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Samir S. Shah, MD; Elizabeth R. Alpern, MD; Lisa Zwerling, MD, MPH; Jennifer R. Reid, MD; Karin L. McGowan, PhD; Louis M. Bell, MD

Arch Pediatr Adolesc Med. 2002;156:469-472.

Objective  To evaluate the risk of bacteremia in children with febrile seizures treated as outpatients.

Methods  A retrospective cohort study was performed involving 379 children aged 2 to 24 months presenting to an urban tertiary care children's hospital emergency department with a febrile seizure between February 1, 1993, and May 31, 1996.

Results  The mean patient age was 15.9 months, and 217 (57%) were male. In 40 patients (10.6%), the use of oral antibiotics before initial emergency department evaluation was reported. Bacteremia occurred in 8 (2.1%) of 379 children studied. None of the children with bacteremia had received previous antibiotics. The causative organisms were Streptococcus pneumoniae in 7 cases and group A Streptococcus in 1 case. There were 5 contaminated cultures (1.3%). Although 2 of the 8 children with bacteremia ultimately required admission, there were no serious adverse outcomes. Six of 7 episodes of S pneumoniae bacteremia were caused by serotypes included in the pneumococcal conjugate vaccine, which was not available at the time of this study.

Conclusions  Children 2 to 24 months of age with febrile seizures are at similar risk for occult bacteremia as those with fever alone. Widespread use of the pneumococcal conjugate vaccine may further decrease the incidence of bacteremia in this population.

From the Divisions of General Pediatrics (Drs Shah, Zwerling, Reid, and Bell), Immunologic and Infectious Diseases (Drs Shah, McGowan, and Bell), and Emergency Medicine (Drs Alpern and Bell), The Children's Hospital of Philadelphia, Philadelphia, Pa. Dr Zwerling is now with the Department of Emergency Medicine, Children's Hospital of Los Angeles, Los Angeles, Calif; Dr Reid is now with the Division of Emergency Medicine, Children's Hospital and Regional Medical Center, Seattle, Wash.

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