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Risk of Serious Bacterial Infection in Children With Fever Without a Source in the Post–Haemophilus influenzae Era When Antibiotics Are Reserved for Culture-Proven Bacteremia
Subhankar Bandyopadhyay, MD;
Jo Bergholte, MS;
Charles D. Blackwell, MD;
Jason R. Friedlander, MD;
Halim Hennes, MD, MS
Arch Pediatr Adolesc Med. 2002;156:512-517.
Objective To determine the rate of serious bacterial infection in children aged
2 to 36 months with fever without a source in the post–Haemophilus influenzae era, when antibiotic therapy is reserved until
blood culture results turn positive.
Design and Setting Retrospective review of emergency department, urgent care center, and
hospital medical records from an urban children's hospital.
Participants Eligible participants were identified from hospital medical record and
microbiology laboratory databases. Immunocompetent individuals aged 2 to 36
months with fever without a source were eligible for enrollment. Exclusion
criteria were temperature less than 39.0°C, identifiable focus of infection,
current or recent antibiotic use, and hospital admission.
Interventions and Outcome Measures Enrolled participants were assigned to group 1 (blood culture obtained)
or group 2 (no blood culture) and did not receive empiric antibiotic treatment
in the emergency department, in the urgent care center, or for home use. Demographic
and outcome data were collected on all enrolled patients.
Results During the study, 9241 febrile children were identified; 2641 (29%)
met the enrollment criteria. Blood cultures (group 1) were performed on 1202
patients (46%), and 37 (3%) had culture-proven occult bacteremia (95% confidence
interval, 2.2%-4.2%). Streptococcus pneumoniae was
the most prevalent organism (84%). The mean ± SD time for reporting
a positive blood culture finding was 17.5 ± 8.5 hours. Two patients
(0.08%; 95% confidence interval, 0.009%-0.27%) developed serious bacterial
infection, and both recovered completely.
Conclusion Reserving antibiotic therapy for culture-proven occult bacteremia was
not associated with increased risk of developing serious bacterial infection
compared with previously published data.
From the Section of Emergency Medicine, Department of Pediatrics, Medical
College of Wisconsin (Drs Bandyopadhyay, Blackwell, and Hennes and Ms Bergholte),
and the Children's Hospital of Wisconsin (Dr Friedlander), Kenosha.
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