Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 12;17(5):e0268131.
doi: 10.1371/journal.pone.0268131. eCollection 2022.

Prognostic value of upper respiratory tract microbes in children presenting to primary care with respiratory infections: A prospective cohort study

Luke J McGeoch  1 , Hannah V Thornton  2 , Peter S Blair  1   3 , Hannah Christensen  1   4 , Nicholas L Turner  3 , Peter Muir  5 , Barry Vipond  5 , Niamh M Redmond  2   6 , Sophie Turnbull  1 , Alastair D Hay  2
Affiliations

Prognostic value of upper respiratory tract microbes in children presenting to primary care with respiratory infections: A prospective cohort study

Luke J McGeoch et al. PLoS One. .

Abstract

Background: The association between upper respiratory tract microbial positivity and illness prognosis in children is unclear. This impedes clinical decision-making and means the utility of upper respiratory tract microbial point-of-care tests remains unknown. We investigated for relationships between pharyngeal microbes and symptom severity in children with suspected respiratory tract infection (RTI).

Methods: Baseline characteristics and pharyngeal swabs were collected from 2,296 children presenting to 58 general practices in Bristol, UK with acute cough and suspected RTI between 2011-2013. Post-consultation, parents recorded the severity of six RTI symptoms on a 0-6 scale daily for ≤28 days. We used multivariable hurdle regression, adjusting for clinical characteristics, antibiotics and other microbes, to investigate associations between respiratory microbes and mean symptom severity on days 2-4 post-presentation.

Results: Overall, 1,317 (57%) children with complete baseline, microbiological and symptom data were included. Baseline characteristics were similar in included participants and those lacking microbiological data. At least one virus was detected in 869 (66%) children, and at least one bacterium in 783 (60%). Compared to children with no virus detected (mean symptom severity score 1.52), adjusted mean symptom severity was 0.26 points higher in those testing positive for at least one virus (95% CI 0.15 to 0.38, p<0.001); and was also higher in those with detected Influenza B (0.44, 0.15 to 0.72, p = 0.003); RSV (0.41, 0.20 to 0.60, p<0.001); and Influenza A (0.25, -0.01 to 0.51, p = 0.059). Children positive for Enterovirus had a lower adjusted mean symptom severity (-0.24, -0.43 to -0.05, p = 0.013). Children with detected Bordetella pertussis (0.40, 0.00 to 0.79, p = 0.049) and those with detected Moraxella catarrhalis (-0.76, -1.06 to -0.45, p<0.001) respectively had higher and lower mean symptom severity compared to children without these bacteria.

Conclusions: There is a potential role for upper respiratory tract microbiological point-of-care tests in determining the prognosis of childhood RTIs.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of participants through the study.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Jin X, Ren J, Li R, Gao Y, Zhang H, Li J, et al.. Global burden of upper respiratory infections in 204 countries and territories, from 1990 to 2019. EClinicalMedicine 2021;37:100986. doi: 10.1016/j.eclinm.2021.100986 - DOI - PMC - PubMed
    1. Troeger C, Blacker B, Khalil IA, Rao PC, Cao J, Zimsen SRM, et al.. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 2018;18(11):1191–210. doi: 10.1016/S1473-3099(18)30310-4 - DOI - PMC - PubMed
    1. Thornton H V., Turner KME, Harrison S, Hammond A, Hawcroft C, Hay AD. Assessing the potential of upper respiratory tract point-of-care testing: a systematic review of the prognostic significance of upper respiratory tract microbes. Clin Microbiol Infect 2019;25:1339–46. doi: 10.1016/j.cmi.2019.06.024 - DOI - PMC - PubMed
    1. Smith S, Morbey R, de Lusignan S, Pebody RG, Smith GE, Elliot AJ. Investigating regional variation of respiratory infections in a general practice syndromic surveillance system. J Public Health 2021;43(2):e153–60. doi: 10.1093/pubmed/fdaa014 - DOI - PubMed
    1. Jankauskaite L, Oostenbrink R. Childhood lower respiratory tract infections: more evidence to do less. Lancet. 2021;398(10309):1383–4. doi: 10.1016/S0140-6736(21)01955-3 - DOI - PubMed

Publication types