Medizinische Universität Graz - Research portal
Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
van, der, Velden, FJS; de, Vries, G; Martin, A; Lim, E; von, Both, U; Kolberg, L; Carrol, ED; Khanijau, A; Herberg, JA; De, T; Galassini, R; Kuijpers, TW; Martinón-Torres, F; Rivero-Calle, I; Vermont, CL; Hagedoorn, NN; Pokorn, M; Pollard, AJ; Schlapbach, LJ; Tsolia, M; Elefhteriou, I; Yeung, S; Zavadska, D; Fink, C; Voice, M; Zenz, W; Kohlmaier, B; Agyeman, PKA; Usuf, E; Secka, F; de, Groot, R; Levin, M; van, der, Flier, M; Emonts, M, , PERFORM, consortium.
Febrile illness in high-risk children: a prospective, international observational study.
EUR J PEDIATR. 2023; 182(2): 543-554.
Doi: 10.1007/s00431-022-04642-1
[OPEN ACCESS]
Web of Science
PubMed
FullText
FullText_MUG
- Co-authors Med Uni Graz
- Kohlmaier Benno
- Zenz Werner
- Study Group Members Med Uni Graz:
- Bauchinger Sebastian
- Baumgart Hinrich
- Benesch Martin
- Binder Alexander
- Eber Ernst
- Gallistl Siegfried
- Gores Gunther
- Haidl Harald
- Hauer Almuthe
- Keldorfer Markus
- Kohlfürst Daniela
- Krenn Larissa
- Leitner Manuel
- Löffler Sabine
- Niedrist Tobias Josef
- Nordberg Gudrun
- Pfleger Andreas
- Pfurtscheller Klaus
- Pilch Heidemarie
- Pölz Lena
- Rajic Glorija
- Roedl Siegfried
- Sagmeister Manfred Gerald
- Schweintzger Nina
- Skrabl-Baumgartner Andrea
- Sperl Matthias
- Stampfer Laura
- Strenger Volker
- Till Holger
- Trobisch Andreas
- Zurl Christoph Johann
- Altmetrics:
- Dimensions Citations:
- Plum Analytics:
- Scite (citation analytics):
- Abstract:
- 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. What is Known: • Immunosuppressed children are at high risk for morbidity and mortality of serious bacterial and viral infection, but often present with fever as only clinical symptom. • Current diagnostic measures in this group are not specific to rule out bacterial infection, and positivity rates of microbiological cultures are low. What is New: • Febrile illness and infectious complications remain a significant cause of mortality and morbidity in HR children, yet management is effective. • The aetiology of febrile illness in immunocompromised children is diverse, and development of pathways for early discharge or cessation of intravenous antibiotics is debatable, and requires better clinical decision-making tools and biomarkers.
- Find related publications in this database (using NLM MeSH Indexing)
- Child - administration & dosage
- Humans - administration & dosage
- Prospective Studies - administration & dosage
- Bacterial Infections - complications, diagnosis, epidemiology
- Fever - diagnosis, etiology, drug therapy
- Anti-Bacterial Agents - therapeutic use
- Virus Diseases - complications, diagnosis, drug therapy
- Biomarkers - administration & dosage
- Find related publications in this database (Keywords)
- Immunocompromised
- Paediatric
- Fever
- Infection
- Antibiotics