Bacteremia in feverish children presenting to the emergency department: a retrospective study and literature review

Abstract

Overall bacteremia rate is currently <0.5% in well-appearing children aged 3-36 months with FWS attending the PED in areas with PCV-7 widespread vaccination and is sufficiently low to preclude laboratory testing in favour of close follow-up. Further research is needed to evaluate a more conservative approach in infants 2-3 months of age.

Invasive Pneumococcal Disease in Infants Younger Than 90 Days Before and After Introduction of PCV7

“…14,29 Studies from the United States, Spain, and Italy have reported similar findings even in settings with moderate PCV7 coverage. [37][38][39][40][41] We also observed a trend toward an increase in the proportion of meningitis in infants with IPD after the introduction of PCV7. Poehling et al 9 reported a 15% proportion of meningitis in young infants; however, Ladhani et al 10 reported a higher proportion of meningitis (37%), which is similar to our study.…”

The Outcome of Blood Cultures in Febrile Children Presenting at theEmergency Department

“…The proportion of occult bacteremia is variable, and for children less than 3 years of age, it was estimated to be 3-10% in the pre-Hemophilus influenzae B (HiB) vaccine era. This figure has dropped after the introduction of the HiB vaccination and is currently 0.5% after the worldwide adoption of this vaccination program [10]. The mortality rate associated with bacteremia may be as high as 30% [11].…”

“…The mortality rate associated with bacteremia may be as high as 30% [11]. The clinical management of children older than 3 months of age, who present in the PED with fever, is still controversial [10,12]. There is great heterogeneity in the evaluation and the management practices of this group of patients, including the need for a complete blood count (CBC), measurement of C-reactive protein (CRP) and blood culture (BC) [2][3][4]6,7,13].…”

“…There is great heterogeneity in the evaluation and the management practices of this group of patients, including the need for a complete blood count (CBC), measurement of C-reactive protein (CRP) and blood culture (BC) [2][3][4]6,7,13]. BC remains still the gold standard approach to determine the presence or absence of pathogens in a child with a suspected serious bacterial infection or fever of unknown origin [10,[14][15][16][17][18]. However, the value of BC in febrile children in the ED has been questioned recently [10,19,20].…”

Consenso para el uso adecuado de antibióticos en el niño menor de 36 meses con fiebre sin foco de infección evidente. Texto completo

“…Ante una BO por este microorganismo, existe de 1% a 5,8% de riesgo de meningitis, de 6% a 10% de otras infecciones localizadas, 0,8% de letalidad; entre un 70% y un 87,5% puede autolimitarse sin mediar tratamiento. 3,16,[37][38][39][40][41][42][43][44] Aproximadamente, 0,02% de los pacientes de 3 a 36 meses con FSF > 39 °C tienen BO por Nm. La presencia de petequias o lesiones purpúricas fuera del área de Valsalva constituyen un signo de alerta.…”