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

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Velden, Fabian JS van der, de Vries, Gabriella, Martin, Alexander, Lim, Emma ORCID: 0000-0002-5403-3065, von Both, Ulrich, Kolberg, Laura, Carrol, Enitan ORCID: 0000-0001-8357-7726, Khanijau, Aakash, Herberg, Jethro, De, Tisham et al (show 25 more authors) , Galassini, Rachel, Kuijpers, Taco, Martinón-Torres, Federico, Rivero-Calle, Irene ORCID: 0000-0002-3678-9264, Vermont, Clementien, Hagedoorn, Nienke, Pokorn, Marko, Pollard, Andrew, Schlapbach, Luregn ORCID: 0000-0003-2281-2598, Tsolia, Maria, Elefhteriou, Irini, Yeung, Shunmay ORCID: 0000-0002-0997-0850, Zavadska, Dace, Fink, Colin, Voice, Marie, Zenz, Werner, Kohlmaier, Benno, Agyeman, Philipp KA, Usuf, Effua, Secka, Fatou, de Groot, Ronald, Levin, Michael, Flier, Michiel van der, Emonts, Marieke and PERFORM Consortium (2022) Febrile illness in high-risk children: a prospective, international observational study [Preprint]

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Abstract

<h4>Purpose: </h4> 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. <h4>Methods: </h4> 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 effect size of predictive features of proven/presumed bacterial or viral infection. <h4>Results: </h4> 599 episodes in 482 children were analysed. Only 78 episodes (13.0%) were definite bacterial, 55 definite viral (9.2%), and 190 were unknown bacterial or viral infections (31.7%). 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)). 82.1% had new empirical antibiotics started on admission (N=492); 94.3% of proven/presumed bacterial, 66.1% of proven/presumed viral, and 93.2% of unknown bacterial or viral infections. Mortality was 1.9% and 87.1% made full recovery. <h4>Conclusions: </h4> 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.

Item Type:	Preprint
Uncontrolled Keywords:	PERFORM Consortium
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Infection, Vet & Ecological Sciences
Depositing User:	Symplectic Admin
Date Deposited:	10 Jun 2024 09:22
Last Modified:	08 Dec 2024 01:34
DOI:	10.21203/rs.3.rs-1897190/v1
Related Websites:	Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3182101
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