A qualitative investigation of paediatric intensive care staff attitudes towards the diagnosis of lower respiratory tract infection in the molecular diagnostics era

John A Clark; Andrew Conway Morris; Constantinos Kanaris; David Inwald; Warwick Butt; Joshua Osowicki; Luregn J Schlapbach; Martin D Curran; Deborah White; Esther Daubney; Shruti Agrawal; Vilas Navapurkar; M Estée Török; Stephen Baker; Nazima Pathan

doi:10.1007/s44253-023-00008-z

A qualitative investigation of paediatric intensive care staff attitudes towards the diagnosis of lower respiratory tract infection in the molecular diagnostics era

Intensive Care Med Paediatr Neonatal. 2023;1(1):10. doi: 10.1007/s44253-023-00008-z. Epub 2023 Jul 7.

Authors

John A Clark^{1

2}, Andrew Conway Morris^{2

3

4}, Constantinos Kanaris^{2

5}, David Inwald², Warwick Butt^{6

7}, Joshua Osowicki⁸, Luregn J Schlapbach⁹, Martin D Curran¹⁰, Deborah White², Esther Daubney², Shruti Agrawal^{1

2}, Vilas Navapurkar², M Estée Török^{2

11}, Stephen Baker¹², Nazima Pathan^{1

2}

Affiliations

¹ Department of Paediatrics, University of Cambridge, Level 8, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK.
² Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
³ Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK.
⁴ Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, UK.
⁵ Blizard Institute, Queen Mary University of London, London, UK.
⁶ Paediatric Intensive Care Unit, Royal Children's Hospital Melbourne, Melbourne, Australia.
⁷ Department of Critical Care, University of Melbourne, Melbourne, Australia.
⁸ Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, Australia.
⁹ Department of Intensive Care and Neonatology and Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland.
¹⁰ United Kingdom Health Security Agency, Clinical Microbiology and Public Health Laboratory, Cambridge, UK.
¹¹ Division of Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge, UK.
¹² Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK.

Abstract

Background: In the past decade, molecular diagnostic syndromic arrays incorporating a range of bacterial and viral pathogens have been described. It is unclear how paediatric intensive care unit (PICU) staff diagnose lower respiratory tract infection (LRTI) and integrate diagnostic array results into antimicrobial decision-making.

Methods: An online survey with eleven questions was distributed throughout paediatric intensive care societies in the UK, continental Europe and Australasia with a total of 755 members. Participants were asked to rate the clinical factors and investigations they used when prescribing for LRTI. Semi-structured interviews were undertaken with staff who participated in a single-centre observational study of a 52-pathogen diagnostic array.

Results: Seventy-two survey responses were received; most responses were from senior doctors. Whilst diagnostic arrays were used less frequently than routine investigations (i.e. microbiological culture), they were of comparable perceived utility when making antimicrobial decisions. Prescribers reported that for arrays to be clinically impactful, they would need to deliver results within 6 h for stable patients and within 1 h for unstable patients to inform their immediate decision to prescribe antimicrobials. From 16 staff interviews, we identified that arrays were helpful for the diagnosis and screening of bacterial LRTI. Staff reported it could be challenging to interpret results in some cases due to the high sensitivity of the test. Therefore, results were considered within the context of the patient and discussed within the multidisciplinary team.

Conclusions: Diagnostic arrays were considered of comparable value to microbiological investigations by PICU prescribers. Our findings support the need for further clinical and economic evaluation of diagnostic arrays in a randomised control trial.

Trial registration: Clinicaltrials.gov, NCT04233268. Registered on 18 January 2020.

Supplementary information: The online version contains supplementary material available at 10.1007/s44253-023-00008-z.

Keywords: Critical care; Diagnostic techniques; Evaluations; Paediatric; Pneumonia; Qualitative; Respiratory system.

Associated data

ClinicalTrials.gov/NCT04233268

Grants and funding

MR/V006118/1/MRC_/Medical Research Council/United Kingdom