Alexander ^{[1
,2
]}

Lim, Emma ^{[1
,4
]}

von Both, Ulrich ^{[5
]}

Kolberg, Laura ^{[5
]}

Carrol, Enitan D. ^{[6
,7
]}

Khanijau, Aakash ^{[6
,7
]}

Herberg, Jethro A. ^{[8
]}

De, Tisham ^{[8
]}

Galassini, Rachel ^{[8
]}

Kuijpers, Taco W. ^{[9
]}

Martinon-Torres, Federico ^{[10
,26
,27
]}

Rivero-Calle, Irene ^{[10
]}

Vermont, Clementien L. ^{[22
]}

Hagedoorn, Nienke N. ^{[3
]}

Pokorn, Marko ^{[11
]}

Pollard, Andrew J. ^{[12
]}

Schlapbach, Luregn J. ^{[13
]}

Tsolia, Maria ^{[14
]}

Elefhteriou, Irini ^{[14
]}

Yeung, Shunmay ^{[15
]}

Zavadska, Dace ^{[16
]}

Fink, Colin ^{[17
]}

Voice, Marie ^{[17
]}

Zenz, Werner ^{[18
]}

Kohlmaier, Benno ^{[18
]}

Agyeman, Philipp K. A. ^{[24
]}

Usuf, Effua ^{[25
]}

Secka, Fatou ^{[25
]}

de Groot, Ronald ^{[25
]}

Levin, Michael ^{[8
]}

van der Flier, Michiel ^{[19
,23
]}

Emonts, Marieke ^{[1
,2
,20
,21
]}

机构：

[1] Newcastle Upon Tyne Hosp NHS Fdn Trust, Great North Childrens Hosp, Paediat Immunol Infect Dis & Allergy, Newcastle Upon Tyne, Tyne & Wear, England

[2] Newcastle Univ, Translat & Clin Res Inst, Newcastle Upon Tyne, Tyne & Wear, England

[3] Erasmus MC Sophia Childrens Hosp, Dept Gen Paediat, Rotterdam, Netherlands

[4] Newcastle Univ, Populat Hlth Sci Inst, Newcastle Upon Tyne, Tyne & Wear, England

[5] Univ Hosp LMU Munich, Dr Von Hauner Childrens Hosp, Div Paediat Infect Dis, Munich, Germany

[6] Univ Liverpool, Inst Infect Vet & Ecol Sci, Liverpool, Merseyside, England

[7] Alder Hey Childrens NHS Fdn Trust, Liverpool, Merseyside, England

[8] Imperial Coll London, Wright Fleming Inst, Sect Paediat Infect Dis, London, England

[9] Univ Amsterdam, Amsterdam Univ Med Ctr, Locat Acad Med Ctr, Dept Pediat Immunol Rheumatol & Infect Dis, Amsterdam, Netherlands

[10] Hosp Clin Univ Santiago, Pediat Dept, Translat Pediat & Infect Dis, Santiago De Compostela, Spain

[11] Univ Med Ctr Ljubljana, Dept Infect Dis, Ljubljana, Slovenia

[12] Univ Oxford, Dept Paediat, Oxford Vaccine Grp, Oxford, England

[13] Univ Zurich, Univ Childrens Hosp Zurich, Childrens Res Ctr, Neonatal & Pediat Intens Care Unit, Zurich, Switzerland

[14] Natl & Kapodistrian Univ Athens, Childrens Hosp P & A Kyriakou, Dept Pediat 2, Athens, Greece

[15] London Sch Hyg & Trop Med, Clin Res Dept, Fac Infect & Trop Dis, London, England

[16] Rigas Stradina Univ, Childrens Clin Univ Hosp, Dept Pediat, Riga, Latvia

[17] Univ Warwick, Micropathol Ltd, Warwick, England

[18] Med Univ Graz, Dept Pediat & Adolescent Med, Div Gen Pediat, Graz, Austria

[19] Radboud Univ Nijmegen, Amalia Childrens Hosp, Pediat Infect Dis & Immunol, Med Ctr, Nijmegen, Netherlands

[20] Newcastle Upon Tyne Hosp NHS Trust, NIHR Newcastle Biomed Res Ctr, Newcastle Upon Tyne, Tyne & Wear, England

[21] Newcastle Univ, Newcastle Upon Tyne, Tyne & Wear, England

[22] Erasmus MC Sophia Childrens Hosp, Dept Pediat, Div Pediat Infect Dis & Immunol, Rotterdam, Netherlands

[23] Wilhelmina Childrens Hosp Univ Med Ctr Utrecht, Pediat Infect Dis & Immunol, Utrecht, Netherlands

[24] Univ Bern, Bern Univ Hosp, Dept Pediat, Inselspital, Bern, Switzerland

[25] MRC Unit, Serrekunda, Gambia

[26] Univ Santiago, Inst Invest Sanitaria Santiago, Grp Genet Vacunas Infecc & Pediat, Santiago De Compostela, Spain

[27] Consorcio Ctr Invest Biomedicaen Red Enfermedades, Madrid, Spain

来源：

EUROPEAN JOURNAL OF PEDIATRICS | 2023年 / 182卷 / 02期

基金：

欧盟地平线“2020”;

关键词：

Immunocompromised; Paediatric; Fever; Infection; Antibiotics; BACTERIAL-INFECTION; VIRAL-INFECTION; NEUTROPENIA; CANCER; PROCALCITONIN; EPIDEMIOLOGY; BACTEREMIA; PREDICTION; ETIOLOGY; SEPSIS;

D O I：

10.1007/s00431-022-04642-1

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

To assess and describe the aetiology and management of febrile illness in children with primary or acquired immunodeficiency at high risk of serious bacterial infection, as seen in emergency departments in tertiary hospitals. Prospective data on demographics, presenting features, investigations, microbiology, management, and outcome of patients within the 'Biomarker Validation in HR patients' database in PERFORM, were analysed. Immunocompromised children (< 18 years old) presented to fifteen European hospitals in nine countries, and one Gambian hospital, with fever or suspected infection and clinical indication for blood investigations. Febrile episodes were assigned clinical phenotypes using the validated PERFORM algorithm. Logistic regression was used to assess the effect size of predictive features of proven/presumed bacterial or viral infection. A total of 599 episodes in 482 children were analysed. Seventy-eight episodes (13.0%) were definite bacterial, 67 episodes probable bacterial (11.2%), and 29 bacterial syndrome (4.8%). Fifty-five were definite viral (9.2%), 49 probable viral (8.2%), and 23 viral syndrome (3.8%). One hundred ninety were unknown bacterial or viral infections (31.7%), and 108 had inflammatory or other non-infectious causes of fever (18.1%). Predictive features of proven/presumed bacterial infection were ill appearance (OR 3.1 (95% CI 2.1-4.6)) and HIV (OR 10.4 (95% CI 2.0-54.4)). Ill appearance reduced the odds of having a proven/presumed viral infection (OR 0.5 ( 95% CI 0.3-0.9)). A total of 82.1% had new empirical antibiotics started on admission (N = 492); 94.3% proven/presumed bacterial (N = 164), 66.1% proven/presumed viral (N = 84), and 93.2% unknown bacterial or viral infections (N = 177). Mortality was 1.9% (N = 11) and 87.1% made full recovery (N = 522). Conclusion: The aetiology of febrile illness in immunocompromised children is diverse. In one-third of cases, no cause for the fever will be identified. Justification for standard intravenous antibiotic treatment for every febrile immunocompromised child is debatable, yet effective. Better clinical decision-making tools and new biomarkers are needed for this population.

引用

页码：543 / 554

页数：12

共 47 条

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