Respiratory virus infections in febrile children presenting to a general practice out-of-hours service.
BACKGROUND
Fever is common in young children and is assumed to be frequently caused by viral infections.


OBJECTIVE
To document respiratory viruses in children with fever presenting at a general practice out-of-hours service (OHS), evaluate presenting symptoms in febrile children with a virus infection, and examine the association between antibiotic prescription and the presence of a viral infection.


METHODS
Nasopharyngeal swabs were obtained to detect respiratory viruses in non-hospitalized children aged ≥ three months to six years presenting with fever at an OHS. Symptoms were assessed using physical examinations and questionnaires. Logistic regression analysis was used to reveal associations between symptoms or diagnoses, and the presence of at least one virus


RESULTS
In total 257 nasopharyngeal swabs were obtained in 306 eligible children; 53% of these children were infected by at least one virus. The most frequently detected viruses were adenovirus (10.9%), RSV type A (10.5%) and PIV type 1 (8.6%). Cough (OR 2.6; 95% CI: 1.4-4.6) and temperature ≥ 38.0°C (OR 2.1; 95% CI: 1.3-3.5) were independent predictors of the presence of a virus, but the discriminative ability was low (AUC 0.64; 95% CI: 0.58-0.71). Antibiotic prescription rate was 37.3%. In 57.4% of children with an antibiotic prescription, a virus was found.


CONCLUSIONS
In over 50% of all febrile children presenting at an OHS, a virus was found. Antibiotic prescription rate was high and not associated to the outcome of viral testing.
Department of General Practice, Erasmus MC, University Medical Center Rotterdam , Rotterdam , the Netherlands.
Marijke
M
Kool
Miriam
M
Monteny
Gerard J J
GJ
van Doornum
Henriette A
HA
Moll
Marjolein Y
MY
Berger
D000256:Adenoviridae / Q000235:genetics; D000257:Adenoviridae Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D039602:After-Hours Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003371:Cough / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D017720:Molecular Epidemiology; D009305:Nasopharynx / Q000821:virology; D009426:Netherlands / Q000453:epidemiology; D010252:Paramyxoviridae / Q000235:genetics; D018184:Paramyxoviridae Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000235:genetics; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D012220:Rhinitis / Q000209:etiology; D014777:Virus Diseases / Q000150:complications / Q000453:epidemiology / Q000821:virology
D000900:Anti-Bacterial Agents
Infectious diseases; emergency and out-of-hours care; general practice; paediatrics