Nosocomial Primary Bacteremia: Clinical and Laboratory Characteristics in Adults and Children

A prospective study was carried out to evaluate the main clinical and laboratory manifestations of nosocomial primary bacteremia among adults and children at the Heart Institute, University of Sao Paulo School of Medicine, Brazil during 1993. Forty occurrences of bacteremia were analyzed; 27 in adults and 13 in children. Among adults, although fever, rigors and alterations in leukocyte count were frequently recorded, rigors and fever were absent in 30% of the cases and the frequency of any associated clinical manifestations was only 55%. Among children, fever occurred most frequently, but rigors were not recorded. It is concluded that the diagnosis of nosocomial bacteremia is imprecise due to frequent absence of the main clinical correlates of bacteremia. Blood cultures should be obtained in patients who are in a setting associated with bacteremia, even if typical clinical signs and symptoms are not presented, and that frequent updating of guidelines for empiric treatment is needed. We also suggest that separate guidelines be established for children and adults because of the differences in the clinical findings in these two groups.