Occult Bacteremia and Septicemia in the Febrile Child Younger Than Two Years

Exploring Acute Febrile Illness in Children: Clinical Characteristics and Diagnostic Challenges

Background Pediatric febrile illnesses are a major cause of hospital admissions and are often associated with significant morbidity and mortality. These illnesses pose a diagnostic challenge to both clinicians and laboratories. This study aims to explore the clinical characteristics of acute febrile illness in children and examine the effectiveness of various diagnostic techniques. Methods This prospective study was carried out at the Mahatma Gandhi Memorial Hospital, Warangal, India, from January 2020 to October 2022. It included children aged one month to 12 years. Results Out of 245 identified cases, 195 met the inclusion criteria. This study found that 18 patients (9.23%) suffered from serious bacterial infections (SBIs). In 63 patients (32.20%), the source of infection remained unidentified. Among those with SBI, UTIs were the most frequent. Bacteremia was identified in 2.5% of the patients. Conclusion SBIs were identified in 18 hospitalized children (9.23%), with UTIs being the most common SBI in children aged one to 36 months. Children in this age group presenting with toxic symptoms should be thoroughly evaluated for SBIs. The study also observed a higher prevalence of Gram-negative bacteremia compared to Gram-positive cases.

Adult patients with occult bacteremia discharged from the emergency department: epidemiological and clinical characteristics

To determine the epidemiological and clinical characteristics of patients who were discharged from the emergency department (ED) and subsequently proved to have bacteremia, we prospectively assessed all patients examined in the ED during an 18-month period from whose blood cultures a significant organism was isolated. Discharged patients were contacted and reevaluated. Two case-control studies were conducted, in which each study patient was matched with a total of 4 control patients. During the study period, 46,336 patients were examined in the ED; 78% were adults and 22% were children. Blood cultures were performed for 25% of the adult patients and for 44% of the children. Although the occurrence of occult bacteremia in patients who were discharged from the ED is 3.7 times more common in children than in adults, the absolute numbers of discharged adults and children with occult bacteremia are similar. Careful clinical assessment will not prevent discharge of some of these patients; however, these patients in general do well and can be safely recalled for reevaluation and complementation of therapy.

Parenteral vs oral antibiotics in the prevention of serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia: a meta-analysis

OBJECTIVE

To determine whether parenteral antibiotics are superior to oral antibiotics in preventing serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia.

METHODS

Using the MEDLINE database, the English language literature was searched for all publications concerning bacteremia, fever, or Streptococcus pneumoniae from 1966 to January 1, 1997. All nonduplicative studies with a series of children with S. pneumoniae occult bacteremia having both orally treated and parenterally treated groups were reviewed. Children were excluded from individual studies if at the time of their initial evaluation they were immunocompromised, had a serious bacterial infection, underwent a lumbar puncture, or did not receive antibiotics.

RESULTS

Only 4 studies met study criteria. From these studies, 511 total cases of S. pneumoniae occult bacteremia were identified. Ten of 290 (3.4%) in the oral group and 5 of 221 (2.3%) in the parenteral antibiotic group developed serious bacterial infections (pooled p-value = 0.467, pooled OR = 1.48; 95% CI, 0.5-4.3). Two patients in the oral group (0.7%) and 2 patients in the parenteral group (0.9%) developed meningitis (pooled p-value = 0.699, pooled OR = 0.67; 95% CI, 0.1-5.1).

CONCLUSION

The rates of serious bacterial infections and meningitis did not differ between children who were treated with oral and parenteral antibiotics. The extremely low rate of complications observed in both groups suggests no clinically significant difference between therapies. A study with >7,500 bacteremic children (or >300,000 febrile children) would be needed to have 80% power to prove parenteral antibiotics are superior to oral antibiotics in preventing serious bacterial infections.

Do oral antibiotics prevent meningitis and serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia? A meta-analysis

OBJECTIVE

To determine whether oral antibiotics prevent meningitis and serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia.

DATA SOURCES

Using the Medline database, the English-language literature was searched for all publications concerning bacteremia, fever, or S pneumoniae from 1966 to April 1996.

STUDY SELECTION

All studies that included a series of children with S pneumoniae occult bacteremia containing orally treated and untreated groups. Children were excluded from individual studies if they were immunocompromised, had a serious bacterial infection, underwent a lumbar puncture, or received parenteral antibiotics.

DATA EXTRACTION

Three authors independently reviewed each article to determine the number of eligible children and the outcome of children meeting entry criteria.

DATA SYNTHESIS

Eleven of 21 studies were excluded, leaving 10 evaluable studies with 656 total cases of S pneumoniae occult bacteremia identified. Patients who received oral antibiotics had fewer serious bacterial infections than untreated patients (3.3% vs 9.7%; pooled odds ratio, 0.35; 95% confidence interval, 0.17 to 0.73). Meningitis developed in 3 (0.8%) of 399 children in the oral antibiotic group and 7 (2.7%) of 257 untreated children (pooled odds ratio, 0.51; 95% confidence interval, 0.12 to 2.09).

CONCLUSION

Although oral antibiotics modestly decreased the risk of serious bacterial infections in children with S pneumoniae occult bacteremia, there was insufficient evidence to conclude that oral antibiotics prevent meningitis. Published recommendations that oral antibiotics be administered to prevent serious bacterial infections in children with possible S pneumoniae occult bacteremia should be reevaluated in light of the lower risk of sequelae from S pneumoniae occult bacteremia and newer data concerning side effects from treatment.

The febrile child

The child with a fever is a common but sometimes difficult problem. The recognition of a serious bacterial infection is usually possible with careful clinical assessment. Occult bacteraemia may be missed and a plan of examination, investigation and management is outlined. The use of antibiotics and antipyretic treatment is discussed.