Relationship between molecular pathogen detection and clinical disease in febrile children across Europe: a multicentre, prospective observational study

Utility of Rapid Nasopharyngeal Swab for Respiratory Pathogens in the Diagnosis of Viral Infections in Children Hospitalized with Fever: A Prospective Validation Study to Improve Antibiotic Use

“…We believe that positive NPSs are accurate enough for predicting real viral infections in clinically stable children, and in these cases, routine antibiotic prescriptions are clinically unjustified. Of note, the enrolled cohort is representative of the target for the NPS, and rates of bacterial and viral infections are in line with larger European cohorts (in both cases, around only 10-15% of children with fever had a bacterial infection), including the relatively high proportion of children with other inflammatory conditions that initially presented with fever [20]. It is possible that other reasons lead clinicians to frequently prescribe antibiotics in children with positive viral swabs, including psychological factors related to legal consequences in case of missed bacterial infections.…”

Procalcitonin and Presepsin as Markers of Infectious Respiratory Diseases in Children: A Scoping Review of the Literature

“…We were unable to conduct a meta-analysis on the results of the selected articles due to their high heterogeneity (in terms of objectives, conclusions, infections and inflammatory indices considered), including about differences on how biomarkers values were reported in the different papers. In addition, the classification of respiratory infections as viral and bacterial in children has an intrinsic limitation, as bronchoalveolar lavage is rarely performed, and also, recent studies have showed that clinical value of individual pathogen detection in determining treatment is low in pediatrics [ 76 ]. In fact, most febrile children cannot be conclusively defined as having bacterial or viral infection when molecular tests supplement conventional approaches.…”

Raising AWaRe-ness of Antimicrobial Stewardship Challenges in Pediatric Emergency Care: Results from the PERFORM Study Assessing Consistency and Appropriateness of Antibiotic Prescribing Across Europe

“…While most often the presumed etiology was correct and treated appropriately ( Figure 4 A and 4 B ) when bacterial or viral etiologies were not clearly identified ( Figure 4 C ), >50% of cases in the viral group received empiric antibiotics. Since molecular testing often detects both bacterial and viral pathogens in febrile children, it seems difficult for clinicians to withhold antibiotics when a viral cause is identified with the remaining possibility of an additional bacterial infection, while slow diagnostic tools such as cultures are still pending [ 20 ]. More than a third of children for whom only viral or noninfectious etiology was recorded as the initial syndrome classification received antibiotics, suggesting that diagnostic uncertainty is not the only driver of inappropriate antibiotic initiation.…”

“…Even when the clinician's judgment suggests a syndrome not requiring antibiotics, clinical uncertainty or concern about a bacterial coinfection or superinfection can result in high Watch antibiotic use until a bacterial cause can be excluded, or a specific pathogen is identified. A recent report from the PERFORM study concluded that it is not always possible to distinguish between bacterial and viral infections, as both pathogens are often jointly detected, leading to broad-spectrum antibiotic use [ 20 ]. The tension between AMS and urgent treatment for presumed sepsis is well recognized.…”