$3.4M grant for study to distinguish bacterial infections from viral infections in infants with fevers

Octavio Ramilo, MD, chief of Infectious Diseases at Nationwide Children's Hospital, is one of three principal investigators who will share in a five-year, $3.4 million grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Dr. Ramilo and a team of more than 50 physicians across the United States are investigating the use of novel technologies for distinguishing between bacterial and viral infections in infants with fevers within emergency departments. This could lead to more rapid and accurate diagnoses and treatment for serious bacterial infections such as bacteremia and meningitis.

The multi-site study, including more than 20 children's hospitals within the Pediatric Emergency Care Applied Research Network (PECARN) network, will make use of RNA biosignatures - biological indicators that can be identified from a blood test - to distinguish infants presenting with fever who have bacterial infections from those infected with non-bacterial, or viral, pathogens.

The evaluation and management of febrile infants, especially those younger than 60 days of age, remains a challenge, particularly in hospital emergency departments. In fact, 6 to 10 percent of these infants arrive with serious, bacterial infections. Current tests to distinguish infants with these infections from those with benign viral illnesses can be invasive, inaccurate and time consuming, sometimes yielding false positive or false negative results. In addition, urine, blood and spinal fluid cultures typically take several days for final results.

"We plan to determine the host response to infection using RNA biosignatures that could help address some very challenging problems when evaluating these young, vulnerable infants," said Dr. Ramilo, also a faculty member at The Ohio State University College of Medicine. "This study could significantly improve the care we can provide to our youngest of patients when they arrive at an emergency department with a fever. We think it will give physicians and families quicker and precise information, helping avoid unnecessary tests and hospitalizations."

Dr. Ramilo is leading the study along with Dr. Nathan Kuppermann of UC Davis Health System in Sacramento and Dr. Prashant Mahajan of Children's Hospital of Michigan and Wayne State University. They are collaborating with colleagues at medical centers around the country as part of the PECARN network. Also involved in the study are Bema Bonsu, MD, an attending physician in the Emergency Department at Nationwide Children's Hospital and Daniel Cohen, MD, an associate director of Emergency Medicine at Nationwide Children's Hospital within the Emergency Department at Nationwide Children's and Asuncion Mejias, MD, an investigator at the Center for Vaccines and Immunity in The Research Institute at Nationwide Children's Hospital within Infectious Diseases.

"Bacterial infections likely carry very distinct biological signatures because they induce different host responses than nonbacterial pathogens," said Dr. Mejias. "We plan to use a type of molecular fingerprint technology to enable physicians to identify the specific markers in bacterial infections, as well as determine if such tests are feasible and practical in the emergency room setting."

There is a need to develop less invasive, highly accurate and timelier diagnostic strategies for febrile infants. Making use of new molecular tools, especially in emergency care, could ultimately help improve care for the youngest of patients, added Dr. Ramilo.

The new study will be conducted through PECARN, which is funded by the Emergency Medical Services for Children Program, part of the Maternal and Child Health Bureau of the U.S. Health Resources and Services Administration. In addition to Nationwide Children's Hospital, UC Davis and Children's Hospital of Michigan and Wayne State University, the following sites are also participating in this study:

Helen DeVos Children's Hospital
Jacobi Medical Center
Johns Hopkins University
Columbia University Medical Center
University of Colorado at Denver
University of Maryland at Baltimore
University of Michigan
University of Utah
Washington University
Women's and Children's Hospital of Buffalo
Cincinnati Children's Hospital
Baylor Research Institute
Bellevue Hospital Center, NYU
Children's Hospital of Boston
Children's Hospital of Philadelphia
Medical College of Wisconsin
Children's Memorial Hospital, Chicago
Children's Research Institute, Washington, D.C.

Source: Nationwide Children's Hospital