Same-day test helps doctors detect hidden infections in critically ill children

A groundbreaking same-day diagnostic test at London's Great Ormond Street Hospital (GOSH) is revolutionizing the way doctors identify hidden and drug-resistant infections in critically ill children. By analyzing a single respiratory sample, the metagenomic testing can detect bacteria, viruses, and fungi that standard tests often overlook, leading to improved patient outcomes.

In a life-threatening case, ten-year-old Willow Crowther from Kent suffered from pneumonia, which resulted in a seizure and multiple cardiac arrests. Her parents were given a grim prognosis, with doctors warning that there was only a 50% chance of her survival. However, the metagenomic test at GOSH revealed that Willow had a drug-resistant bacterial infection, necessitating a different antibiotic than the one previously prescribed.

Stacey Moore, Willow's mother, emphasized the critical importance of the test, stating that it saved her daughter's life. Her father, Russ, expressed his gratitude, noting that the timely treatment allowed Willow to recover from the infection and spend several months in the hospital.

The metagenomic testing at GOSH has been studied in a 2024-5 trial involving 122 critically ill children in the pediatric intensive care unit (ICU). The results of this study have been published in the Lancet Microbe. This diagnostic method analyzes all genetic material present in a sample, detecting thousands of different pathogens. In contrast, traditional methods such as culturing bacteria in Petri dishes or using PCR require clinicians to pre-determine what they are looking for.

The study revealed that metagenomic testing at GOSH identified around nine in 10 bacteria and viruses and all fungi in samples. In a quarter of cases, the test results influenced prescribing decisions, including starting, stopping, or altering antibiotic treatments. Dr. Sam Ray, a consultant in pediatric intensive care medicine at GOSH and co-author of the study, highlighted the significance of traditional testing, which often required clinicians to make educated guesses about the infection they were investigating.

The study has enabled the identification of infections that would have otherwise been missed, ensuring that children receive the appropriate treatment and preventing unnecessary antibiotic use, which contributes to growing antimicrobial resistance.

Moreover, metagenomic testing at GOSH has detected 50 organisms that were not identified by routine diagnostics, potentially serving as an early warning system against emerging infections. Dr. Julianne Brown, head of the GOSH Metagenomics Service and co-senior author of the study, explained that the new testing is gradually being implemented in approximately 30 intensive care units across the UK, treating both adults and children.

Dr. Brown believes that this innovative testing could play a crucial role in identifying new infections that may pose a pandemic threat, allowing healthcare professionals to respond swiftly and implement necessary measures.