Ontology highlight
ABSTRACT: Background
The PERFORM study aimed to understand causes of febrile childhood illness by comparing molecular pathogen detection with current clinical practice.Methods
Febrile children and controls were recruited on presentation to hospital in 9 European countries 2016-2020. Each child was assigned a standardized diagnostic category based on retrospective review of local clinical and microbiological data. Subsequently, centralised molecular tests (CMTs) for 19 respiratory and 27 blood pathogens were performed.Findings
Of 4611 febrile children, 643 (14%) were classified as definite bacterial infection (DB), 491 (11%) as definite viral infection (DV), and 3477 (75%) had uncertain aetiology. 1061 controls without infection were recruited. CMTs detected blood bacteria more frequently in DB than DV cases for N. meningitidis (OR: 3.37, 95% CI: 1.92-5.99), S. pneumoniae (OR: 3.89, 95% CI: 2.07-7.59), Group A streptococcus (OR 2.73, 95% CI 1.13-6.09) and E. coli (OR 2.7, 95% CI 1.02-6.71). Respiratory viruses were more common in febrile children than controls, but only influenza A (OR 0.24, 95% CI 0.11-0.46), influenza B (OR 0.12, 95% CI 0.02-0.37) and RSV (OR 0.16, 95% CI: 0.06-0.36) were less common in DB than DV cases. Of 16 blood viruses, enterovirus (OR 0.43, 95% CI 0.23-0.72) and EBV (OR 0.71, 95% CI 0.56-0.90) were detected less often in DB than DV cases. Combined local diagnostics and CMTs respectively detected blood viruses and respiratory viruses in 360 (56%) and 161 (25%) of DB cases, and virus detection ruled-out bacterial infection poorly, with predictive values of 0.64 and 0.68 respectively.Interpretation
Most febrile children cannot be conclusively defined as having bacterial or viral infection when molecular tests supplement conventional approaches. Viruses are detected in most patients with bacterial infections, and the clinical value of individual pathogen detection in determining treatment is low. New approaches are needed to help determine which febrile children require antibiotics.Funding
EU Horizon 2020 grant 668303.
SUBMITTER: Shah P
PROVIDER: S-EPMC10405323 | biostudies-literature | 2023 Sep
REPOSITORIES: biostudies-literature
Shah Priyen P Voice Marie M Calvo-Bado Leonides L Rivero-Calle Irene I Morris Sophie S Nijman Ruud R Broderick Claire C De Tisham T Eleftheriou Irini I Galassini Rachel R Khanijau Aakash A Kolberg Laura L Kolnik Mojca M Rudzate Aleksandra A Sagmeister Manfred G MG Schweintzger Nina A NA Secka Fatou F Thakker Clare C van der Velden Fabian F Vermont Clementien C Vincek Katarina K Agyeman Philipp K A PKA Cunnington Aubrey J AJ De Groot Ronald R Emonts Marieke M Fidler Katy K Kuijpers Taco W TW Mommert-Tripon Marine M Brengel-Pesce Karen K Mallet Francois F Moll Henriette H Paulus Stéphane S Pokorn Marko M Pollard Andrew A Schlapbach Luregn J LJ Shen Ching-Fen CF Tsolia Maria M Usuf Effua E van der Flier Michiel M von Both Ulrich U Yeung Shunmay S Zavadska Dace D Zenz Werner W Wright Victoria V Carrol Enitan D ED Kaforou Myrsini M Martinon-Torres Federico F Fink Colin C Levin Michael M Herberg Jethro J
The Lancet regional health. Europe 20230726
<h4>Background</h4>The PERFORM study aimed to understand causes of febrile childhood illness by comparing molecular pathogen detection with current clinical practice.<h4>Methods</h4>Febrile children and controls were recruited on presentation to hospital in 9 European countries 2016-2020. Each child was assigned a standardized diagnostic category based on retrospective review of local clinical and microbiological data. Subsequently, centralised molecular tests (CMTs) for 19 respiratory and 27 bl ...[more]