Bacteremia in an ambulatory setting. Improved outcome in children treated with antibiotics
E. R. Woods, J. L. Merola, W. G. Bithoney, H. Spivak and P. H. Wise
Division of Adolescent/Young Adult Medicine, Children's Hospital, Boston, MA 02115.
We undertook a study of 414 bacteremic patients (167 with Haemophilus
influenzae and 247 with Streptococcus pneumoniae bacteremia) to evaluate
their clinical presentation, laboratory and clinical results, and
subsequent outcomes. Patients with H influenzae bacteremia were more likely
to have soft-tissue foci, poorer clinical appearance at presentation, and
be at higher risk for subsequent serious focal infections, persistent
bacteremia, and subsequent hospital admissions than patients with S
pneumoniae. Patients with H influenzae bacteremia had a 21.1-fold increase
in risk of meningitis (95% confidence interval [CI] of 3.8 to 78.0)
compared with those with S pneumoniae. The odds ratio for initial lumbar
puncture was 5.25 (95% CI [1.1-23.6]). Ambulatory patients treated with
antibiotics at presentation were less likely to develop new serious
soft-tissue infections, persistent bacteremia, or to require subsequent
hospital admissions than untreated patients. The effect of treatment was
greater for patients with S pneumoniae than those with H influenzae.
Careful follow-up and reevaluation of patients with presumptive bacteremia
is essential because treated and untreated patients can still develop
serious soft-tissue infections.
