• John A Clark, Conway MorrisAndrewA0000-0002-3211-3216Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK.Division of Immunology, Department of Pathology, University o, Martin D Curran, Deborah White, Esther Daubney, Iain R L Kean, Vilas Navapurkar, Josefin Bartholdson Scott, Mailis Maes, Rachel Bousfield, M Estée Török, David Inwald, Zhenguang Zhang, Shruti Agrawal, Constantinos Kanaris, Fahad Khokhar, Theodore Gouliouris, Stephen Baker, and Nazima Pathan.
• Department of Paediatrics, Addenbrooke's Hospital, University of Cambridge, Level 8, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. jac302@cam.ac.uk.
• Crit Care. 2023 Jan 10; 27 (1): 1111.

PurposeRespiratory infections are the most common reason for admission to paediatric intensive care units (PICU). Most patients with lower respiratory tract infection (LRTI) receive broad-spectrum antimicrobials, despite low rates of bacterial culture confirmation. Here, we evaluated a molecular diagnostic test for LRTI to inform the better use of antimicrobials.MethodsThe Rapid Assay for Sick Children with Acute Lung infection Study was a single-centre, prospective, observational cohort study of mechanically ventilated children (> 37/40 weeks corrected gestation to 18 years) with suspected community acquired or ventilator-associated LRTI. We evaluated the use of a 52-pathogen custom TaqMan Array Card (TAC) to identify pathogens in non-bronchoscopic bronchoalveolar lavage (mini-BAL) samples. TAC results were compared to routine microbiology testing. Primary study outcomes were sensitivity and specificity of TAC, and time to result.ResultsWe enrolled 100 patients, all of whom were tested with TAC and 91 of whom had matching culture samples. TAC had a sensitivity of 89.5% (95% confidence interval (CI95) 66.9-98.7) and specificity of 97.9% (CI95 97.2-98.5) compared to routine bacterial and fungal culture. TAC took a median 25.8 h (IQR 9.1-29.8 h) from sample collection to result. Culture was significantly slower: median 110.4 h (IQR 85.2-141.6 h) for a positive result and median 69.4 h (IQR 52.8-78.6) for a negative result.ConclusionsTAC is a reliable and rapid adjunct diagnostic approach for LRTI in critically ill children, with the potential to aid early rationalisation of antimicrobial therapy.© 2023. The Author(s).

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