Optimizing Virus Identification in Critically Ill Children Suspected of Having an Acute Severe Viral Infection

Adrienne G. Randolph, Anna A. Agan, Ryan F. Flanagan, Jennifer K. Meece, Julie C. Fitzgerald, Laura L. Loftis, Edward J Truemper, Simon Li, Jill M. Ferdinands

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: Multiplex rapid viral tests and nasopharyngeal flocked swabs are increasingly used for viral testing in PICUs. This study aimed at evaluating how the sampling site and the type of diagnostic test influence test results in children with suspected severe viral infection. Design: Prospective cohort study. Setting: PICUs at 21 tertiary pediatric referral centers in the United States. Patients: During the 2010-2011 and 2011-2012 influenza seasons, we enrolled children (6 mo to 17 yr old) who were suspected to have severe viral infection. Interventions: We collected samples by using a standardized protocol for nasopharyngeal aspirate and nasopharyngeal flocked swabs in nonintubated patients and for endotracheal tube aspirate and nasopharyngeal flocked swabs in intubated patients. Measurements and Main Results: Viral testing included a single reverse transcription-polymerase chain reaction influenza test and the GenMark Respiratory Viral Panel (20 viruses). We enrolled 90 endotracheally intubated and 133 nonintubated children. We identified influenza in 45 patients with reverse transcription-polymerase chain reaction testing; the multiplex panel was falsely negative for influenza in two patients (4.4%). Six patients (13.3%) had not been diagnosed with influenza in the PICU. Non-influenza viruses were identified in 172 of 223 children (77.1%). In nonintubated children, the same virus was identified by nasopharyngeal flocked swabs and nasopharyngeal aspirate in 133 of 183 paired samples (72.7%), with +nasopharyngeal aspirate/-nasopharyngeal flocked swabs in 32 of 183 paired samples (17.4%). In intubated children, the same virus was identified by nasopharyngeal flocked swabs and endotracheal tube aspirate in 67 of 94 paired samples (71.3%), with +nasopharyngeal flocked swabs/-endotracheal tube aspirate in 22 of 94 paired samples (23.4%). Most discrepancies were either adenovirus or rhinovirus in both groups. Conclusions: Standardized specimen collection and sensitive diagnostic testing with a reverse transcription-polymerase chain reaction increased the identification of influenza in critically ill children. For most pathogenic viruses identified, results from nasopharyngeal flocked swabs agreed with those from nasopharyngeal or endotracheal aspirates.

Original languageEnglish (US)
Pages (from-to)279-286
Number of pages8
JournalPediatric Critical Care Medicine
Volume17
Issue number4
DOIs
StatePublished - Apr 1 2016

Fingerprint

Virus Diseases
Critical Illness
Human Influenza
Viruses
Reverse Transcription
Polymerase Chain Reaction
Specimen Handling
Rhinovirus
Routine Diagnostic Tests
Tertiary Care Centers
Adenoviridae
Cohort Studies
Prospective Studies
Pediatrics

Keywords

  • children
  • influenza
  • respiratory failure
  • respiratory tract infection
  • viral testing

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Randolph, A. G., Agan, A. A., Flanagan, R. F., Meece, J. K., Fitzgerald, J. C., Loftis, L. L., ... Ferdinands, J. M. (2016). Optimizing Virus Identification in Critically Ill Children Suspected of Having an Acute Severe Viral Infection. Pediatric Critical Care Medicine, 17(4), 279-286. https://doi.org/10.1097/PCC.0000000000000661

Optimizing Virus Identification in Critically Ill Children Suspected of Having an Acute Severe Viral Infection. / Randolph, Adrienne G.; Agan, Anna A.; Flanagan, Ryan F.; Meece, Jennifer K.; Fitzgerald, Julie C.; Loftis, Laura L.; Truemper, Edward J; Li, Simon; Ferdinands, Jill M.

In: Pediatric Critical Care Medicine, Vol. 17, No. 4, 01.04.2016, p. 279-286.

Research output: Contribution to journalArticle

Randolph, AG, Agan, AA, Flanagan, RF, Meece, JK, Fitzgerald, JC, Loftis, LL, Truemper, EJ, Li, S & Ferdinands, JM 2016, 'Optimizing Virus Identification in Critically Ill Children Suspected of Having an Acute Severe Viral Infection', Pediatric Critical Care Medicine, vol. 17, no. 4, pp. 279-286. https://doi.org/10.1097/PCC.0000000000000661
Randolph, Adrienne G. ; Agan, Anna A. ; Flanagan, Ryan F. ; Meece, Jennifer K. ; Fitzgerald, Julie C. ; Loftis, Laura L. ; Truemper, Edward J ; Li, Simon ; Ferdinands, Jill M. / Optimizing Virus Identification in Critically Ill Children Suspected of Having an Acute Severe Viral Infection. In: Pediatric Critical Care Medicine. 2016 ; Vol. 17, No. 4. pp. 279-286.
@article{ddc2a7f56bc244a4909ed03ac4260389,
title = "Optimizing Virus Identification in Critically Ill Children Suspected of Having an Acute Severe Viral Infection",
abstract = "Objectives: Multiplex rapid viral tests and nasopharyngeal flocked swabs are increasingly used for viral testing in PICUs. This study aimed at evaluating how the sampling site and the type of diagnostic test influence test results in children with suspected severe viral infection. Design: Prospective cohort study. Setting: PICUs at 21 tertiary pediatric referral centers in the United States. Patients: During the 2010-2011 and 2011-2012 influenza seasons, we enrolled children (6 mo to 17 yr old) who were suspected to have severe viral infection. Interventions: We collected samples by using a standardized protocol for nasopharyngeal aspirate and nasopharyngeal flocked swabs in nonintubated patients and for endotracheal tube aspirate and nasopharyngeal flocked swabs in intubated patients. Measurements and Main Results: Viral testing included a single reverse transcription-polymerase chain reaction influenza test and the GenMark Respiratory Viral Panel (20 viruses). We enrolled 90 endotracheally intubated and 133 nonintubated children. We identified influenza in 45 patients with reverse transcription-polymerase chain reaction testing; the multiplex panel was falsely negative for influenza in two patients (4.4{\%}). Six patients (13.3{\%}) had not been diagnosed with influenza in the PICU. Non-influenza viruses were identified in 172 of 223 children (77.1{\%}). In nonintubated children, the same virus was identified by nasopharyngeal flocked swabs and nasopharyngeal aspirate in 133 of 183 paired samples (72.7{\%}), with +nasopharyngeal aspirate/-nasopharyngeal flocked swabs in 32 of 183 paired samples (17.4{\%}). In intubated children, the same virus was identified by nasopharyngeal flocked swabs and endotracheal tube aspirate in 67 of 94 paired samples (71.3{\%}), with +nasopharyngeal flocked swabs/-endotracheal tube aspirate in 22 of 94 paired samples (23.4{\%}). Most discrepancies were either adenovirus or rhinovirus in both groups. Conclusions: Standardized specimen collection and sensitive diagnostic testing with a reverse transcription-polymerase chain reaction increased the identification of influenza in critically ill children. For most pathogenic viruses identified, results from nasopharyngeal flocked swabs agreed with those from nasopharyngeal or endotracheal aspirates.",
keywords = "children, influenza, respiratory failure, respiratory tract infection, viral testing",
author = "Randolph, {Adrienne G.} and Agan, {Anna A.} and Flanagan, {Ryan F.} and Meece, {Jennifer K.} and Fitzgerald, {Julie C.} and Loftis, {Laura L.} and Truemper, {Edward J} and Simon Li and Ferdinands, {Jill M.}",
year = "2016",
month = "4",
day = "1",
doi = "10.1097/PCC.0000000000000661",
language = "English (US)",
volume = "17",
pages = "279--286",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Optimizing Virus Identification in Critically Ill Children Suspected of Having an Acute Severe Viral Infection

AU - Randolph, Adrienne G.

AU - Agan, Anna A.

AU - Flanagan, Ryan F.

AU - Meece, Jennifer K.

AU - Fitzgerald, Julie C.

AU - Loftis, Laura L.

AU - Truemper, Edward J

AU - Li, Simon

AU - Ferdinands, Jill M.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Objectives: Multiplex rapid viral tests and nasopharyngeal flocked swabs are increasingly used for viral testing in PICUs. This study aimed at evaluating how the sampling site and the type of diagnostic test influence test results in children with suspected severe viral infection. Design: Prospective cohort study. Setting: PICUs at 21 tertiary pediatric referral centers in the United States. Patients: During the 2010-2011 and 2011-2012 influenza seasons, we enrolled children (6 mo to 17 yr old) who were suspected to have severe viral infection. Interventions: We collected samples by using a standardized protocol for nasopharyngeal aspirate and nasopharyngeal flocked swabs in nonintubated patients and for endotracheal tube aspirate and nasopharyngeal flocked swabs in intubated patients. Measurements and Main Results: Viral testing included a single reverse transcription-polymerase chain reaction influenza test and the GenMark Respiratory Viral Panel (20 viruses). We enrolled 90 endotracheally intubated and 133 nonintubated children. We identified influenza in 45 patients with reverse transcription-polymerase chain reaction testing; the multiplex panel was falsely negative for influenza in two patients (4.4%). Six patients (13.3%) had not been diagnosed with influenza in the PICU. Non-influenza viruses were identified in 172 of 223 children (77.1%). In nonintubated children, the same virus was identified by nasopharyngeal flocked swabs and nasopharyngeal aspirate in 133 of 183 paired samples (72.7%), with +nasopharyngeal aspirate/-nasopharyngeal flocked swabs in 32 of 183 paired samples (17.4%). In intubated children, the same virus was identified by nasopharyngeal flocked swabs and endotracheal tube aspirate in 67 of 94 paired samples (71.3%), with +nasopharyngeal flocked swabs/-endotracheal tube aspirate in 22 of 94 paired samples (23.4%). Most discrepancies were either adenovirus or rhinovirus in both groups. Conclusions: Standardized specimen collection and sensitive diagnostic testing with a reverse transcription-polymerase chain reaction increased the identification of influenza in critically ill children. For most pathogenic viruses identified, results from nasopharyngeal flocked swabs agreed with those from nasopharyngeal or endotracheal aspirates.

AB - Objectives: Multiplex rapid viral tests and nasopharyngeal flocked swabs are increasingly used for viral testing in PICUs. This study aimed at evaluating how the sampling site and the type of diagnostic test influence test results in children with suspected severe viral infection. Design: Prospective cohort study. Setting: PICUs at 21 tertiary pediatric referral centers in the United States. Patients: During the 2010-2011 and 2011-2012 influenza seasons, we enrolled children (6 mo to 17 yr old) who were suspected to have severe viral infection. Interventions: We collected samples by using a standardized protocol for nasopharyngeal aspirate and nasopharyngeal flocked swabs in nonintubated patients and for endotracheal tube aspirate and nasopharyngeal flocked swabs in intubated patients. Measurements and Main Results: Viral testing included a single reverse transcription-polymerase chain reaction influenza test and the GenMark Respiratory Viral Panel (20 viruses). We enrolled 90 endotracheally intubated and 133 nonintubated children. We identified influenza in 45 patients with reverse transcription-polymerase chain reaction testing; the multiplex panel was falsely negative for influenza in two patients (4.4%). Six patients (13.3%) had not been diagnosed with influenza in the PICU. Non-influenza viruses were identified in 172 of 223 children (77.1%). In nonintubated children, the same virus was identified by nasopharyngeal flocked swabs and nasopharyngeal aspirate in 133 of 183 paired samples (72.7%), with +nasopharyngeal aspirate/-nasopharyngeal flocked swabs in 32 of 183 paired samples (17.4%). In intubated children, the same virus was identified by nasopharyngeal flocked swabs and endotracheal tube aspirate in 67 of 94 paired samples (71.3%), with +nasopharyngeal flocked swabs/-endotracheal tube aspirate in 22 of 94 paired samples (23.4%). Most discrepancies were either adenovirus or rhinovirus in both groups. Conclusions: Standardized specimen collection and sensitive diagnostic testing with a reverse transcription-polymerase chain reaction increased the identification of influenza in critically ill children. For most pathogenic viruses identified, results from nasopharyngeal flocked swabs agreed with those from nasopharyngeal or endotracheal aspirates.

KW - children

KW - influenza

KW - respiratory failure

KW - respiratory tract infection

KW - viral testing

UR - http://www.scopus.com/inward/record.url?scp=84958811690&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958811690&partnerID=8YFLogxK

U2 - 10.1097/PCC.0000000000000661

DO - 10.1097/PCC.0000000000000661

M3 - Article

VL - 17

SP - 279

EP - 286

JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

SN - 1529-7535

IS - 4

ER -