Announcement

Collapse
No announcement yet.

Lancet Microbe . Lower respiratory tract infections in children requiring mechanical ventilation: a multicentre prospective surveillance study incorporating airway metagenomics

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Lancet Microbe . Lower respiratory tract infections in children requiring mechanical ventilation: a multicentre prospective surveillance study incorporating airway metagenomics


    Lancet Microbe


    . 2022 Apr;3(4):e284-e293.
    doi: 10.1016/S2666-5247(21)00304-9. Epub 2022 Mar 9.
    Lower respiratory tract infections in children requiring mechanical ventilation: a multicentre prospective surveillance study incorporating airway metagenomics


    Alexandra Tsitsiklis 1 , Christina M Osborne 2 , Jack Kamm 3 , Kayla Williamson 4 , Katrina Kalantar 3 , Gytis Dudas 5 , Saharai Caldera 6 , Amy Lyden 3 , Michelle Tan 3 , Norma Neff 3 , Victoria Soesanto 4 , J Kirk Harris 7 , Lilliam Ambroggio 8 , Aline B Maddux 9 , Todd C Carpenter 9 , Ron W Reeder 10 , Chris Locandro 10 , Eric A F Simões 11 , Matthew K Leroue 9 , Mark W Hall 12 , Athena F Zuppa 13 , Joseph Carcillo 14 , Kathleen L Meert 15 , Anil Sapru 16 , Murray M Pollack 17 , Patrick S McQuillen 18 , Daniel A Notterman 19 , J Michael Dean 10 , Matt S Zinter 18 , Brandie D Wagner 4 , Joseph L DeRisi 20 , Peter M Mourani 21 , Charles R Langelier 22



    AffiliationsFree article

    Abstract

    Background: Lower respiratory tract infections (LRTI) are a leading cause of critical illness and mortality in mechanically ventilated children; however, the pathogenic microbes frequently remain unknown. We combined traditional diagnostics with metagenomic next generation sequencing (mNGS) to evaluate the cause of LRTI in critically ill children.
    Methods: We conducted a prospective, multicentre cohort study of critically ill children aged 31 days to 17 years with respiratory failure requiring mechanical ventilation (>72 h) in the USA. By combining bacterial culture and upper respiratory viral PCR testing with mNGS of tracheal aspirate collected from all patients within 24 h of intubation, we determined the prevalence, age distribution, and seasonal variation of viral and bacterial respiratory pathogens detected by either method in children with or without LRTI.
    Findings: Between Feb 26, 2015, and Dec 31, 2017, of the 514 enrolled patients, 397 were eligible and included in the study (276 children with LRTI and 121 with no evidence of LRTI). A presumptive microbiological cause was identified in 255 (92%) children with LRTI, with respiratory syncytial virus (127 [46%]), Haemophilus influenzae (70 [25%]), and Moraxella catarrhalis (65 [24%]) being most prevalent. mNGS identified uncommon pathogens including Ureaplasma parvum and Bocavirus. Co-detection of viral and bacterial pathogens occurred in 144 (52%) patients. Incidental carriage of potentially pathogenic microbes occurred in 82 (68%) children without LRTI, with rhinovirus (30 [25%]) being most prevalent. Respiratory syncytial virus (p<0·0001), H influenzae (p=0·0006), and M catarrhalis (p=0·0002) were most common in children younger than 5 years. Viral and bacterial LRTI occurred predominantly during winter months.
    Interpretation: These findings demonstrate that respiratory syncytial virus, H influenzae, and M catarrhalis contribute disproportionately to severe paediatric LRTI, co-infections are common, and incidental carriage of potentially pathogenic microbes occurs frequently. Further, we provide a framework for future epidemiological and emerging pathogen surveillance studies, highlighting the potential for metagenomics to enhance clinical diagnosis.
    Funding: US National Institutes of Health and CZ Biohub.


Working...
X