综合性呼吸道病毒检测在治疗发烧的幼婴时的局限性
Vincent Julien Chessex1, Florence Anne Barbey2, Patrick Haberstich2
1KSA Children's Hospital Aarau, Aarau, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
The Journal of pediatrics
|November 2, 2025
概括
综合性呼吸道病毒检测在发烧的幼儿中发现严重细菌感染 (SBI) 的价值有限. 已建立的炎症标志物和尿液分析在这个人群中的风险分层方面更有效.
科学领域:
- 儿童传染病 儿童传染病
- 临床诊断 临床诊断 临床诊断
- 流行病学 流行病学
背景情况:
- 发烧的幼儿 (FYI) 经常接受广泛的测试,以排除严重的细菌感染 (SBI).
- 呼吸道病毒感染在FYI中很常见,可以模仿SBI的症状,使诊断复杂化.
- 在FYI中对SBI风险分层进行全面呼吸道病毒检测的实用性仍然不清楚.
研究的目的:
- 评估综合性呼吸道病毒检测对发烧的幼儿风险分层的贡献.
- 为了确定病毒检测是否有助于发烧的幼儿的临床管理.
- 为了将病毒检测的有效性与SBI风险评估的既定标记进行比较.
主要方法:
- 对456名住院发烧的幼婴 (≤90天或≤52个月经后6/7周) 的回顾性队列研究.
- 纳入标准:呼吸道病毒检测结果呈阳性或综合小组的结果呈阴性.
- 主要结局:严重细菌感染率 (SBI),按呼吸道病毒检测结果分层.
主要成果:
- 整体SBI率为15.4% (70/456),包括细菌病和脑膜炎.
- 阳性病毒检测的婴儿SBI率为11.9%;只有流感和RSV的SBI率明显较低.
- 93%的SBI病例表现出异常的炎症标志物或尿液分析,无论病毒检测结果如何.
结论:
- 综合性呼吸道病毒检测对发烧的幼儿SBI风险分层具有有限的价值.
- 病毒检测似乎不能增强临床决策或取代既有的风险分层方法.
- 有针对性的测试策略可以为发烧的幼儿提供更有效地利用医疗保健资源.
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