Occult Bacteremia Is Rare in Young Children with Unexplained Fever

Occult Bacteremia Is Rare in Young Children with Unexplained Fever

Since introduction of the pneumococcal vaccine, urinary tract infection has become the most common bacterial infection in children who have fever without localizing signs.

Occult bacteremia and invasive disease are important concerns in children with unexplained high fever. Investigators retrospectively compared the risk for serious infection in children (age range, 3–36 months) who presented to a U.K. pediatric emergency department (ED) with fever (>39^oC) without localizing signs before (1997–1999) and after (2001–2004) introduction of the pneumococcal conjugate vaccine (PCV7).

During the pre-PCV7 period, 17 of 148 children had positive blood cultures, and pathogens were identified in 10 cases (Streptococcus pneumococcus in 6, Moraxella catarrhalis in 2, Staphylococcus aureus in 1, and Streptococcus pyogenes in 1). In the post-PCV7 period, 13 of 275 children had positive blood cultures, and a pathogen was identified in only one case (Enterococcus sp). The rate of occult bacteremia among children with unexplained fever decreased from 6.8% to 0.4% in the pre- and postvaccine periods, respectively. Rates of positive urine cultures did not change during the pre- and post-PCV7 periods (6.8% and 7.6%, respectively). About 60% of the children in each period received antibiotics; most (>90%) received antibiotics during the initial ED visit.

Comment: Successful immunization programs remove important health risks in children. Children aged 3 to 36 months who have completed Haemophilus influenzae type B and PCV7 immunizations and who present with fever without localizing signs should be evaluated for urinary tract infections. Other cultures (including blood cultures) and treatment should be based on clinical condition and local epidemiology of nonvaccine serotypes. An accurate immunization history is essential.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine February 4, 2009

Citation(s):

Waddle E and Jhaveri R. Outcomes of febrile children without localising signs after pneumococcal conjugate vaccine. Arch Dis Child 2009 Feb; 94:144.

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occult bacteremia in 3-36 months
C. A. Pop, northern Ontario, Canada, 7 Jan 2010 4:48 AM EST
Did this article mean that, (after the introduction of PCV-7 and HIB vaccines) we are much less concerned of an... [more]

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