Bacteremia in previously healthy children in Emergency Departments: clinical and microbiological characteristics and outcome

Abstract

A blood culture (BC) is frequently requested in both patients with a suspected occult bacteremia/invasive infection as well as those with certain focal infections. Few data are available on the characteristics of patients in whom a bacteremia is identified in the Pediatric Emergency Department (PED). A prospective multicenter registry was established by the Spanish Pediatric Emergency Society. Epidemiological data, complementary test results, clinical management, and final outcome were recorded. Data from the first three years of the registry were analyzed. A true bacterial pathogen grew in 932 of 65,169 BCs collected [1.43 %; 95 % confidence interval (CI) 1.34-1.51 %], with 711 of them collected in patients without previously known bacteremia risk factors. Among them, 335 (47.1 %) were younger than 1 year old and 467 (65.7 %) had a normal Pediatric Assessment Triangle (PAT) on admission. Overall, the most frequently isolated bacterial species was Streptococcus pneumoniae (27.3 %; 47.6 % among patients with an altered PAT). The main pathogens were Escherichia coli (40.3 %) and S. agalactiae (35.7 %) among patients younger than 3 months, S. pneumoniae among patients 3-60 months old (40.0 %), and S. aureus (31.9 %) among patients over 60 months of age. Neisseria meningitidis was the leading cause of sepsis in patients older than 3 months. Eight patients died; none of them had a pneumococcal bacteremia and all had abnormal PAT findings on admission. S. pneumoniae is the main cause of bacteremia in patients without bacteremia risk factors who attended Spanish PEDs. Age and general appearance influence the frequency of each bacterial species. General appearance also influences the associated mortality.

Validation of the “Step-by-Step” Approach in the Management of Young Febrile Infants

“…17 Indeed 1 of the most frequent IBI in young febrile infants is UTI with associated bacteremia. 23,24 In our study, general appearance, age, and urine dipstick identified almost 80% of the IBI patients and, more interestingly, 85% of the sepsis and 90% of the bacterial meningitis. young febrile infants.…”

“…Improvement in the perinatal antibiotic prophylaxis has reduced the incidence of S. agalactiae early-onset sepsis, 35 -37 E coli is nowadays the leading cause of bacteremia in this population, 6,7,17,24 and Listeria is rarely involved. 6,7,17,24 On the other hand, new biomarkers that have been shown to be better predictors of IBI have been included in many management protocols. Curiously, the Lab-score, developed less than 10 years ago, revealed a lower performance compared with previously published studies.…”

Bacteremia in children: epidemiology, clinical diagnosis and antibiotic treatment

“…Patients with occult bacteremia had higher mean temperature (40.2 C ± 0.5 C) when compared with patients with negative or contaminated cultures (p value < 0.001) [31]. The introduction of the heptavalent pneumococcal conjugate vaccine (PCV7) led to further declines in the overall rates of occult bacteremia to <0.5-1% [83,84].…”

“…Occult bacteremia may represent a lag in the clinical manifestation of the disease, and this has been documented in various studies [83][84][85][86]. It is difficult to ascertain the seriousness of occult bacteremia, but biomarkers such as neutrophil count, CRP and PCT are useful analytical parameters [84,85].…”

“…The risk of adverse outcomes of bacteremia is increased by 4-6-fold in patients presenting with sepsis [42,83]. Mortality approaches 10-20% for children with sepsis admitted to a pediatric intensive care unit (PICU) [101][102][103].…”