학술논문
Lower respiratory tract infections in children requiring mechanical ventilation: a multicentre prospective surveillance study incorporating airway metagenomics
Document Type
article
Author
Tsitsiklis, Alexandra; Osborne, Christina M; Kamm, Jack; Williamson, Kayla; Kalantar, Katrina; Dudas, Gytis; Caldera, Saharai; Lyden, Amy; Tan, Michelle; Neff, Norma; Soesanto, Victoria; Harris, J Kirk; Ambroggio, Lilliam; Maddux, Aline B; Carpenter, Todd C; Reeder, Ron W; Locandro, Chris; Simões, Eric AF; Leroue, Matthew K; Hall, Mark W; Zuppa, Athena F; Carcillo, Joseph; Meert, Kathleen L; Sapru, Anil; Pollack, Murray M; McQuillen, Patrick S; Notterman, Daniel A; Dean, J Michael; Zinter, Matt S; Wagner, Brandie D; DeRisi, Joseph L; Mourani, Peter M; Langelier, Charles R
Source
The Lancet Microbe. 3(4)
Subject
Language
Abstract
BackgroundLower 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.MethodsWe 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.FindingsBetween 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