The following is the summary of “Rapid detection of respiratory pathogens in critically ill children” published in the January 2023 issue of Critical care by Clark, et al.

Respiratory illnesses cause most pediatric intensive care units (PICU) admissions. Unfortunately, the majority of patients diagnosed with a lower respiratory tract infection (LRTI) are given broad-spectrum antimicrobials despite the low rates of bacterial culture confirmation. In this study, we assessed an LRTI molecular diagnostic tool to help guide more effective antibiotic management.

The Acute Lung Infection Rapid Test for Ill Children (>37/40 weeks corrected gestation to 18 years) Children who required mechanical ventilation and were suspected of having either a community-acquired or ventilator-associated LRTI participated in a single-center, prospective, observational cohort research. Researchers tested a custom TaqMan Array Card (TAC) for the identification of pathogens in non-bronchoscopic bronchoalveolar lavage (mini-BAL) samples, with a target number of 52 pathogens. Results from TAC were compared to those from the standard microbiological analysis. The sensitivity and specificity of TAC and the time to result were the primary endpoints of the study.

About 100 patients were included; all were subjected to TAC testing, and 91 had concordant culture samples. When compared to conventional bacterial and fungal culture, TAC showed a sensitivity of 89.5% (95% CI95, 66.9-98.7) and a specificity of 97.9% (CI95, 97.2-98.5). With TAC, the time it took to get a result was 25.8 hours (IQR 9.1-29.8 hours). In contrast, the median time for a positive culture result was 110.4 hours (interquartile range [IQR] 85.2-141.6 hours), while the median time for a negative result was 69.4 hours (IQR 52.8-78.6). In summary, TAC provides a robust and quick supplementary diagnostic method for LRTI in critically sick children, with the potential to improve the early rationalisation of antimicrobial medication.