ArticleThe Lancet. Microbe2022
Lower respiratory tract infections in children requiring mechanical ventilation: a multicentre prospective surveillance study incorporating airway metagenomics.
Article in The Lancet. Microbe, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.
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Who cites it
31 citing papers in PubMed, 59 citations in OpenAlex.
- Lower Respiratory Microbiome Dysbiosis Is Associated With Poor Prognosis in Acute Severe Lower Respiratory Tract Infection.MedComm · 2026Article
- Early Environments, Lasting Effects: Air Pollution, Microbes, and Respiratory Infection Risk in Children.Pediatric pulmonology · 2026Review
- Respiratory Viral Co-Infections in Pediatric Patients: Clinical Impact and Implications for Healthcare Practice-A Narrative Review.Healthcare (Basel, Switzerland) · 2026Review
- Host-microbiome archetypes differentiate infection from pathogen carriage in the human lower airway.Nature communications · 2026Article
- Diagnostic and Clinical Value of Targeted Next-Generation Sequencing for Pediatric Respiratory Infections in Northern China.The clinical respiratory journal · 2026Article
- Clinical metagenomics for diagnosis and surveillance of viral pathogens.Nature reviews. Microbiology · 2026Review
- Application of metagenomic next-generation sequencing in children with pneumonia of unknown etiology.Frontiers in cellular and infection microbiology · 2026Article
- Analysis of bacterial pathogen spectrum and epidemiological characteristics of pediatric lower respiratory tract infections: a large sample study based on bronchoalveolar lavage.BMC infectious diseases · 2025Article
- Respiratory admissions and impact of COVID-19 lockdowns for children with severe cerebral palsy.Developmental medicine and child neurology · 2025Observational
- Performance of broad-spectrum targeted next-generation sequencing in lower respiratory tract infections in ICU patients: a prospective observational study.Critical care (London, England) · 2025Observational
- Simultaneous detection of pathogens and antimicrobial resistance genes with the open source, cloud-based, CZ ID platform.Genome medicine · 2025Article
- Evidence of multiple bacterial, viral, and parasitic infectious disease agents inInfection ecology & epidemiology · 2025Article
- Article
- Epidemiology and Diagnostic Accuracy of Respiratory Pathogens in Pediatric Populations: Insights From Global Studies.Cureus · 2024Review
- Article
- Metagenomic next-generation sequencing of plasma cell-free DNA improves the early diagnosis of suspected infections.BMC infectious diseases · 2024Article
- The antibiotic resistance reservoir of the lung microbiome expands with age in a population of critically ill patients.Nature communications · 2024Observational
- Development of a portable on-site applicable metagenomic data generation workflow for enhanced pathogen and antimicrobial resistance surveillance.Scientific reports · 2023Article
- Comparative study of diagnostic efficacy of sputum and bronchoalveolar lavage fluid specimens in community-acquired pneumonia children treated with fiberoptic bronchoscopy.BMC infectious diseases · 2023Article
- Metagenomics characterization of respiratory viral RNA pathogens in children under five years with severe acute respiratory infection in the Free State, South Africa.Journal of medical virology · 2023Article
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Authors and funding
33 authors at 12 institutions in 1 country.
Funding
Abstract
backgroundLower respiratory tract infections (LRTI) are a leading cause of critical illness and mortality in mechanically ventilated children; however, the pathogenic microbes frequently remain unknown. We combined traditional diagnostics with metagenomic next generation sequencing (mNGS) to evaluate the cause of LRTI in critically ill children.
methodsWe conducted a prospective, multicentre cohort study of critically ill children aged 31 days to 17 years with respiratory failure requiring mechanical ventilation (>72 h) in the USA. By combining bacterial culture and upper respiratory viral PCR testing with mNGS of tracheal aspirate collected from all patients within 24 h of intubation, we determined the prevalence, age distribution, and seasonal variation of viral and bacterial respiratory pathogens detected by either method in children with or without LRTI.
findingsBetween Feb 26, 2015, and Dec 31, 2017, of the 514 enrolled patients, 397 were eligible and included in the study (276 children with LRTI and 121 with no evidence of LRTI). A presumptive microbiological cause was identified in 255 (92%) children with LRTI, with respiratory syncytial virus (127 [46%]), Haemophilus influenzae (70 [25%]), and Moraxella catarrhalis (65 [24%]) being most prevalent. mNGS identified uncommon pathogens including Ureaplasma parvum and Bocavirus. Co-detection of viral and bacterial pathogens occurred in 144 (52%) patients. Incidental carriage of potentially pathogenic microbes occurred in 82 (68%) children without LRTI, with rhinovirus (30 [25%]) being most prevalent. Respiratory syncytial virus (p<0·0001), H influenzae (p=0·0006), and M catarrhalis (p=0·0002) were most common in children younger than 5 years. Viral and bacterial LRTI occurred predominantly during winter months.
interpretationThese findings demonstrate that respiratory syncytial virus, H influenzae, and M catarrhalis contribute disproportionately to severe paediatric LRTI, co-infections are common, and incidental carriage of potentially pathogenic microbes occurs frequently. Further, we provide a framework for future epidemiological and emerging pathogen surveillance studies, highlighting the potential for metagenomics to enhance clinical diagnosis.
fundingUS National Institutes of Health and CZ Biohub.
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