Incidence, Characteristics, and Outcomes of Clinically Undetected Bacteremia in Children Discharged Home From the Emergency Department

Abstract

Background: Despite a recent decline in the rates of invasive infections, bacteremia in young children remains a significant challenge. We aimed to describe patient characteristics, microbial etiology, and outcomes of bacteremic, well-appearing children 3–36 months of age who were discharged home from the pediatric emergency department (PED) on their index visit. Methods: A retrospective cohort study in the PED of a tertiary children’s hospital from 1 June 2015 until 30 June 2021. We included all well appearing, immunocompetent infants 3–36 months old evaluated for fever and discharged home from the PED after a blood culture was drawn. We extracted demographic, clinical and laboratory data from the patient’s electronic medical records for the index visit and subsequent encounters. Results: During the study period, 17,114 children evaluated for fever met the inclusion criteria. Seventy-two patients (0.42%) had positive cultures for known pathogens. Thirty-six (50%) were male and 36 (50%) younger than 1 year. The most common isolates were S. pneumonia 26%. (n = 19), K. Kingae 25%. (n = 18) and Salmonella spp. 13.9% (n = 10). Sixty patients (85.7%) were recalled to the ED or had a scheduled appointment, 10 (14.3%) returned spontaneously and two were followed up by phone. The median time between visits was 28.7 hours (IQR 19.1–41.1). One patient was admitted to intensive care during the course of hospitalization. There were no deaths. Conclusion: The rate of undetected true bacteremia in our study was low and our data suggest that significant clinical deterioration during the first 24 hours is rare.

Risk of Bacteremia in Febrile Children and Young Adults With Sickle Cell Disease in a Multicenter Emergency Department Cohort

“…Our results are similar to small single-center studies from the past 10 years that have reported a wider range of bacteremia (0.3%-4.2%, with a weighted average of 1.9%), limited by their smaller sample sizes . The incidence of bacteremia in SCD has decreased over the past 30 years in conjunction with the introduction of prophylactic measures, disease-modifying medications, and vaccine development, but it still occurs and is higher than the risk of undetected bacteremia in febrile young children (age 3-36 months) without SCD who present to the ED . Our results focus on the risk of bacteremia among children with SCD and fever who have already arrived in a pediatric ED.…”

“… 12 , 18 The incidence of bacteremia in SCD has decreased over the past 30 years in conjunction with the introduction of prophylactic measures, disease-modifying medications, and vaccine development, 4 , 5 , 10 , 19 but it still occurs and is higher than the risk of undetected bacteremia in febrile young children (age 3-36 months) without SCD who present to the ED. 20 Our results focus on the risk of bacteremia among children with SCD and fever who have already arrived in a pediatric ED. The relatively low risk of bacteremia and the positive outcomes achieved even for children who were diagnosed with bacteremia who were initially discharged from the ED and later readmitted, may be useful for discussion among ED and acute care clinicians about the appropriate workup, treatment, and disposition of children with SCD and fever and whether a more targeted deployment of resources is feasible.…”