Antimicrobial treatment of occult bacteremia

Bass, James W.; Steele, Russell W.; Wittler, Robert R.; Weisse, Martin E.; Bell, Valerie; Heisser, Anna; Brien, James H.; Fajardo, J. Eduardo; Wasserman, Glenn M.; Vincent, J; Jones, Ronald G.; Banks, Richard; Krober, Marvin S.; Eitzen, Edward M.; Kotchmar, George S.; Greenwall, Kurt; Baugh, James; Robb, Merlin L.; Mason, Jon D.

doi:10.1097/00006454-199306000-00003

Cited by 109 publications

(67 citation statements)

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“…In 1993, Bass et al also evaluated children between 3 and 36 months and discovered occult bacteremia in 11.5% of the patients, with 10% having infection by type-b H. influenzae [14]. In our study, H. influenzae was only found in one patient (Table 1); this low rate was probably due to universal vaccination for this bacterium [15].…”

Section: Discussionmentioning

confidence: 42%

Evaluation of the incidence of occult bacteremia among children with fever of unknown origin

Berezin¹,

Iazzetti²

2006

Braz J Infect Dis

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We reviewed the incidence of occult bacteremia, to identify the most frequent etiological agents of bacteremias in otherwise healthy children from one month to 10 years old, who had fever of unknown origin attended at the emergency ward of an urban, university-affiliated pediatric referral center. This was a retrospective medical record review, evaluating children with fever. Data were collected from the initial visit, when blood cultures, hematological properties and hemosedimentation rates were examined. Fever was considered as the highest temperature assessed in the hospital or reported by the responsible adult. Occult bacteremia was discovered in 1.4% of the 1,051 children evaluated, and the most common etiologic agent was Streptococcus pneumoniae. Total leukocyte count and blood sedimentation rates greater than 30 mm 3 were not predictive factors for occult bacteremia. Fever greater than 39ºC was the most important factor for predicting occult bacteremia (P<0.001). The presence of occult bacteremia was significantly correlated with patient hospitalization.

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Section: Discussionmentioning

confidence: 42%

Evaluation of the incidence of occult bacteremia among children with fever of unknown origin

Berezin¹,

Iazzetti²

2006

Braz J Infect Dis

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“…A antibioticoterapia empírica é outro ponto de grande controvérsia nestas estratégias. A introdução de antibiótico empírico pode reduzir as IBG e suas complicações 12,13,[28][29][30] . Entretanto, o uso exagerado de antibióticos pode ter um impacto no aumento das taxas de resistência bacteriana.…”

Section: Diagnósticos Finaisunclassified

“…Estudos dos anos 80 e 90 constataram que as crianças de até 3 anos com FSSL, contagem de leucócitos > 15.000/mm 3 e temperatura > 39 ºC tinham risco de IBG 7,[12][13][14] . Em 1992, Baraff & Lee 12 estimaram em 13% o risco de BO em pacientes com contagem de leucócitos ≥ 15.000/mm 3 .…”

Section: Introductionunclassified

Fever without source: evaluation of a guideline

Machado¹,

Cardoso²,

Paulis³

et al. 2009

J Pediatr (Rio J)

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Objective: To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS). Methods:Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture. Results:We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 ºC. In 107 (49.8%) children, there was spontaneous resolution of fever; in 88 (40.9%), benign self-limited disease was identified; and in 20 (9.3%), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60%) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours. Conclusion:The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection. J Pediatr (Rio J)

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“…При этом на долю пневмококка приходилось 50-90% случаев заболеваний, от 3 до 25% случаев вызывала H. influenzae типа b, а остальные случаи бактериемии были обусловлены Salmonella ssp. и Neisseria meningitidis [14]. Одно временно со снижением распространенности бактериемии и менингита на фоне вакцинации от пневмококка и гемофильной палочки во многих странах сократилась и заболеваемость пнев-мококковой пневмонией [15].…”

Section: вопросы современной педиатрииunclassified