This Article  • Full text  • PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (16)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Bacterial Infections  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

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.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Updated Review of Blood Culture Contamination
Hall and Lyman
Clin. Microbiol. Rev. 2006;19:788-802.
ABSTRACT | FULL TEXT  

Incidence of Occult Bacteremia Among Highly Febrile Young Children in the Era of the Pneumococcal Conjugate Vaccine: A Study From a Children's Hospital Emergency Department and Urgent Care Center
Stoll and Rubin
Arch Pediatr Adolesc Med 2004;158:671-675.
ABSTRACT | FULL TEXT  

Management of Febrile Children in the Conjugate Pneumococcal Vaccine Era
Gabriel et al.
CLIN PEDIATR 2004;43:75-82.
ABSTRACT  

Empiric Antibiotics for Suspected Infant Outpatient Bacteremia: Unnecessary?
JWatch Infect. Diseases 2002;2002:3-3.
FULL TEXT  

Support for Expectant Management of Highly Febrile Young Children
JWatch General 2002;2002:4-4.
FULL TEXT